Transcript of Newsnight - 2020 06 17

This is the subtitle text from BBC Newsnight’s piece on the Tavistock dated 18th June 2020.

The author JK Rowling is famous the world over and lauded by millions of children for creating a boy called Harry Potter, but in a long essay she published last week she stepped into more contentious territory, expressing concerns regarding the issue of gender transition.
Newsnight has reported previously on England's only NHS specialist clinic for young people with gender dysphoria - a sense of unease a person may have because of a mismatch between their biological sex and their gender identity. The Gender Identity Development Service has been under intense scrutiny over the past few years. It says it always takes a cautious approach to treatment, but Newsnight has exclusively seen substantial evidence of concerns from some staff over whether the care provided by the service IS always safe.
This report by producer Hannah Barnes, and reporter, Deborah Cohen.
Young people struggling with their gender identity may be referred to England’s only specialist clinic, the Gender Identity Development Service, or GIDS, based at London's Tavistock and Portman Foundation Trust.
It is difficult area to work in and last year, following serious debt concerns over children's welfare, it conducted an internal review of the service. It recommended that areas for improvement but did not identify any immediate issues in relation to patient safety. Yet evidence exclusively seen by Newsnight reveals serious tensions at the heart of GIDS. We have seen well over 100 pages of transcripts, of interviews conducted with staff as part of the review, and they make a series of complaints.
Staff say they were discouraged from going to the lead safeguarding officer with concerns about children's welfare. They say decisions about medical treatment were taken too quickly. And they say that some parents appear to prefer that the child was transgender and straight rather than gay - Pushing them towards transition.
The transcripts have been voiced in this film by actors and edited for clarity. But the words were all relate by GIDS clinicians to the Medical Director is part of the review process.
“Let us pray that I am wrong. Because if I am not, very many vulnerable children have been very poorly treated and will be left with potentially a lifetime of damage. We're not talking about little things. The reality is by not doing anything, children are potentially still being medically mismanaged.”
When a child is assessed by GIDS they may be offered a puberty blocker drug. These stop a young person's body developing breasts, periods, facial hair or a deeper voice. The NHS has recently updated guidance on these drugs, acknowledging that little is known about the long-term effects. What impact they might have on the brains of children and their bones. GIDS has said in the past it has found itself caught between people who want these treatments quickly and those who think they should not be given at all.
Many children referred to GIDS are extremely distressed and have complex needs. The clinicians we have spoken to say there is often lots to explore before medication should be considered. But they say there is wide variation in practice. It is claimed that the transcripts that many staff are worried and openly discuss their fears.
“Maybe we are medicating gay children, kids with autism and maybe medicating traumatised children. And if we are, we are doing bad things to these vulnerable kids.”
NHS England says that young people should be referred for medical treatment, puberty blocking drugs, after a minimum of three sessions. But the review heard from several staff that one member of the leadership, Sarah Davidson, would refer children for treatment after only one or two appointments.
“I was working with an executive on one case of assessment of a young person and the executive member agrees to refer to this person to the medical pathway within the first hour of meeting him.”
“Are those not supposed to happen?”
“Absolutely it should never happen. Because this is a pathway that will lead to huge, huge changes for this young person. It could lead to potentially infertility and so on.”
We have been told that cases like this have been discussed at team meetings in GIDS. When some staff raise concerns about the speed of assessment, we understand the response was typically that the young person was experiencing very intense and severe gender dysphoria.
Such a quick referral would not allow for full exploration of what else is going on, staff claim. They say this could risk putting young people on potentially life changing medicines who may have been struggling with issues such as mental health and sexuality.
Homophobia [in] families is mentioned in all transcripts that Newsnight has seen. Staff say that while there was some discussion in the service about this, they did not feel the issue was properly addressed.
We have spoken to a number [off] staff of the record, and most did not want to go on camera, even on the condition of anonymity. But the transcripts are backed up by this former clinician who left GIDS last year. The words are voiced by an actor.
“We did have a lot of families and parents who would actively tell us that I am so glad that at least [my] child is not gay or lesbian. Implying that having a trance outcome would be better for their children.”
“I had a case that there was a lot of trauma in the family and the young person had come out initially as a lesbian and had faced a lot of homophobic bullying. [Both] within the family and quite openly in school. And suddenly that young person change their mind and they started identifying as trans.”
In some of these cases clinicians thought it would not be appropriate for them to refer for puberty blockers but they would be overruled by GIDS director Polly Carmichael, the transcripts suggest.
“The young person had clearly told me and my colleague that my mum [wants] the hormone more than I do and when we took to senior management, Polly Carmichael, she suggested that we refer. Even though this was not clinically indicated.”
These are only some of the examples mentioned in the transcripts. Staff also voiced concerns about the degree of trauma [they’re] witnessing in children and the process of gaining consent for medical treatment. It is accepted in the review that staff raised these concerns over the number of years, both to the leadership of GIDS and senior figures in the Tavistock trust. But in the transcripts, staff say they were not listened to.
“The reality is that our concerns were raised all the time and were shut down.”
And that when they did speak up, they were then seen as a problem.
"People who raise concerns are seen as troublemakers and difficult. I think it is the case that somehow the organisation works to evacuate people who are not compliant. When I raised concerns I was told that I had to toe the line or I would not progress in my career.”
Staff also say that senior management were unable to reassure them that their concerns were unfounded.
"I kept saying to her, are we hurting children? And she did not say no. I kept saying to her, will we get sued and she did not say no. The only solace she gave me is she said it would not be me that would be sued, it would be Tavistock. She was not able to say to me that it is fine, we are not hurting the children.”
In the transcripts we have seen, clinicians were worried about the impact different kinds of abuse might have on young people trying to resolve questions about their gender identity. These could be seen as safeguarding issues.
Staff claim they were discouraged from referring these cases to social services and from seeking advice. The Tavistock, like other NHS organisations, has a named person that clinicians can turn to to discuss specific safety concerns. That person is Sonia Appleby, but the transcripts allege that staff were discouraged from speaking to her by the director, Polly Carmichael.
“There was a very clear message from senior management about being really cautious about how we talk to the safeguarding team. Specifically, Sonia Appleby.”
“I know that Polly feels she does not like the scrutiny of Sonia. I think that is all. She is the trust safeguarding lead.”
“I have had some consultations with Polly Carmichael about some of the young people I was seeing and some of the concerns I had raised and [Polly very] directly told me not to go to Sonia to share those concerns.”
“Is that safe?”
“No. I would say that perhaps that is why more than 40 clinicians decided to leave the service within three years.”
We have been told that if clinicians did approach Sonia Appleby, they felt she understood the complexity of the work of GIDS and were supported by her. [Mrs Appleby’s] solicitor told us that she had started legal proceedings against the trust last year and it would not be appropriate to comment further.
It is unlikely that all staff will have been as critical of GIDS as the ones whose [interviews] we have read but the transcripts we have seen represent a sizeable minority of the total number conducted with front line GIDS [staff]. The review acknowledge the need to “address unwarranted variation” at GIDS and accepted the need to be more “robust in resolving concerns raised by staff”. It also recommended new regular audits of safeguarding practices and social services referrals.
But some staff do not feel it went far enough and they are not confident in the current management's ability to enact change.
Newsnight has seen evidence that the Tavistock's Chief Executive and chair have been told that the interview transcripts may contain concerns about child protection issues and they have been encouraged to read them themselves.
We showed some of the transcripts to the Children's Commissioner for England and contacted the health care regulator, the CQC, about what we have seen. Both are interested in speaking to the people involved. The CQC encouraged anyone with specific safeguarding or safety concerns to contact them directly. It added that it is due to inspect GIDS although because of Covid, routine inspections are currently on pause until autumn.
[An official] NHS review is under way into how young people visiting GIDS should be best supported. There is good practice taking place at the service but for some staff, this review cannot be completed soon enough.
Deborah Cohen. [Well] no one from the Tavistock and Portman NHS Foundation Trust agreed to be interviewed on the programme, but in a statement the trust said:
“[GIDS is a safe and caring service which supports a wide range of children and young people grappling with distress about their gender identity… The Tavistock and Portman NHS Foundation Trust stand by its 2019 report into the service. We are confident that it fairly addressed the issues raised and strongly refute the allegations put to us by Newsnight”
“Safeguarding is of the utmost importance to the Trust. In August 2018 a safeguarding lead was created specifically for GIDS to reflect the growth in the service. This role fits within the well-understood safeguarding pathway and procedures across the Trust.”
The Trust said that “any safeguarding issues that were identified during the review were further investigated and, where appropriate, addressed in the review's recommendations" and that they have kept both NHS England and the Care Quality Commission fully informed. The Trust added that the majority of patients using the service will not be referred on to endocrinology services for consideration for hormone blocking drugs.
Details of organisations offering information and support about some of the issues raised in that film are available at bbc.co.uk/actionline or you can call for free at any time to hear recorded information on 0800 077 077.