Children will only be referred to trans clinics if their parents agree under planned overhaul of NHS rules

Children will only be referred to transgender clinics if their parents agree, under a planned overhaul of NHS rules.

Teachers, social workers and GPs have been able to send kids to the Tavistock gender identity service without having to gain parental consent.

But new plans outlined in a public consultation document say children will only be referred if they, their parents and a specialist agree that it is in the best interests of the child, in two separate reviews.

It is the latest in a series of proposals to reform children’s services following a damning review by Dr Hilary Cass, the former president of the Royal College of Paediatrics and Child Health.

Her interim report found that the approach under the Tavistock put its patients ‘at considerable risk’ of poor mental health and was not ‘a safe or viable long-term option’.

Teachers, social workers and GPs have been able to send kids to the Tavistock gender identity service (pictured) without having to gain parental consent. But new plans outlined in a public consultation document say children will only be referred if they, their parents and a specialist agree that it is in the best interests of the child, in two separate reviews 

Figures released last month by University College London shows rates of newly recorded transgender identity from 2000 to 2018, by age group. In 2000, there was 1.45 new cases of transgender identify per 100,000 person-years. But this figure jumped five-fold to 7.81 cases per 100,000 in 2018

The service, which is based at Tavistock and Portman NHS Foundation Trust in North London and is the only one of its kind in England, is due to close in March and will be replaced by two regional sites.

Experts have criticised the clinic’s ‘affirmative’ approach to treating children with supposed gender dysphoria, where they feel that they are not the same sex as they were born, and a lack of exploring alternative health conditions before putting children on puberty blockers.

Under a new ‘referral consultation service’, children who may be sent on to a gender service, will have a ‘consultation, advice and liaison meeting’.

This will involve parents, clinicians and the child agreeing on the best path forward, deciding whether or not that involves a referral to a children’s gender service, and then creating a care plan with other services that can be accessed while on the waiting list.

The consultation document, published by NHS England this week, said these steps are necessary ‘in view of the relatively high number of children and young people who present to gender incongruence services with other complex needs, such as mental health needs, neurodiversity or autism’.

It adds that it will also help address concerns raised by the Care Quality Commission ‘about the lack of support or risk assessment’ for children on a waiting list.

Previously, children did not need parental consent to be referred to the Tavistock, and in some cases it was not needed to start puberty blockers. 

The service will temporarily introduce a maximum age of 16, with teenagers aged 17 referred to an adult clinic.

Any children who have already been referred to a gender identity service and are yet to be seen will not be subject to the new referral restrictions, the NHS said.

There are thought to be as many as 8,000 in this situation.

An NHS spokesperson said: ‘These proposals are intended to ensure that children who may be experiencing challenges with their gender identity are properly connected to local services and that age-appropriate referrals are made to the new specialist gender service which will go live next year.

‘In a separate consultation, NHS England has also proposed that the new specialist children’s gender service will not routinely be able to provide any medical intervention, including the use of puberty blockers, to children under 16 years of age.’