Closure of GIDS and new regional services for youth gender identity services
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NHS England has announced it will be commissioning new regional youth gender identity services on the recommendation of the Cass Review.

As part of this process, the Tavistock and Portman NHS Foundation Trust (the Tavistock) will wind down the Gender Identity Development Service (GIDS) until its contract naturally expires in Spring 2023.

The new regional services are intended to absorb the current patient load at GIDS, and provide better access to care for those facing long waiting lists and inaccessible clinics.

The regionalisation of services is a good thing. The current system is no longer fit for purpose and cannot – and, in its present state, will never be able to – handle patient demand. There is an overwhelming evidence base for more and better local services that can no longer be ignored. We hope that the proposed regional youth services mark the beginning of more accessible, robust, and long-lasting gender identity services across the UK.

According to the NHS plans, GIDS will be wound down over the remainder of its contract and everyone currently on a waiting list will have their place honoured in the new system. GIDS has been unable to provide a service worthy of its users for years now, a fact noted by both the CQC and the Cass Review. These service failings have led GIDS to become a symbolic centre around which anti-gender arguments have revolved for years. Although some may celebrate its closure as a symbolic win, we believe it represents a real step forward – not back – for trans healthcare. Improvements to gender identity services in the UK - especially for young people – have to come about through whole system change, from the top and from the bottom.

In the initial, 'Early Adopter' stages, two regional hubs will be set up: one in London, and one in the North-West of England. These regional centres will be led by experienced providers of paediatric care, and will help improve mental health support for young people using gender identity services.

The North of England is all too often neglected in healthcare provision, and it’s promising to see that these initial proposals are already moving away from the London-centric GIDS model.

Of course, GI maintains a healthy scepticism until we see results. But we tentatively hope that the creation of these services will fulfil the urgent need to reduce waiting lists in the coming years, and follow on from the successful pilot schemes like Indigo and CMAGIC as the first steps to building "a national network of regional services across the country over the coming years".

We do have some serious concerns about the proposals – particularly around the new research protocol on puberty-delaying treatments (PDTs, or ‘puberty blockers’). Despite a nascent wealth of international evidence as to their efficacy, the Cass Review team have been sceptical of the existing research base for PDTs, finding "insufficient evidence... to make firm recommendations around their routine use".

There is no evidence that there will be additional barriers to PDTs under the new model, and Dr Cass herself has emphasised that young people should be able to access appropriate services “at the earliest feasible point in their journey”. However, the NHS have made clear that once the new research protocol is in place, enrolling in the scheme will be necessary to access any such hormone treatments. It would be unethical to demand that young people hand over their medical details for research purposes, or risk losing access to life-saving treatment, and we will be working with other LGBT+ organisations and research ethicists to investigate this further. Bureaucratic obstacles are already stopping people from accessing desperately needed treatments in the current system: we do not need any more.

Despite these concerns, we remain cautiously optimistic about the overall plan. We have long served as a ‘critical friend’ to GIDS, trying to help the service do best for the young people under its care, whilst acknowledging the need for its eventual - and careful - abolition. With no other options available, the only way to work was within a broken system. With better models now mapped out, the time for that abolition is now.

Gendered Intelligence has been at the forefront of the fight for more accessible, more widespread, higher quality trans healthcare for many years. There is still a long, long way to go. But this is plainly a win for trans healthcare, and we should let ourselves take it as one. We fervently hope that these proposals are the seeds of change: the first steps on the path to local, accessible gender identity services for all who need them.

Editors: email [email protected]

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