NHS CYP Guidance

The document, which does not bear the name of any NHS professional, asks providers of mental health support to children and young people (CYP) to invite those on the national waiting list for gender services for a face-to-face appointment. Providers are told: “We request all CYP who have been allocated to your service for mental health review are assessed as soon as possible.” One group is asked to be “reviewed and or assessed by… 30 June 2024.”

To enable providers to satisfy this request, they are allocated further funding for an initial face-to-face assessment – but no recurrent funding. We assume what is being sought and funded is (at best) an assessment and onward referral to already long waiting lists for mental health services or for autism/ADHD support.

As part of this process, children and young people on the waiting list for trans healthcare have been sent a “Gender Experience Summary Form”, asking them or their families whether they are receiving support from “the private sector or from abroad… such as… hormone treatment.”

The reality for all but a tiny minority of trans youth is that treatment is not available on the NHS. And regulatory harassment has diminished the pool of UK-based private providers of trans healthcare to almost nothing.

Against this background, the document recognises that many trans youth will have sourced hormone treatment from “unregulated providers or unregulated sources.” It states that the largest “unregulated provider” is a service called GenderGP, which it says is “registered overseas and is therefore outside the reach of the UK health regulators.” Good Law Project holds no brief for GenderGP but obviously “registered overseas” is not the same as “unregulated.” Nevertheless, the document seems to treat the two as one and the same.

At the assessment, providers are asked to “advise” the child or young person and their parent/carer not to take puberty blockers or gender-affirming hormones obtained through these routes without appropriate care. NHS England does not identify what “appropriate care” is and it is hard to see what available care it would describe as regulated.

Providers are told not to prescribe or to stop prescribing puberty blockers or gender-affirming hormones. They are also told that if the trans child or young person and/or their family “disregards your advice and you consider that this puts the child/young person at increased risk, then a safeguarding referral may also be appropriate in line with standard safeguarding approaches.”

It seems to us – and to those inside the NHS who have leaked the document to us – that what purports to be an “assessment” in fact an exercise in bringing very significant pressure to bear on trans youth and their families to cease private treatment, backed up with a threat of a safeguarding referral to social services if they do not.