Steph's Place

NHS Interim Service Spec for Children & Young People with Gender Dysphoria - Review Pt 2

A referrals process designed to deter access?

In this second article I’m going to look at the referrals process outlined in the interim service spec. In order to understand just how bad this is, it’s worthwhile to understand broadly what the current referral’s process is - or rather was.


Note : Im going to use CYP throughout to refer to Children or Young People / Person.


Referrals Then & Now

Previously, referrals into the GIDS service could be made by a range of professionals in various organisations in addition to GPs - schools & colleges, social services and voluntary organisations such as Mermaids & Gendered Intelligence, among others.

This referral would go directly to GIDS, and the referral would be added to the waiting list.


That changed in 2021 (if memory serves me) following Bell vs Tavistock being overturned and some findings of the Cass Review. Following this, referrals were sent to an external organisation rather than GIDS, adding another step in the process. 


In doing so, the NHS effectively created an additional waiting list to get onto the GIDS waiting list - something likely to be discriminatory in and of itself, as no other service operates such a process.

Which is where we are now, with the waiting list for the GIDS service (and the new ones which will inherit the situation) currently sitting at an estimated 8 to 10 thousand children and young people. Or, to place that in context - every CYP referred from 2018 to date is sitting on the waiting list.


What we had was a situation where getting referred for help was actually relatively easy, bypassing the usual issues trans people face by minimising the influence of uncooperative GPs or medical practitioners.


Referrals in the Service Spec

So, what's changed in the new service spec?


Section 8.2 covers the referrals process. Its a long and convoluted read, but the short of it is as follows:

Under the new referrals process, a referral can now only be made by a ‘healthcare professional’. Ths ‘professional’ must then contact the new service, arrange a consultation with them and the local ‘secondary team’ - effectively convening a Multi Discipliniary Team (MDT) to discuss whether or not a referral will be allowed to be made to the new service and the CYP is added to the waiting list.


If a referral is not allowed, the CYP will be handed back to a ‘local care team’ to manage and they will not be added to the waiting list - but instead will be pointed to ‘psycho-educational material’ and ‘ guidance on local referral and/or assessment options’ It even refers to ‘watchful waiting’, a term used only by those who practice conversion abuse.


So many issues, where do we start?

The most obvious issue is that this new referrals process removes the existing ease of referral from those who know / work with the CYP, to a much more restrictive model which places multiple additional barriers to accessing the service.


It’s not defined which ‘healthcare professionals’ will be able to refer, which means it's likely that only GPs will be able to do so - with all the problems this entails from uncooperative GPs.

Except a GP cannot refer. With their already stretched thin workload, GPs must convene and take part in an MDT panel in order to get approval from the service to refer. 


Referrals must be pre-authorised by the new service.

No other NHS service that I've been able to find employs this model. As such, this would seem to place the service spec at odds with EA2010 - specifying such a referral model that applies only to those under the EA2010 protected characteristic of ‘gender reassignment’ would appear to be direct discrimination.


There’s more...


Not only is the referrals process incredibly badly designed, there is no mention at all of any assessment process the referrer (GP) must undertake in order to gather the relevant data before asking for permission to refer. How can a ‘health professional’ discuss obtaining a referral with an MDT without a relevant assessment taking place prior to the discussion?


There are no measures in place to protect the CYP from an uncooperative ‘health professional’ who refuses to refer.

And on top of that, this referrals process places an uncosted, unstaffed additional burden on existing services that are already at or beyond breaking point.


There’s also no mention at all of what these ‘psycho-educational materials’ are, nor who will be producing them. A later paragraph states they will include : 

'Information on gender identity development including research evidence and how to support an exploratory approach that allows their child or young person time and opportunity to consider different options in a flexible and non-judgemental context.'


Which sounds supportive unless you known that an insistence on an ‘exploratory approach’ to ‘consider different options’ is thinly veiled conversion therapy, and that the ‘research’ being used here is so out of date and irrelevant as to be entirely useless.  But we will cover that in a later article.



The new referrals process can be summarised as follows:


  • Directly discriminatory

  • Adds multiple, additional, completely unnecessary barriers to accessing treatment for the CYP

  • Removes ‘health professional’ autonomy in making referrals

  • Is uncosted in both time and staffing terms through the formation of an MDT just to discuss authorising a referral to be made

  • Fails to introduce measures to protect the CYP from uncooperative ‘health professionals’ in seeking a referral

  • Fails to detail any required assessments to be done by the referrer

  • Fails to detail these ‘psycho-educational materials’ and who is / how they are going to be produced, nor what standards they will be produced to.


In short, this process is designed to make accessing treatment near impossible, for both the CYP and the ‘healthcare professional’ doing the referral. 

Making things more difficult is a recurring theme with this new ‘service spec’, and it's a key component in a type of conversion abuse broadly known as ‘desistance abuse’.


This is designed to make accessing transition related care so difficult through the introduction of entirely unnecessary barriers, artificially increasing the time it takes to actually get help in the hope that the CYP will ‘give up’ or ‘age out’ of the service without any treatment being provided.


When coupled with the evidence from Part 1, where deliberately underspeccing the service will lead to long waiting lists - this is little more than delaying tactics designed to inflict long term trauma through the suppression of identity, while providing plausible deniability to those making access to care so difficult.


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