Interim Service Specification for Specialist Gender Dysphoria Services for Children and Young People Public Consultation

Task 

Following agreement by a committee of the NHS England Board, in July 2022, NHS England announced its plan to establish new services for children and young people experiencing gender incongruence and gender dysphoria. Part of this plan was to decommission the Gender Identity Development Service (GIDS) for children and adolescents, delivered by the Tavistock and Portman NHS Foundation Trust in London, and replace it with two ‘Phase 1’ services. The Phase 1 services will be commissioned against an interim service specification, which will replace the service specification used by the GIDS. 

In order to hear the views of patients, parents and carers, clinicians and service providers, as well as any other interested parties, NHS England conducted a public consultation that ran between 20th October and 4th December 2022. The draft interim service specification was published online along with a consultation guide and an Equality and Health Inequalities Impact Assessment. The consultation asked both quantitative questions and qualitative questions on the following topics:  

  • Changes to the service specification including: the composition of the clinical team; clinical leadership; working with referrers and local services; and referral sources  

  • Clarification of NHS England’s approaches towards social transition  

  • Management of patients accessing prescriptions from unregulated sources  

  • Suggestions for other changes or additions to the interim service specification  

  • The Equality and Health Inequalities Impact Assessment 

In total, the consultation received 5,183 responses with an average of over 2,800 responses per qualitative question that detailed the views, ideas, and suggestions of respondents.  

NHS England subsequently commissioned TONIC to undertake independent analysis of the consultation responses and produce a written report detailing the findings. 

Our Approach 

Before the analysis commenced, a data cleansing process was conducted to ensure all responses being analysed were relevant. This cleansing was carried out in five main ways: 

  • The raw dataset was assessed for duplicate responses 

  • Blank submissions were removed  

  • Content-free qualitative answers were removed e.g. “I don’t know” or “no comment” 

  • Offensive, joking, and unfathomable responses were removed 

  • Submissions in which individuals had falsely identified as patients were reclassified as having been made by members of the public.  

Outcome 

Following the analysis TONIC conducted, it was found that responses to the open-ended consultation questions fell into two groups, which were labelled Group A and Group B.  

Those in Group A tended to support the idea of children and young people accessing gender dysphoria services and entering a pathway to transition, while those in Group B appeared to support the belief that children and young people should primarily receive comprehensive psychological support in order to explore the causes of their sense of gender dysphoria. 

Furthermore, respondents in Group A were largely opposed to the proposals outlined in the interim service specification, believing that the changes would increase delays, lengthen already long waiting lists, and block access to services, resulting in significant harm to gender dysphoric children and young people. Many of these respondents considered the interim service specification to be based on outdated and inaccurate evidence, feeling that some of the proposed changes had been motivated by political and ideological desires to prevent children and young people from entering pathways to transition.  

Respondents in Group B were largely in favour of the proposals outlined in the interim service specification. Many individuals in this group believing that an increased focus on mental health issues would address what they felt to be the underlying causes of gender dysphoria, without children and young people progressing towards what they believed were harmful medical interventions such as puberty blockers and gender reassignment surgery. A significant proportion of this group of respondents believed that the previous child gender services had been negatively impacted by ideological influences. 

There was substantial variation among respondent types, what group they fell into, and whether they tended to agree or disagree with the interim proposals. Parents, clinicians and members of the public were more likely to agree or partially agree whereas patients, service providers, LGBTQ+ individuals and friends/family of transgender people were more likely to disagree or partially disagree.