Doctors warn on HSE use of controversial about-to-close clinic
Health Minister Stephen Donnelly has agreed to an urgent request to meet doctors from the National Gender Service (NGS) over concerns about the HSE’s ongoing use of the UK’s Tavistock clinic for Irish children with gender-identity issues.
Four senior doctors at the NGS, which deals with patients over 17 years of age, wrote to Donnelly on Thursday — after Siobháin Ní Bhriain, HSE national lead on integrated care, said the HSE would continue to use Tavistock’s Gender Identity Development Service (GIDS), despite a critical report by Dr Hillary Cass.
HSE figures show 238 Irish children have been referred to the English clinic between 2014 and May of this year. The interim Cass report into the clinic found Tavistock clinicians felt “pressure” to adopt an “unquestioning affirmative approach” to gender that was at odds with standard clinical assessment requirements.
A lack of documented assessments meant there was missing evidence justifying transition regimes involving puberty blockers and hormones, while gender issues “overshadowed” other health issues that patients had.
Gender-affirming care is promoted by transgender support groups in Ireland, such as BelongTo and Teni.
Last week Dr Paul Moran, a consultant psychiatrist with the NGS based in Loughlinstown in south Dublin, told Newstalk he was “shocked” when Ní Bhrian said the HSE was happy to continue using Tavistock.
The centre is to be closed down next year and replaced by two other centres, following Cass’s recommendations.
Ní Bhriain, who declined to be interviewed by the Sunday Independent, was responding to reports in this newspaper that Moran and his NGS colleagues had told the HSE in 2019 that Tavistock’s satellite clinic in Crumlin Hospital was “unsafe”, because of a lack of assessments.
Moran predicted “significant” future levels of regret among patients who transitioned as children, due to the poor level of care he said they had received.
On Thursday, Moran, along with consultant endocrinologist Donal O’Shea, consultant psychiatrist Ian Schneider, and NGS clinical lead Karl Neff, wrote a joint letter to Donnelly, raising concerns about the HSE’s policy to keep using Tavistock’s GIDS. Donnelly, who is currently on leave, responded promptly, to say he would meet the consultants after his return.
Moran said the referrals from Tavistock were ‘a complete disaster’
A Department of Health source said Minister Donnelly was happy to meet with the clinicians to hear their concerns, and the minister was glad to see that the HSE is considering the implications arising from the interim Cass report.
The Sunday Independent has seen a redacted copy of “an audit” that Schneider carried out in 2019 on 18 patients referred to the NGS from Tavistock or Crumlin that was sent to the HSE by Moran in December 2020 to demonstrate the alleged poor level of care given to Irish patients.
Of the 18, seven had no accompanying assessment report showing their diagnosis and treatment plans. Eleven patients had serious mental health or social problems, aside from gender issues.
In the accompanying email to the HSE, Moran said “it had become clear that the GIDS were not competent to adequately assess children’s suitability for medical transition”.
“It was also clear that there was a high level of co-morbid mental illness, social adversity and functional impairment among these children, which the GIDS assessment either did not recognise, or did not address,” wrote Moran.
This weekend Moran said the NGS continued to treat 10 of the 18 patients from the 2019 audit. One desisted from gender change, three have ongoing assessments, two are still on waiting lists, and two are not contactable.
Moran said the referrals from Tavistock were “a complete disaster”, as inadequate assessments were carried out on all 18 patients in its audit.
He said this required the NGS to carry out full assessments and to develop treatment plans for each, to deal with the range of issues, such as self-harming or violent behaviour.
“I met one of those patients recently, who has now fully transitioned [to a transgender woman] — and from having huge social problems, after a lot of help, she is now working in a caring profession,” said Moran.
“That’s one example of how a patient can be helped, if they have all their needs met.”
Moran said the NGS would use its meeting with the minister to press him to stop HSE referrals of children to Tavistock under the treatment abroad scheme.
The doctors also want the Department to invest in creating an Irish solution that would allow the NGS to extend its care model to younger patients.
Moran said there are “vociferous people” who want a model of care that “pushes hormones on pre-puberty kids” instead of funding social supports.
The HSE said it is “currently considering the interim Cass report, to assess whether it has any implications for future service provision in Ireland.”
It said that Tavistock assesses Irish children referred by treating clinicians in Ireland by carrying out a psychological/psychiatric assessment.
“If hormonal/puberty-blocking treatment is recommended, it is then considered and supervised by the endocrinologist clinician in Children’s Health Ireland [Crumlin],” it said.
It said “no complaints” were made by or in relation to named patients by any clinician, family or patient, and so “there were no complaints requiring a file review”.
The HSE has been unable to recruit consultants to staff a dedicated child and adolescent service gender clinic, but said it is working to “resolve this problem”.
An English legal firm last week predicted it would take some 1,000 medical negligence actions against the Tavistock clinic on behalf of patients wrongly prescribed hormones or puberty blockers.
However, the clinic has pointed out that just over 1,000 of the 19,000 patients referred to it in the last 10 years were referred for hormone treatment.
“The service is committed to patient safety,” a Tavistock spokesman said.
“It works with every young person on a case-by-case basis, with no expectation of what might be the right pathway for them, and only the minority of young people who are seen in our service access any physical treatments while with us.”