Classification: Official
Publication reference: PRN01451
To:
- Dr Hilary Cass
Dear Dr Cass,
NHS England update on work to transform gender identity services
We wanted to update you on the progress NHS England is making to transform and expand the provision of care in children and young people’s gender services, in line with your recommendations and advice, as well the work underway to review adult gender services.
Implementation plan
We know that children, young people and their families are worried and distressed about the time it can take to access treatment and support. While the transformation of services will take time, we are today setting out the next steps of NHS England’s plan to implement the recommendations set out in your final review. This includes:
- expanding service delivery, with a specialist service in each of the 7 regions
- bolstering the workforce training and development
- finalising the service specification as well as a revised clinical policy for gender affirming hormones
- supporting the providers to establish a national provider collaborative, which in time will take the lead on the approach and delivery of clinical management and future research activities
- completing a study that links the data from the services provided by the former GIDS to an adult data set
- the National Research Oversight Board continuing to oversee the process for establishing a clinical study into the potential benefits and harms of puberty suppressing hormones for children and young people with gender incongruence, in partnership with the National Institute for Health and Care Research
- establishing a programme of work to explore the issues around a detransition pathway by October 2024
It is an ambitious programme of work to deliver but we are already making considerable progress on a number of your recommendations to ensure that the NHS delivers high quality services for patients, with foundations that are built on the strongest possible evidence base.
In April, NHS England opened 2 new services for children and young people in the North West and London. These services offer a fundamentally different clinical model to what has gone before, ensuring that new multidisciplinary teams take a more cautious approach to assessment, diagnosis and intervention, including social transition particularly for younger children and that the primary clinical approach will be psychosocial and psychological rather than medical.
In addition, NHS England is on track to meet its commitment to stand up regional specialist children and young people’s gender service providers by 2026. A new South West service led by Bristol Royal Hospital for Children (part of University Hospitals Bristol and Weston NHS Foundation Trust) will start to see patients from the waiting list by November 2024.
We are also working with Cambridge University Hospitals NHS Foundation Trust to mobilise a service for the East of England with an anticipated start date in Spring 2025. Plans are maturing for additional services in the Midlands, Yorkshire, the South East and the North East. These new services will ensure that care is closer to home with local services working alongside the specialist regional providers.
Referral pathway
Furthermore, NHS England is also publishing the new referral pathway specification. The new referral pathway will ensure that young people’s wider health and care needs are also considered as part of their assessment for readiness to engage with the specialist gender service.
This specification has taken on board significant and constructive feedback following stakeholder engagement and a public consultation, as well as recommendations from your final report. This includes ensuring that when families and carers are making decisions around social transition they should be seen as early as possible by a clinical professional with relevant experience.
Review of adult services
One of the recommendations in your report was to bring forward the planned review of the adult service specification. When we last wrote to you in April, we were able to confirm that we had not only brought forward the review of the adult service specification but announced that we would also conduct a broader review into the operation of each of the commissioned adult services.
This review will provide an important way of exploring the broader concerns and issues with adult services that were reported to you during your review of services for children and young people. We appreciate the courage it took for those individuals to speak to you, and we have separately been discussing how best we can support them to share their experiences with this review.
NHS England’s review of adult services will assess not only the quality (i.e. effectiveness, safety, and patient experience) and stability of each service, but also whether the existing service model is still appropriate for the patients it is caring for. The programme of reviews will be led by Dr David Levy, and will carefully consider experiences, feedback and outcomes from clinicians and patients, past and present. The first onsite visits are scheduled to commence in September 2024.
Dr Levy will be supported by a panel of expert clinicians, patients and other key stakeholders, including representatives from the CQC, Royal Colleges and professional bodies. The findings of this review will inform an updated adult gender service specification (non-surgical interventions) which will then be subject to engagement and public consultation.
There is a wide range of work to do in order to put your recommendations into practice, but we feel much of that can be achieved over the next two years. Thank you for your continued focus on the issues you identified and your support in implementation.
Yours sincerely,
John Stewart, National Director, Specialised Commissioning, NHS England
Prof James Palmer, Medical Director, Specialised Commissioning, NHS England