Mick Hartley

Hadley Freemn in the Sunday Times interviews Hannah Barnes on her new book – Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children.

How the Tavistock gender clinic ran out of control:

It wasn’t easy for Hannah Barnes to get her book published. As the investigations producer for Newsnight and a long-term analytical and documentary journalist, she is used to covering knotty stories and this particular one, she knew better than most, was complex. She had been covering the Gender Identity Development Service (Gids), based at the Tavistock and Portman NHS Foundation Trust in north London — the only one of its kind for children in England and Wales — since 2019 and decided to write a book about it. “I wanted to write a definitive record of what happened because there needs to be one,” she tells me. Not everyone agreed. “None of the big publishing houses would take it,” she says. “Interestingly, there were no negative responses to the proposal. They just said, ‘We couldn’t get it past our junior members of staff.’

” Whatever their objections were, they could not have been about the quality of Barnes’s book — Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children is a deeply reported, scrupulously non-judgmental account of the collapse of the NHS service, based on hundreds of hours of interviews with former clinicians and patients. It is also a jaw-dropping insight into failure: failure of leadership, of child safeguarding and of the NHS. When describing the scale of potential medical failings, the clinicians make comparisons with the doping of East German athletes in the 1960s and 1970s and the Mid Staffs scandal of the 2000s, in which up to 1,200 patients died due to poor care. Other insiders discuss it in reference to the Rochdale child abuse scandal, in which people’s inaction led to so many children being so grievously let down.

Gids treats children and young people who express confusion — or dysphoria — about their gender identity, meaning they don’t believe their biological sex reflects who they are. Since the service was nationally commissioned by the NHS in 2009 it has treated thousands of children, helping many of them to gain access to gonadotropin-releasing hormone agonists, known as “puberty blockers”, originally formulated to treat prostate cancer and to castrate male sex offenders, and also used to treat endometriosis and fertility issues. The service will shut this spring, following a deeply critical interim report in February 2022 by Dr Hilary Cass, a highly respected paediatrician who was hired by NHS England to look into the service. Dr Cass concluded that “a fundamentally different service model is needed”.

Gids should be an easy story to tell: many people have been trying to blow the whistle for a long time, but Anna Hutchinson, a clinical psychologist who used to work at the Tavistock Centre, told Barnes that those who spoke up were “always driven out one way or another”….

Because this story touches on gender identity — one of the most sensitive subjects of our era — it has been difficult to get past the ideological battles to see the truth. Was the service helping children become their true selves, as its defenders contended? Or was it pathologising and medicalising unhappy kids and teenagers, as others alleged?

This reflects the fraught, partisan ways people see gender dysphoria: is it akin to being gay and therefore something to be celebrated?; or is it an expression of self-loathing, like an eating disorder, requiring therapeutic intervention? This has led to the current confusion over whether the planned conversion therapy ban should include gender as well as sexuality. “Conversion therapy” obviously sounds terrible, and politicians across the spectrum — from Crispin Blunt on the right to Nadia Whittome on the left — have loudly voiced their support for the inclusion of gender on the bill, which would thereby suggest that therapy for gender dysphoria is analogous to trying to “cure” someone of homosexuality.

But many clinicians argue that including gender would potentially criminalise psychotherapists exploring with their patients the reason for their confusion; after all, a doctor wouldn’t simply validate a bulimic’s desire to be thin — they’d try to find the cause of their inner discomfort and help them learn to love their body. Gids itself has long been conflicted about this complex issue. Dr Taylor wrote in 2005 that staff didn’t agree among themselves about what they were seeing in their patients: “were they treating children distressed because they were trans,” Barnes writes in Time to Think, “or children who identified as trans because they were distressed?” …

Dr Polly Carmichael took over as Gids’s director in 2009 and, in 2011, the service undertook an “early intervention study” to look at the effect of blockers on under-16s, because so little was known about their impact on children. Instead of waiting for the study results, Gids eliminated all age limits on blockers in 2014, letting kids as young as nine access them. At the same time referrals were rocketing, meaning clinicians had less time to assess patients before helping them access blockers. In 2009 Gids had 97 referrals. By 2020 there were 2,500, with a further 4,600 on the waiting list, and clinicians were desperately overstretched. “As the numbers seeking Gids’s help exploded around 2015, there was increased pressure to get through them. In some cases that meant shorter, less thorough assessments. Some clinicians have said there was pressure on them to refer children for blockers because it would free up space to see more children on the waiting list,” Barnes says.

Clinicians were seeing increasingly mentally unwell kids, including those who didn’t just identify as a different gender but as a different nationality and race: “Usually east Asian, Japanese, Korean, that sort of thing,” Dr Matt Bristow, a former Gids clinician, tells Barnes. But this was seen by Gids as irrelevant to their gender identity issues. Past histories of sexual abuse were also ignored: “[A natal girl] who’s being abused by a male, I think a question to ask is whether there’s some relationship between identifying as male and feeling safe,” Bristow says. But, clinicians point out, any concerns raised with their superiors always got the same response: that the kids should be put on the blockers unless they specifically said they didn’t want them. And few kids said that. As one clinician told Barnes: “If a young person is distressed and the only thing that’s offered to them is puberty blockers, they’ll take it, because who would go away with nothing?”

Then there was the number of autistic and same-sex-attracted kids attending the clinic, saying that they were transgender. Less than 2 per cent of children in the UK are thought to have an autism spectrum disorder; at Gids, however, more than a third of their referrals had moderate to severe autistic traits. “Some staff feared they could be unnecessarily medicating autistic children,” Barnes writes.

There were similar fears about gay children. Clinicians recall multiple instances of young people who had suffered homophobic bullying at school or at home, and then identified as trans. According to the clinician Anastassis Spiliadis, “so many times” a family would say, “Thank God my child is trans and not gay or lesbian.” Girls said, “When I hear the word ‘lesbian’ I cringe,” and boys talked to doctors about their disgust at being attracted to other boys. When Gids asked adolescents referred to the service in 2012 about their sexuality, more than 90 per cent of females and 80 per cent of males said they were same-sex attracted or bisexual. Bristow came to believe that Gids was performing “conversion therapy for gay kids” and there was a bleak joke on the team that there would be “no gay people left at the rate Gids was going”. When gay clinicians such as Bristow voiced their concerns to those in charge, they say it was implied that they were not objective because they were gay and therefore “too close” to the work. (Gids does not accept this claim.)

What if becoming trans is — for some people — a way of converting out of being gay? If a boy is attracted to other boys but feels shame about it, then a potential way around that is for him to identify as a girl and therefore insist he’s heterosexual. This possibility complicates the government’s plan — which has cross-party support — for including gender alongside sexuality in the bill to ban conversion therapy, if enabling a young person to change gender is, in itself, sometimes a form of conversion therapy….

On the one hand, it feels incredible that such a disaster happened. How did an NHS service medicalise so many autistic and same-sex-attracted young people, unhappy teenage girls and children who simply felt uncomfortable with masculine or feminine templates, with so little knowledge of the causes of their distress or the effects of the medicine? And how did Carmichael, still the director of Gids, suffer no repercussions, whereas those who tried to blow the whistle say they were bullied out of their jobs? On the other hand, it is a miracle that the information is now out. For too long, too many people have turned a blind eye to problems arising from gender ideology, including healthcare for gender dysphoric children — because they have been focused on trying to be on the right side of history, they refused to look at the glaring wrongs.

Barnes knows that some will be angry at her for having written the book. But she also knows that she had to write it: “There’s been this idea that the kind of treatment young people got at Gids — physical interventions — is safe treatment for all gender-distressed children,” she says. “But even among the clinicians working on the front line of this issue, there is no consensus about the best way to care for these kids. There needs to be debate about this, and it needs to come out of the clinic and into society, because this isn’t just about trans people — it’s bigger than that. It’s about children.”

It's good that we're finally talking about this, but the battle is far from over. And how many Tavistocks are there still operating elsewhere? – in the US, for instance? Never mind Glasgow's Sandyford Clinic…