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Today @GoodLawProject & @JolyonMaugham published a letter asking @NHSEngland to enforce its contract with @TaviandPort over GIDS waiting times.
As parents of children distressed about gender, many of whom are on this waiting list, we offer some thoughts. https://drive.google.com/file/d/1Qb5iUshzWopd3OkjkJvXy1-OqT2xEVs2/view
As parents of children distressed about gender, many of whom are on this waiting list, we offer some thoughts. https://drive.google.com/file/d/1Qb5iUshzWopd3OkjkJvXy1-OqT2xEVs2/view
We’ve said before, the waiting list is cruel. It shows the service model is broken.
Among many complacent lines by Tavi QC at the judicial review was that the waiting list is "simply a fact that is inescapable", like we should all just tiptoe around it. https://twitter.com/BayswaterSG/status/1313945696970715136?s=20
Among many complacent lines by Tavi QC at the judicial review was that the waiting list is "simply a fact that is inescapable", like we should all just tiptoe around it. https://twitter.com/BayswaterSG/status/1313945696970715136?s=20
@GoodLawProject is seeking judicial review. But as @JolyonMaugham knows, judicial review is a legal remedy of last resort, granted only where there is no alternative remedy for the problem in question.
So is there an alternative remedy here? Yes.
https://www.lexology.com/library/detail.aspx?g=840ca85c-6576-4b52-9477-91b9f55cc933
So is there an alternative remedy here? Yes.
https://www.lexology.com/library/detail.aspx?g=840ca85c-6576-4b52-9477-91b9f55cc933
In Sept, @NHSEngland announced a broad & independent review under @Hilary_Cass to cover: current & future workforce requirements (vii); increase in referrals & its implications (viii); "any other relevant matters" (ix). Clearly, an alternative remedy.
https://www.england.nhs.uk/wp-content/uploads/2020/09/GIDS_independent_review_ToR.pdf
https://www.england.nhs.uk/wp-content/uploads/2020/09/GIDS_independent_review_ToR.pdf
Cass will also review (i to v): treatments, clinical models, pathways of care, referral criteria for specialist gender identity services, recognising there are "individuals with less complex expressions of gender incongruence who do not need specialist gender identity services".
The @GoodLawProject letter talks about the contract between @NHSEngland & @TaviandPort as dated 30 Dec 2019. Actually the contract expired in April: 30 Dec is just the "Date of Review" in anticipation of its renegotiation (which process is itself another 'alternative remedy').
Even so, the case doesn’t rest on an expired contract but on a legal right to treatment within 18 weeks, which doesn’t apply when “delaying the start of your treatment is in your best clinical interests” or monitoring in CAMHS is “clinically appropriate”.
https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england
https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england
There’s ample evidence that gender dysphoria mostly resolves without medical treatment, so an absence of medical intervention is integral to the effective treatment of gender dysphoria in most cases. Delay is in the ”best clinical interests” of most.
http://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.html
http://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.html
And to quote @russellviner ”There is little research evidence on the long-term physical & psychological consequences of early intervention. It is therefore difficult to assess if the proposed benefits of early intervention outweigh the possible risks."
The legal letter suggests patients can get treatment overseas - perhaps from @GenderGP . In fact, patients must “obtain prior authorisation” which would hardly be granted to an outfit whose protocols are based on entirely different principles than the NHS.
https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england
https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england
We wonder if @JolyonMaugham has conflated treatment with physical intervention? GIDS is commissioned to reduce distress & as one wise GIDS clinician has observed: “just as there are multiple routes into gender dysphoria there will be many routes out of it” https://www.bayswatersupport.org.uk/j-k-rowling
As GIDS has said: “we just have to be really careful not to conflate treatment, in the broadest sense, with physical intervention… what we offer is not just physical intervention. It is really important to say that right up front, because often that is what treatment is seen as”
source: Dr Wren testimony to @Commonswomequ, Q55
http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/women-and-equalities-committee/transgender-equality/oral/21638.html
http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/women-and-equalities-committee/transgender-equality/oral/21638.html
Importantly, there’s no evidence - literally none - that medical interventions are more effective treatments for gender dysphoria than non-medical. https://link.springer.com/article/10.1007/s10508-020-01844-2
A right to treatment within 18 weeks would cut both ways. Parents responding to a child’s gender distress with self-diagnosis & hormones may ask the NHS to pay for it. But if so, parents who prioritise thoughtful psychological exploration can also demand NHS funding for it.
Finally, it’s really important, when talking about distressed children and adolescents, that we have less bluster, more calm exploration of evidence & risk.
Difference of opinion isn't hatred, it's the oxygen that science and society need to breathe and grow.
Difference of opinion isn't hatred, it's the oxygen that science and society need to breathe and grow.
@JolyonMaugham sometimes when we ourselves are personally invested in the outcome, it can be hard to maintain the distance necessary to assume the good faith of those with whom we disagree. But holding onto that good faith is the only way out of the mess this issue has got into.
