Doctor reforming controversial Tavistock clinic 'dismissed change'

Doctor with key role in reforming controversial NHS Tavistock transgender clinic ‘dismissed need for change during speech at major conference’

  • Clinic was set to close in July 2022 after inspectors rated it as ‘inadequate’

A senior doctor with a key role in reforming the controversial NHS Tavistock transgender clinic has been recorded questioning the need for change. 

Professor Gary Butler, clinical lead for the only NHS children’s gender clinic in England and Wales, also publicly challenged the author of the Cass review into the clinic, and accused her of ‘nepotism’ at a conference in Ireland.

In audio obtained by BBC Newsnight, Prof Butler can be heard saying he feels like the Gender Identity Development Service (Gids), based at London’s Tavistock and Portman NHS Foundation Trust, has been the subject of ‘lies’ in the media.

However, when approached by Newsnight, Prof Butler said he ‘fully supported’ the recommendations for a new service.

The Gids was set to close in July 2022 after inspectors who visited in late 2020 rated it as ‘inadequate’, but it will now remain open until at least March 2024.

Senior doctor Professor Gary Butler in charge of reforming the controversial Tavistock clinic has been recorded questioning the need for change

An independent review, led by Dr Hilary Cass, called for a ‘fundamentally different’ model of care for children with gender dysphoria and in July last year NHS England announced plans to replace Gids with two new regional hubs.

Prof Butler, a consultant paediatric endocrinologist at University College London Hospitals (UCLH), told transgender healthcare professionals that the Cass Review had highlighted the need to provide ‘developmentally appropriate healthcare for children and young people.’

But he said: ‘What on earth are we doing now? It’s exactly what we’re doing at the present time, and what the Gids is doing.’

Prof Butler was awarded a key role in designing the new service, as one of several clinicians tasked with implementing a new training programme.

Professor Gary Butler was heard on an audio recording publicly questioning the need for change at the Tavistock clinic

An independent review, led by Dr Hilary Cass (pictured), called for a ‘fundamentally different’ model of care for children with gender dysphoria.

In the recording, Prof Butler is heard also questioning the personal integrity of Dr Cass.

He implied there had been what he referred to as ‘nepotism’ around the choice of two hospitals in the south of England as the sites for new clinics, suggesting Dr Cass’s previous involvement in them both had been a factor.

NHS England says the two new regional hubs, which are set to replace Gids, are taking longer than anticipated to set up. 

Referring to the hospitals, which will form these new hubs, Prof Butler voiced concerns about the new workforce, claiming that none of the staff had ‘any experience of management of gender incongruence in young people’.

He continued: ‘It’s shocking.’

Meanwhile, there are more than 8,000 young people currently waiting for care.

In a statement, Prof Butler told BBC Newsnight the reported comments were ‘highly selective’ and part of a presentation on gender identity services in the UK.

‘I wish to make clear that I fully support Dr Hilary Cass’s recommendations to develop new services for young people experiencing gender dysphoria,’ he added.

The Cass Review told BBC Newsnight, that while it accepts people hold different views on how services should develop, there was ‘general consensus that the current model of care, within a single specialist gender service, cannot provide timely, holistic care for the mix of children and young people seeking support’.

It said Dr Cass did not select which hospitals would form the new regional centres, saying accusations to the contrary were ‘baseless’.

While Gids has helped some young people, critics – including young trans people seen by the clinic – told the BBC that it was sometimes too quick to refer young people for medical interventions and it could overlook mental health difficulties.

Em, a 19-year-old trans man, who has identified as male since early childhood, told Newsnight, ‘they push the drugs on you so early on.’ He was first prescribed puberty blockers by Prof Butler when he was 12.

Em rejects any suggestion that there’s no need for change. He told the programme: ‘The new system needs to be a mental health service.

‘For them, you weren’t transgender unless you’re willing to go the full way [in medically transitioning]. I was a child. I did not know what I was doing.’

The NHS says little is known about the long-term side effects of puberty blockers in children with gender dysphoria. Dr Cass has insisted there needs to be more research.

A UCLH spokesperson told Newsnight that it would be inappropriate to comment on an individual patient’s care, but added that Gids clinicians ‘discuss non-medical interventions with patients before and after referral to our endocrinology clinic’.

‘Patients only begin medical treatment if they are assessed as having full competence to consent and there is parental support,’ UCLH said, adding that the clinic follows the service specification set out by NHS England.

In a statement, the Tavistock and Portman NHS Foundation Trust said it had reviewed Newsnight’s claims, saying they ‘do not align with the evidence we have’, though it declined to give specifics about that evidence.

BBC Newsnight 10.30pm BBC Two and BBC iPlayer, Wednesday 24th May

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