Entry 4 – Navigation (July 2021)

Posted in: Journal

A journey of a thousand miles begins with a single step.”

Lao Tzu

It has been a little while since my last entry and there have been a number of developments both internal to the Review and relating to the broader context the Review is operating within.  We have received a lot of comments and submissions through our website, some in direct response to our letter to NHSE/I. Feedback like this is really important, and I will respond to some of the concerns and queries in this blog.

Meanwhile, the public dialogue around gender identity continues to occupy a prominent place in the mainstream media. These broader issues are important and will continue to form the backdrop to my Review and some clearly touch on the activities of the Review. However, some are more relevant to adults and broader societal responsibilities. For that reason, it is crucial that they do not distract me from the core objectives of the Review itself. Some of the sadly polarised public narrative has no place in debates about how best to manage the healthcare for this group of children and young people, many of whom are in a state of extreme distress by the time they are able to access clinical support.

If you were to ask me what good would look like at the end of the Review, I would say that we should be well on the way to building a system of care where every child and young person who is questioning their gender identity or experiencing gender incongruence is able to receive the support they need as soon as possible, so they can find the right pathway for them.

I have previously written about the need to use both evidence and research, combined with user experience and professional expertise to work out how to set up these systems and to understand the treatment options. But gathering that evidence and experience is a slow process, as illustrated in our infographic, which shows just how complex it will be to integrate the information from multiple sources. We only have this one chance to do this really well, so cutting corners is not an option.

I always said that this Review would respond to the situation as it developed and take account of practical issues as they evolve, while also keeping a focus on the endgame. You may have seen that I have written to NHS England and NHS Improvement (NHSE/I) providing an update on the Review and emphasising the need to strengthen support for the children and young people who are currently on the waiting list for the Gender Identity Development Service (GIDS).

NHSE/I have now written back to me about a new regional professional support service they are in the process of establishing as an interim measure, the application and success of which we will have to consider carefully as part of the Review, as we think through the future service model.

The Gender Identity Development Service, with the best will in the world, cannot keep up with the pace of seeing new referrals and providing the necessary support and review of patients already in the system, although they are making every effort to streamline their service and to recruit new staff. This is the reason I suggested to NHSE/I that there is a need to build capacity outside of GIDS.

Some of you are understandably worried that this might not be achievable and / or that it is just putting another barrier in the way of accessing the GIDS service. I recognise that primary care services, paediatric and CAMHS teams have capacity and staffing problems of their own. And because almost all children questioning their gender get referred directly to GIDS, staff outside the GIDS team often don’t yet have the training or experience to help them.

Despite these challenges, I believe there is general agreement that we have to try and make some changes. Because if you always do what you always did, you’ll always get what you always got; which in this case is distressed young people waiting too long for services. To grow more services we have to start somewhere. It is important to remember that the existing GIDS staff started somewhere too – bringing transferable therapy expertise that they had developed in CAMHS or other services for young people and expanding their expertise to include learning about gender diversity.

With that in mind, we have committed to prioritise work to explore how best to develop the workforce outside of GIDS by working with a range of clinical professionals to understand what assessment tools might be needed, what training is necessary, and what the implications are for the longer-term workforce plan.

We will be keeping everyone updated on progress and will soon be able to say more about our formal research programme and how those with lived or professional experiences can contribute to building the evidence base.