Thousands of children still awaiting first appointment for gender care

The national waiting list for children’s gender care in England and Wales rose after the opening of two new specialist hubs, with more than 5,700 under-18s waiting an average of 100 weeks for a first appointment.

The two services, led by London’s Great Ormond Street Hospital (Gosh) and Alder Hey Children’s Hospital in Liverpool, opened in April following the closure of the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust.

The new centres took on a total of 236 patients from Gids, but thousands more children are still awaiting appointments, data obtained by the PA news agency shows.

The figures have been described by experts as “concerning” and “deeply depressing”, as they emphasised the importance of children and young people having “timely access to the professional care and support they need”.

Distress

NHS England acknowledged the worry and distress long waiting times can cause but said plans due to be set out will help to transform gender care services.

At the point Gids closed at the end of March, the number of children on the national waiting list was 5,560.

This rose to 5,769 by the end of May, and the youngest person on the waiting list at that point was under five years old, according to the Freedom Of Information (FOI) requests by PA.

The exact age was not given as it constitutes personal third party data, NHS England said.

Of the 127 patients transferred from Gids to the Gosh gender service, all had been met for a first appointment by the end of May.

Alder Hey said all 109 patients transferred from Gids to its gender service were scheduled to be seen for a first appointment between its opening and June 30.

The two new centres, which currently serve patients across England and Wales, have around 40 full-time equivalent staff (FTE) staff, the figures also showed.

When it opened, the Alder Hey hub had 7.8 FTE staff, a figure which has since risen to 15.7 FTE staff as of May 31.

Meanwhile the Gosh hub had 14.63 FTE staff employed on opening, with the figure increasing to 24.23 WTE staff by the end of June.

The figures do not refer to headcount of people employed but instead to the number of full-time equivalent positions, which allows the workforce for both clinics to be compared.

Staffing challenges

In its response to the Cass Review in April, NHS England acknowledged that the “transformation and expansion” of its gender care service “will take time to fully deliver, and the pace of progress will continue to be impacted by staffing challenges”.

NHS England has previously said it hopes the two centres will be the first of up to eight specialist centres as part of the north and south hubs over the next two years.

It is understood NHS Wales Joint Commissioning Committee (JCC) hopes to work with NHS England to consider a regional centre in Wales in the future.

In her final report, Dr Hilary Cass said the length of the waiting list to access gender services has “significant implications” for children and their families.

She recommended a care model which is “holistic and personal”, potentially comprising a wide range of interventions and services, including paediatric and mental health services.

It is understood the NHS plan for implementing the Cass recommendations is expected to be published soon.

Dr Roman Raczka, president of the British Psychological Society, said: “These latest figures make for concerning reading. It is imperative that children and young people have timely access to the professional care and support they need.

“We must remember that behind the numbers, headlines and often toxic public discourse, there are children and young people who need to access care.

“All too often the issue of gender care which has played out in public has been damaging to the children, young people and families desperately seeking help and this must change.”

Disparity

Ashley Grossman, an endocrinologist who has been practising for more than 40 years, and who has treated adult transgender patients, described the children’s waiting list figures as “deeply depressing” but said they “probably reflect the huge disparity in general between the requirements for mental health services for children and the resources available”.

The emeritus professor of endocrinology at the University of Oxford said: “There seems to have been a large rise in demand for these services, especially since the isolation and loss of schooling during the pandemic, so I suspect this is a much wider problem than for children with gender dysphoria alone.”

An NHS spokesperson said: “We know that children, young people and their families are worried and distressed about the time it can take to access treatment and support from gender services.

“NHS England is making good progress on delivering the recommendations of the Cass Review – expanding services with two new specialist centres which opened in April and more to follow, and we will shortly set out further detailed plans for how all of the Cass Review’s recommendations will be delivered in order to transform the provision of care in gender services.”

A Department of Health and Social Care spokesperson said: “For too long, children and young people who are questioning their gender identity have struggled to get the support they need.

“We are working with NHS England to transform gender identity services to tackle waiting times and ensure everyone receives holistic care, guided by clinical experts, paediatricians and psychologists.”