The interim service specification
On 9 June 2023, NHS England published an interim service specification which outlines the aims of Gender Incongruence treatment services and the clinical approaches to treatment which should be adopted going forwards. The new guidance states that hormone suppressing drugs will no longer routinely be offered to children with gender dysphoria.
In their announcement NHS England state, “We have previously made clear, including the draft interim service specification we consulted on, the intention that the NHS will only commission puberty supressing hormones as part of clinical research. This approach follows advice from Dr Hilary Cass’ Independent Review highlighting the significant uncertainties surrounding the use of hormone treatments.”
Per the interim service specification, the service providers are advised to adopt individualised pathways to treatment plans, to be determined in the young person’s best interests. When devising treatment plans young people will receive standardised comprehensive assessments to allow the service to understand the young person’s needs. The treatments will be decided by multidisciplinary teams with expertise in areas including gender incongruence, childhood and adolescent development and mental health, expertise in sex development, and endocrine intervention, and Neurodevelopment disorders including learning disability and autism spectrum conditions.
NHS England has advised that policies governing the prescription of puberty supressing hormone treatments and masculinising and feminising hormones are being prepared. The consultation report notes that the draft interim clinical commissioning policy proposes that puberty supressing hormones (GnRH analogues) are ‘not routinely commissioned’ as there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment and that they should only be accessed as part of research.
The specification states that “Children, young people and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources.”
In the event that young people who attend the service has already started puberty suppressing hormones outside of NHS protocols, the service may consider prescribing puberty suppressing hormones through NHS protocols if the multidisciplinary team and endocrine clinic believe this is an appropriate harm reduction measure. Baseline investigations would need to take place prior to such a prescription being made.
Should young people attend the service has already started masculising/feminising hormones, the service may continue the prescription through NHS protocols provided particular criteria are met.
NHS England recognise the importance of research and data collection in the future service model. The service will be expected to take part in continuous data collection, reporting and audit to support the NHS in developing a better understanding of the relevant patient cohorts; and for evaluating and enhancing the benefits of the service model; and building research capabilities to conduct high-quality studies across the clinical pathway. NHS England has established a new national Children and Young People’s Gender Dysphoria Research Oversight Board to carry out structured research programmes into areas including epidemiology; prediction; the course of gender querying; and outcomes of psychological treatments to reduce distress.
The specification makes it clear that providers delivering the service moving forward must be an established specialist tertiary paediatric unit with a strong partnership with mental health services, be an established academic centre with a strong track record of research in children and young people and have robust safeguarding frameworks in place. The specification goes on to say that the clinical management approach should be open to exploring all developmentally and psychosocially appropriate options for children and young people who are experiencing gender incongruence.
The Pogust Goodhead Clinical Negligence Team
We believe the new service specifications are a step in the right direction in ensuring young people experiencing gender incongruence receive the high-quality care and support they are entitled to, and that the treatment pathways for these individuals are supported by clinical research and data.
Pogust Goodhead’s clinical negligence team is experienced in supporting individuals who have received medical care falling below the standards they are entitled to expect. We are currently investigating claims in negligence against various gender dysphoria treatment centres on behalf of individuals who feel let down by the service.
If you, or someone you know, has concerns about the treatment they received at the Tavistock GIDS clinic or another gender dysphoria treatment provider and would like more information, please get in touch with our legal team via our website, or alternatively by calling +44 (0) 3330 155 900 for a free initial confidential chat.
