The video discusses the complex and contentious issues surrounding the Gender Identity Development Service (GIDS) in England, based at the Tavistock and Portman Foundation Trust. Concerns have been raised by staff about the fast-tracking of medical treatments for young people struggling with gender identity, with claims that decisions are made too swiftly and without sufficient assessment. Staff inputs from an internal review highlight their fears that vulnerable children might be misdiagnosed, rushed into treatments, and potentially face lifelong consequences.

Amid the controversy, there are allegations that staff were discouraged from voicing their concerns about patient safety, particularly regarding the use of puberty blockers which have unknown long-term effects. Staff reported feeling sidelined when they raised issues about inappropriate referrals and the influence of parental desires for a transgender rather than a gay outcome on children's treatment paths. Concerns were also raised that internal processes within GIDS could sideline necessary safeguarding measures.

Main takeaways from the video:

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Key Vocabularies and Common Phrases:

1. safeguarding [ˈseɪfˌɡɑːdɪŋ] - (noun) - Measures or protocols in place to protect people's health, well-being, and human rights. - Synonyms: (protection, preservation, safety)

Staff claim they were discouraged from going to the lead safeguarding officer with concerns about children's welfare.

2. puberty blocker [ˈpjuːbərti ˈblɒkər] - (noun) - Medications used to delay the physical changes associated with puberty. - Synonyms: (hormone suppressant, growth blocker, delay agent)

When a child is assessed by jIds, they may be offered a drug called apex puberty blocker.

3. dysphoria [dɪsˈfɔːriə] - (noun) - A state of unease or generalized dissatisfaction with life usually in the context of gender identity. - Synonyms: (unhappiness, dissatisfaction, discontent)

We understand the response was typically that the young person was experiencing very intense and severe gender dysphoria.

4. traumatized [ˈtrɔːmətaɪzd] - (adjective) - Subjected to lasting shock as a result of an emotionally disturbing experience or physical injury. - Synonyms: (shocked, pained, upset)

Maybe we're medicating traumatized children.

5. homophobia [ˌhəʊməˈfəʊbiə] - (noun) - Dislike of or prejudice against gay people. - Synonyms: (prejudice, heterosexism, anti-gay sentiment)

homophobia in families is mentioned in all of the transcripts Newsnight has seen.

6. endocrinology [ˌɛndəʊkrəˈnɒlədʒi] - (noun) - The branch of physiology and medicine concerned with endocrine glands and hormones. - Synonyms: (hormone study, gland biology, metabolic study)

The majority of patients using the service will not be referred to an endocrinology service for consideration for hormone blocking drugs.

7. mismanaged [ˌmɪsˈmænɪdʒd] - (verb) - To manage or administer poorly or incorrectly. - Synonyms: (mishandle, bungle, botch)

The reality is, by not doing anything, children are potentially still being medically mismanaged.

8. allegations [ˌælɪˈɡeɪʃənz] - (noun) - Claims or assertions that someone has done something illegal or wrong, typically made without proof. - Synonyms: (claims, accusations, assertions)

The Tavistock and Portman NHS Foundation Trust stands by its 2019 review of the service and strongly refutes the allegations put to us by Newsnight.

9. unwarranted [ʌnˈwɔːrəntɪd] - (adjective) - Not justified or authorized. - Synonyms: (unjustified, excessive, unnecessary)

The review acknowledged the need to address unwarranted variation at GIDs.

10. variation [ˌveəriˈeɪʃən] - (noun) - A change or difference in condition, amount, or level, typically with certain limits. - Synonyms: (difference, deviation, divergence)

The review acknowledged the need to address unwarranted variation at GIDs.

NHS child gender clinic - Staff welfare concerns shut down - BBC Newsnight

Young people struggling with their gender identity may be referred to England's only specialist clinic, the Gender Identity development service, or GIDS, based at London's Tavistock and Portman Foundation Trust. It's a difficult area to work in, and last year, following serious staff concerns over children's welfare, the trust conducted an internal review of the service. It recommended areas for improvement, but did not identify any immediate issues in relation to patient safety.

Yet evidence exclusively seen by Newsnight reveals serious tensions at the heart of gidds. We've seen well over 100 pages of transcripts of interviews conducted with staff. As part of the review, they make a series of claims. Staff say they were discouraged from going to the lead safeguarding officer with concerns about children's welfare. They say decisions about medical treatment were taken too quickly, and they say that some parents appear to prefer their child was transgender and straight rather than gay, pushing them towards transition.

The transcripts have been voiced in this film by actors and edited for clarity, but the words were all relayed by Jid's clinicians to the trust's medical director as part of the review process. Let's pray that I am wrong, because if I am not wrong, very many vulnerable children have been very poorly treated and will be left with potentially a lifetime of damage. Here we're not talking about little things. The reality is, by not doing anything, children are potentially still being medically mismanaged.

When a child is assessed by jIds, they may be offered a drug called apex puberty blocker. These stop a young person's body developing breasts, periods, facial hair or a deeper voice. The NHS has recently updated its guidance on these drugs, acknowledging that little is known about their long term effects or what impact they might have on children's brains and bones. Jids has said in the past it finds itself caught between people who want these treatments to be given quickly and those who think they shouldn't be given at all.

Many children referred to GIDs are extremely distressed and have complex needs. The clinicians we've spoken to say there's often lots to explore before medication should be considered, but they say there's wide variation in practice. It's claimed in the transcripts that many staff are worried and openly discuss their fears. Maybe we are medicating gay kids, maybe we're medicating kids with autism, maybe we are medicating traumatized children. And if we are, we're doing bad things to these vulnerable kids.

NHS England says that young people should be referred for medical treatment puberty blocking drugs after a minimum of three sessions. But the review heard from several staff that one member of the JIDS leadership, Sarah Davidson, would refer children for treatment after only one or two appointments. I was working with an executive on one case of assessment of a young person, and the executive member agrees to refer this person to the medical pathway within the first hour of meeting him. And that is not supposed to happen. Absolutely. It should never happen, because this is a pathway that will lead to huge, huge changes for this young person. You know, it could lead to potentially infertility and so on.

We've been told that cases like this have been discussed at team meetings in Jed's, when some staff raised concerns about the speed of assessment. We understand the response was typically that the young person was experiencing very intense and severe gender dysphoria. Such a quick referral wouldn't allow for full exploration of what else is going on. Staff claim. They say this could risk putting young people on potentially life changing medicines who may have been struggling with issues such as their mental health and sexuality.

homophobia in families is mentioned in all of the transcripts Newsnight has seen. Staff say that while there was some discussion in the service about this, they didn't feel the issue was properly addressed. We've spoken to a number of staff off the record. Most didn't want to go on camera, even on the condition of anonymity. But the transcripts are backed up by this former clinician who left Jids last year. Their words are being voiced by an actor.

We did have a lot of families and parents who would actively tell us that, oh, I'm so glad, at least my child is not gay or lesbian, implying that having a trans outcome would be better for their children. I had a case, there was a lot of trauma in the family. The young person had come out initially as a lesbian and had faced a lot of homophobic bullying, both very subtly within the family and quite openly in school. And suddenly the young person changed their mind and they started identifying as trans. In some of these cases, clinicians thought that it wouldn't be appropriate for them to refer for puberty blockers, but they would be overruled by Judd's director, Polly Carmichael.

The transcript suggests the young person had very clearly told me and my colleague that my mum wants the hormone more than I do. And when we took it to senior management, Polly Carmichael, she suggested that we referred, even though this was not clinically indicated. These are only some of the examples mentioned in the transcripts. Staff also voice concerns about the degree of trauma they're witnessing in children and the process of gaining consent for medical treatment.

It's accepted in the review that staff raise these concerns over a number of years, both to the leadership of Jades and to senior figures in the Tavistock trust. But in the transcripts, staff say they weren't listened to. The reality is that our concerns were raised all the time and were shut down and that when they did speak up, they were then seen as the problem. People who raise concerns are seen as trouble making and difficult. I think it is the case that somehow the organisation works to evacuate people who are not compliant. When I raised concerns, I was told that I had to toe the line or I would never progress in my career.

Staff also say that senior management were not able to reassure them that their concerns were unfounded. I kept saying to her, are we hurting children? And she did not say no. I kept saying to her, will we get sued? She did not say no. The only solace she gave me was that she said it would not be me that would be sued, it would be the Tavistock that would be suede. She was not able to say to me, it's fine, we are not hurting the children.

In the transcripts we've seen, clinicians are worried about the impact different kinds of abuse might have on young people trying to resolve questions about their gender identity. These could be seen as safeguarding issues. Staff claim they were discouraged from referring these cases to social services and from seeking advice. The Tavistock, like other NHS organisations, has a named person clinicians can turn to to discuss specific safety concerns. That person is Sonya Appleby.

But the transcripts allege that staff were discouraged from speaking to her by the director of Jades, Polly Carmichael. There was a very clear message from senior management about being really cautious about how we talked to the safeguarding team at the Tavi and specifically SoNya Appleby. I know that Polly feels she does not like Sonya's scrutiny. I think that is odd. She is the trust safeguarding lead. I've had some consultations with Polly Carmichael about some of the young people I was seeing and some of the concerns I'd raised. And Polly very directly told me not to go to Sonia to share those concerns. Is that safe? No. And I would say that perhaps that's why more than 40 clinicians decided to leave the service within three years.

We've been told that if clinicians did approach SoNYa Appleby, they felt she understood the complexity of the Gid's work and was supported by her misses. Appleby's solicitor told us that she'd started legal proceedings against the trust last year and it wouldn't be appropriate to comment further.

It's unlikely that all staff will have been as critical of JIDs as the ones whose interviews we've read, but the transcripts we've seen represent a sizable minority of the total conducted with frontline JIDS staff. The review acknowledged the need to address unwarranted variation at GIDs and accepted the need to be more robust in resolving concerns raised by staff. It also recommended new regular audits of safeguarding practices and social services referrals, but some staff don't feel it went far enough and are not confident in the current management's ability to enact change.

Newsnight has seen evidence that the Tavistock's chief executive and chair have been told that the interview transcripts may contain concerns about child protection issues and they've been encouraged to read them themselves. We showed some of the transcripts to the children's Commissioner for England and contacted the healthcare regulator, the CQC, about what we'd seen. Both were interested in speaking to the people involved. The CQC encouraged anyone with specific safeguarding or safety concerns to contact them directly. It added that it is due to inspect Jidsdez, though because of COVID routine inspections are currently paused until autumn.

An official NHS review is underway into how young people visiting gids should be best supported. There is good practice taking place at the service, but for some staff this review cannot be completed soon enough.

Deborah Cohen well, no one from the Tavistock and Portman NHS Foundation Trust agreed to be interviewed on the program, but in a statement the trust GIDS is a safe and caring service which supports a wide range of children and young people grappling with distress about their gender identity. The Tavistock and Portman NHS Foundation Trust stands by its 2019 review of the service. We are confident that it fairly addressed the issues raised and strongly refute the allegations put to us by Newsnight. safeguarding is of the utmost importance to the trust. In August 2018, a safeguarding lead was created specifically for jids to reflect the growth in the service.

This role fits within the well understood safeguarding pathway and procedures across the trust. Well, the trust said that any safeguarding issues that were identified during the review were further investigated and, where appropriate, addressed in the reviews recommendations and that they have kept both NHS England and the care quality commissioned fully informed. The trust added that the majority of patients using the service will not be referred to an endocrinology service for consideration for hormone blocking drugs.

Gender Identity, Safeguarding, Medical Ethics, Healthcare, Education, Science, Bbc Newsnight