YT YouTube2Text

YouTube2Text → Transcripts → Kathleen Stock: Inside Britain's new trans clinics

Kathleen Stock: Inside Britain's new trans clinics — Transcript

by UnHerd · 7,089 words · 1,015 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:02hello and welcome to unheard I'm Sally
0:04ChatOn unheard editor today we're going
0:08to talk about one of the most difficult
0:10divisive and emotive issues affecting
0:13our politics culture and medicine today
0:16it's gender identity most importantly
0:19we're going to talk about how it is
0:21affecting our children and how gender in
0:23congruity that's the idea that you're
0:25born in the wrong body is being treated
0:28by the NHS in the under
0:3017s until a year ago most young people
0:33experiencing any sort of gender related
0:35distress were referred to jids the
0:37gender identity development service at
0:40the world-renowned Tavis and Portman
0:42trust this service tiny at first had
0:45grown over three decades into an
0:47operation that was underst staffed under
0:49pressure and suddenly uncertain as to
0:52whether its approach was the right one
0:53as a result staff turned whistleblowers
0:56and its protocols and patients came
0:58under scrutiny amid serious concerns a
1:02review by Hillary Cass was commissioned
1:05this delivered its interim verdict just
1:07over a year ago and it was that jids
1:09should be closed down but what is going
1:12to take its place there are hundreds of
1:14confused youngsters seeking help and
1:16where can they expect to find it
1:19Kathleen stock unheard columnist has
1:21spent the past month investigating what
1:23the new gender service for children
1:25might look like will it have learned the
1:27lessons from jids and what hope do those
1:29kids her she's going to talk through
1:32some of her findings with us today
1:34welcome Kathleen hi so Kathleen perhaps
1:37we should start at the beginning and you
1:39might set the scene for us um explain
1:41why jids was set up what what is or what
1:44what was jids jids was a service for
1:49children um and adolescents who um had
1:53gender disphoria which is now being
1:56represented as gender in congruence but
1:58it the children children who were in
2:00extreme distress about um their sex
2:04bodies and many of whom um had the idea
2:08that they really should have been born
2:10um as the opposite sex and that was a
2:13small number a relatively small number
2:16of
2:17patients um but in the last 10 years
2:21more I suppose
2:23um it the the numbers have exponentially
2:27rocketed up because it was young it was
2:29young boys wasn't it it was back in the
2:31880s set up yes I mean it was it was
2:33very rare that a child would um be sent
2:37to jids it was it was considered to be a
2:39very exceptional disorder and it was
2:41considered to be a disorder social
2:44trends changed it became the the the
2:47disorder became more well known which
2:49seemed to have partly produced more
2:51patience because more people more kids
2:53heard about it and that gave them way I
2:55think to explain their own experience or
2:58whatever the explanation is the P
3:00patient um referrals Rose very
3:03quickly and in the course of that um
3:06most recent period in jid's history um
3:10they started using puberty blockers
3:12which are powerful drugs that as they
3:16would say pause puberty in order to give
3:19you time to think um they
3:24also it is suggested by some studies do
3:27other things that aren't quite so benign
3:29yes um as as perhaps we'll discuss what
3:32then happened where did where did the
3:33where did Crisis occur as far as I can
3:35see having read um the judicial review
3:39um documents having looked at Hannah
3:40Barn's book which is meticulous um
3:43having looked at the Care Quality
3:44commission report um there was a number
3:46of problems there all along um part
3:50particularly to do with recordkeeping
3:52they don't seem to have any records
3:54accurate records how many patients they
3:55actually gave those drugs to so there
3:57was poor
3:58recordkeeping there was um insufficient
4:01uh assessments psychological assessments
4:04prior to uh being sent to the endocrine
4:07knowled ists um and there was also so
4:10insufficient in quality insufficient in
4:12quantity there was um as as later
4:15reviews have shown the cast review in
4:16particular which we'll come on to but
4:18that's an independent review that was
4:19commissioned into gids has shown there
4:22was very poor communication between
4:23psychologists and endocrinologists at
4:26University College Hospital so it's just
4:28a range of problems in administering
4:30these powerful drugs in order supposedly
4:33to have therapeutic effects but also
4:35they were the waiting lists grew uh the
4:38number of patients they were supposed to
4:40see was um far more than they could cope
4:43with so there was just a number of
4:45problems there and so Hillary Cass was
4:47called in yes um so Hillary Cass is a
4:50distinguished pediatrician she's a
4:52former president of the Royal College of
4:54Pediatrics and she was brought in um in
4:582021 one I think yeah um to do an
5:02independent review Into the service um
5:05and she then came to the conclusion that
5:09the service had to be
5:11closed um and she's recommended a new
5:15structure which involves two new
5:16services in the medium term one based in
5:20the south of England called the southern
5:22Hub which is a partnership between great
5:25Orman Street um the evina children's
5:28hospital and South London and morsley um
5:30NHS trust and one based in the north of
5:34England which is a partnership between
5:36older hay children's hospital and Royal
5:38Manchester children's hospital and those
5:40are supposed to be the first two
5:43services but ultimately she wants other
5:45Regional centers as well so we're in a
5:49transition period now actually gids is
5:51has not closed um and the director uh
5:56poly Michel the Dr poly Michel the the
5:58clinical Psych ologist who oversaw the
6:00service through um all of the problems
6:03that I've just described is still in in
6:05place I and I interviewed Hannah B
6:07actually she was the one person who she
6:09was willing to sort of name as someone
6:11who was possibly part of the problem um
6:14right well she still she's still in
6:16place and they still manage um a cohort
6:19of a thousand around a thousand patients
6:21that's what their website says um that
6:24what they are is close to New referrals
6:27so um the waiting list is being managed
6:30by a separate entity now not by G jids
6:32itself and um it's another NHS trust do
6:35you know how long that waiting list is I
6:37think it's over 7,000 as well as of July
6:40it was over 7,000 and presumably it's
6:42growing because um the southern Hub and
6:45the northern Hub have yet to uh start
6:49receiving patients or doing any kind of
6:51patient care jids is close to New
6:53referrals so there's this void um where
6:57proper care should be and there are
6:59other people who are involved as well
7:01aren't there um in the new pilot schemes
7:04that who were involved in the original
7:06jids aren't there yes so something that
7:08I um discovered in researching this
7:11piece is that the figures from the old
7:14some would say discredited service are
7:18prominent in the new hubs um one of them
7:21by his own admission is Professor Gary
7:23Butler who is the chief endocrinologist
7:26at University College Hospital routinely
7:29puberty blockers well he he is on record
7:32himself uh talking to the Daily Mail few
7:35years ago saying that he routinely
7:37prescribes um puberty blockers to what
7:40he describes as children with lifelong
7:43gender dysphoria um so he he um gave a
7:47speech to a conference uh this year
7:50where he said that he would been
7:52employed in the new Hub the southern Hub
7:55he was very critical of uh Hillary Cass
7:58I was going to say how do he yes he
8:00doesn't seem to feel very well disposed
8:02towards her he in this speech anyway
8:04perhaps he was uh you know being a bit
8:08colorful but he he kind of made a joke
8:10about nepotism that somehow he implied
8:13that it was nepotism that she was
8:16involved in the hospitals in particular
8:17were involved she said that nobody in
8:19these hospitals um or the hospitals
8:22rather had no experience of dealing with
8:24gender dysphoria or in congruence um but
8:27he he described himself is um having
8:30fought back to be able to continue to
8:34provide endocrine services to trans
8:36identified children it's interesting so
8:38that means that sort of what was
8:40therapeutic is becoming clinical which
8:42is that well that's the that's the whole
8:44um interest interesting thing about
8:47puberty blockers is that um you're
8:49prescribing this extremely powerful drug
8:53that has effects on the whole body and
8:56the Brain in order to alleviate
8:58psychological distress and that's
9:01unusual I mean of course psychiatrists
9:03psychiatrists rather um often prescribe
9:08um mood altering drugs but this is not
9:11just mood altering and and also
9:13psychiatrists tend to be um quite
9:17cautious when giving them to children so
9:19there's a number of ways in which this
9:20is unusual and and that that speaks to a
9:23theme that really emerged for me in
9:24researching the piece you know I already
9:26knew it but it really became underlined
9:28that gender medicine is exceptional lied
9:31it is not historically anyway treated as
9:34part of wider medical structures as soon
9:37as a a child is diagnosed with a gender
9:40identity disorder or dysphoria um what C
9:44Hillary Cass calls diagnostic
9:45overshadowing takes place which that
9:47sort of thing becomes very prominent in
9:49everyone's mind and they sort of forget
9:52to look at the wi what's going on for
9:53that child in her mental health in her
9:55home situation is she autistic and so on
9:58and that's one of the things that she
9:59wanted to do is in her interim report
10:01that's what she said so it's very clear
10:02that in cass's recommendations thus far
10:05in her interim report and then also in
10:07the um they've they NHS England have now
10:10released an interim service
10:11specification for these new Services
10:14moving forward it's very clear that they
10:16want to bring ha back gender medicine
10:19for children and Adolescent into wider
10:22pediatric practice because there are
10:23comorbidities as well aren't there
10:25affecting what the the sorts of children
10:27who are presenting yes so there's a
10:29relatively High uh number in this cohort
10:31of autistic children or children
10:33neurodiverse there's also um High number
10:37of girls I mean sex is definitely
10:39relevant in this and that's the ironic
10:42thing of course that we're not supposed
10:43to describe these girls as female but
10:46they are female and that is relevant
10:48causally to why they're in this cohort
10:50and um there's also uh same-sex
10:54attraction tends to be um
10:56disproportionately represented so
10:58affirmation is this um it's really at
11:01the heart of the dispute um about how to
11:03treat this cohort of children and
11:05adolesence and it's whether we should
11:08affirm their identities as
11:10in uh believe them in inverted commas or
11:13believe their experience in other words
11:16kind of exceed to their way of
11:17presenting themselves um not challenge
11:21it in any well not I think really not
11:24challenge it although there's some
11:26argument about whether that so so people
11:29these days who are promoting affirmation
11:31will often say but it's also compatible
11:33with exploration but the question is is
11:36it really if you can't say this is a
11:38female if you can't utter the word she
11:41if you can't if you have to um use the
11:44pronouns that um you're being asked to
11:46use with a child the child is asking you
11:47to in what way can you really explore
11:49Alternatives where in fact um
11:53they're you know they're really the sex
11:56that they are yeah one of the people who
11:57you quote in your piece um describes um
12:02affirming a child you you need to
12:04absolutely believe them um yes because
12:06it's and she Compares it with if a child
12:08is disclosing sexual abuse yes
12:10disclosing sexual AB so that comes from
12:12a transwoman clinician who heads up an
12:15adult's gender service and there's quite
12:17a bit in the piece about adult gender
12:19Services because they effectively have
12:22access to um I would say children age 17
12:27or at least adolescence age7
12:29because let's bear in mind as well that
12:30what we're talking about at the moment
12:31are kids under 17 yes we're talking
12:33about under 17 year olds but as soon as
12:35you get to um the age of 17 and that's
12:38another aspect of the piece um every
12:41every 17-year-old on the waiting list
12:43existing waiting list for jids has been
12:44sent a letter saying why um you should
12:46transfer to an adult waiting list so
12:48there's a whole separate discussion
12:50perhaps we'll have in a minute about
12:51what's happening there but this is a
12:53clinician uh Dr Christine mimna who um
12:57in an interview I found said made this
13:02comparison between um a child telling
13:05you that she's been sexually abused in
13:08which case you should believe her and
13:09you shouldn't discount her experience
13:11and you shouldn't say um no that didn't
13:14happen and a child telling you that
13:17she's a boy and so the affirmatory um
13:21approach is one side the exploratory
13:23approach is the other side um and so and
13:26that there presumably that's attention
13:29of affirmation tend to deny that there's
13:31any tension but the the critics would
13:33say yes of course there's a tension
13:34because you have to find the language to
13:36be able to talk to the child and say
13:38that things might not be as you think
13:40they are within the treatment of gender
13:42dysphoria there is seems to be there are
13:44two approaches the affirmatory approach
13:46and the exploratory approach and so are
13:48those two odds would you say The
13:51Advocates of affirmation tend to insist
13:53that it is compatible with exploration
13:56and exploration meaning it really EXP
13:58exploring what's going on here and not
14:00necessarily making a a forone conclusion
14:04that the child will transition but
14:06critics say no you can't actually have
14:08proper open ended exploration if you are
14:11confined by um having to use the
14:14preferred pronouns the terminology of
14:17the child and often the child's parents
14:20um you have to be able to say I'm afraid
14:22you are a female and so on and so is the
14:26problem therefore not just going to be
14:28represented in these new hubs if the
14:31same people are well this is the
14:32question no no because there's because
14:34what seems to have happened is that um
14:38the new hubs the managers in the new
14:39hubs for whatever reason the people I
14:42talked to thought it was probably um
14:45ignorance rather than anything more
14:48Sinister they just didn't understand the
14:50complexity the ideological complexity of
14:52this area but they have they've employed
14:54on the same teams um people who are very
14:57Pro affirmation and people people who um
15:00are not who are very much more um who
15:03are against affirmation really or
15:04certainly against automatic affirmation
15:06and that's producing a lot of tension on
15:08these teams because as someone said to
15:11me um who who is involved um you know
15:17you can't say yes and no at the same
15:18time you've got you've got to come to a
15:20conclusion and uh there seems to be some
15:23degree of Deadlock so but at least
15:26concerns are being ered which they
15:27weren't shut down initially yes I mean I
15:30don't think I talked to anyone who said
15:32that things were worse than they are I
15:34mean they're very the the overarching
15:36sense I get from people who are critical
15:38of affirmation is that they're very
15:39pleased that Cass is on board they feel
15:42immensely heartened by her approach so
15:44far it seems clearly to be bringing
15:47gender medicine into the fold of uh
15:50standard methodologies for Pediatric
15:52practice and for adolescent child an
15:55adolescent mental health um so from that
15:58perspec respective they're happy it's
15:59just that on on the ground in
16:01implementing this service specification
16:04in producing training materials for new
16:06clinicians there's quite a lot of um
16:08Discord and then there's this wider
16:10worry about the atmosphere in trusts and
16:12hospitals because a lot of them have
16:14been rainbow washed as it were well I
16:17was I was going to say one of the
16:18problems as well at jids was the fact
16:19that mermaids were so you know closely
16:22involved with it and also gendered
16:25intelligence and what I thought was
16:26interesting was that there's a statement
16:27from gendered in which said they
16:29welcomed the closure of jids and the
16:31Improvement of gender services for young
16:32people as jids had become a symbolic
16:34center around which anti-gender
16:35arguments had revolved for years um and
16:38I wonder whether this is going to be
16:41rectified with the new service because
16:43another thing that's happening as well
16:44isn't it um Cass is going to is she
16:46suggesting that we she roll out um
16:49puberty blocker trials which haven't
16:51been yes I mean that's um Cass has
16:55insisted that if puberty blockers are to
16:58be prescribed in future it can only be
17:01under the opes of a clinical trial I
17:03think in the in a draft of the new
17:05service specification for puberty
17:07blockers that I saw there is one Clause
17:09that says unless circumstances are very
17:11exceptional or something like that but
17:13but mainly you've got to be on a trial
17:16but equally there was someone you quoted
17:17who said that that would be insane yes
17:19so I did talk to a research manager who
17:20has very an NHS clinical trial manager
17:24rather who had very strong views about
17:26this and who felt that this would have
17:29to be what is called a ctim this
17:31clinical trial I'm afraid I'm not going
17:33to be able to REM tell you what that
17:35stands for but C is the gold standard of
17:37clinical trials now for what um I looked
17:40at the original ethics application of um
17:43jids when they were um proposing their
17:46uh study their early intervention study
17:49uh back a few years ago about puberty
17:51blockers and they did not tick the box
17:53that said it was a c if it's going to
17:55happen at all it will have to be a c and
17:57the standards governing SE temps are
17:59very very high and if there's the
18:02slightest risk to participants and
18:04particularly to Children then that will
18:06be heavily factored in in the ethics
18:08appc in in scrutiny of the ethics of the
18:10thing she said there's lots of other
18:12things you could do you could um look at
18:14animal studies you could do a deep dive
18:16into the existing literature of these
18:18drugs on other um populations for
18:21instance those are that go through
18:23precocious their children that go
18:25through precocious puberty where these
18:26drugs have been used so there's lots and
18:28lots of things you could do other than a
18:29clinical trial on these children who
18:31let's Rec remember have are physically
18:34healthy you know they don't have
18:35precocious puberty they don't have
18:37they're not interx or whatever the sort
18:39of myth about these children are they're
18:42just a average children um who been
18:45given this extremely um powerful drug
18:49with and there's some evidence of uh
18:51impact on renal function on uh liver
18:55function on B cognitive function so all
18:58of those risks you know we don't know
19:00much about them just the suggestion of
19:01them she said would be enough to mean
19:04that a a c temp could wouldn't be
19:05possible so I I don't know if that's
19:07true but it's interesting in terms of um
19:10prescribing the puberty blockers for
19:12children does that help their mental
19:13health would that that well there's I
19:15mean everything about this um practice
19:18is is disputed but there's increasing
19:20evidence that um well the evidence is
19:23mixed because very recently in the last
19:25month even I think um somebody has rean
19:28analyz some of the data that came out of
19:30jids about there being no change to
19:32Mental Health on puberty blockers and it
19:33turned out that if you
19:35disaggregate um the findings there was a
19:38lot of change um but in in in kids some
19:43basically some really improved and some
19:45really deteriorated and if you average
19:47it out it looks like there's no change
19:49but in fact that wasn't at least that's
19:52one way of putting it there's a
19:53different way of putting it as well is
19:55there so is there um conflict within as
19:57far as you know the the Pilots with
19:59regard to the the testing questions for
20:02me is the same Endocrinology Department
20:04seem to be involved again also at leads
20:07that's another thing that my research
20:09uncovered deep in the minutes of an
20:11older hay board meeting um it was
20:13announced that the lead's endoc
20:15Endocrinology Department would be that
20:17would be now associated with this new
20:18Northern harb now that's exactly the one
20:20that was involved in the satellite
20:22Clinic of jids as described in Hannah
20:25Bar's book and if you look shut down if
20:27you look at the um Endocrinology
20:29Department or the the subset of the
20:31department that's involved with Le jids
20:33their website is still live as part of
20:35the Le children hospital and um they've
20:37all got their pronouns listed so and so
20:41would you say that they're in danger of
20:42repeating old mistakes at the moment I
20:44would say they're in danger of it yes
20:46from the outside it seems to me that um
20:49the that there is a lot
20:52of uh activism still in hospital trusts
20:57um they they a lot of them are signed up
20:59to Charter mark schemes LGBT Charter
21:01mark schemes well like stonewall's um
21:04diversity Champion scheme was the sort
21:06of original one of those NHS England is
21:09still a Stonewall diversity Champion for
21:11instance but there's also new ones
21:13there's um the the rainbow badge scheme
21:16which is an accreditation scheme that's
21:18now being rolled out and and some of the
21:20trusts involved in these hubs are are
21:22rainbow badged um which means that the
21:26LGBT foundation for instance who is
21:28associated with this scheme can look at
21:30all their policies and say you need to
21:32do this you know you need to get rid of
21:33gendered language in your maternity
21:35services or you need to make sure that
21:38everybody knows to ask for pronouns so
21:41in to some degree these activist
21:44organizations are still having a
21:46influential effect on the environment in
21:49which these children are being cared for
21:52um and there's also the staff networks
21:53the LGBT staff networks which tend to be
21:56very transactivism
21:58Pro
21:59affirmation um and you know so it's not
22:02inconceivable that there will be some
22:04degree of resistance to cass's measures
22:06in these hubs and among the people that
22:07you spoke to what was their their key
22:09concern do you think I think part of the
22:11concern is that um because I discovered
22:14uh that uh you know the Discord within
22:17the southern Hub is basically well I
22:20don't know there is a hold up in the
22:22southern Hub now we should talk about
22:23the southern Hub then I mean I don't
22:25know that that's a result of the Discord
22:27um but but I do know that last week um
22:30very suddenly it was announced that um
22:33so they were about to roll out their
22:34training materials they were about to
22:36start teaching new clinicians um
22:38everything's been paused the training
22:40materials were being formulated by by
22:43these te by a team that invol Gary
22:46Butler um by his own admission so
22:48there's been a pause and I also was told
22:51the manager has resigned um so there's
22:53some kind of hold up now um and the
22:57people I talked to who don't know when
22:59they don't have a schedule for when
23:00everything will start again in the
23:01meantime of course uh G jids is not
23:04taking any new patients so the the
23:07waiting list is getting longer and
23:08longer and then there's this problem
23:10about what happens to the 16y olds 17
23:12year olds maybe even 15 year olds
23:13actually when they get there um who will
23:16never have seen anyone um for the length
23:20of their adolescence as it were and at
23:2217 can go onto an adult list and at that
23:26point all bets are off because you know
23:29the adult service specification for um
23:32gender dysphoria for treating gender in
23:34congruence is was written in 2019 it
23:37Cass has not had any influence on it
23:40whatsoever and it is whole different
23:43ball game there is no mandatory
23:45psychological assessment at all you can
23:46self-refer you don't need to go to your
23:48GP you can how many how many
23:49appointments would it need two hthe two
23:52to get on hormones um and you need only
23:55need one clinician within that service
23:57to sign off a
23:59myectomy and um part of the because
24:03there are very long adult waiting lists
24:04as well part of the um nhs's England's
24:07attempt to get rid of the adult waiting
24:09list or to bring them down is to
24:10introduce these new what they call Pilot
24:13Services um there's four of them at the
24:15moment one of them is run by Dr
24:17Christine mimar the person who makes the
24:19equation between disclosing sexual abuse
24:21and disclosing disclosing gender
24:23identity but these pilot services are
24:26explicitly ideological and affirmatory
24:29you know run by trans people for Trans
24:32people we believe you um you will be
24:36you're not given time to think it
24:38doesn't seem like there's much room
24:40given the presentation of these services
24:42online and the things that their leaders
24:45say in interviews it doesn't seem like
24:48there's especially these pilot ones
24:49which are embedded in Sexual Health
24:50Services run by lgbtq clinicians quite
24:54often um there's just not a lot of room
24:56to imagine skepticism here here it seems
24:58much more like you know you're here
25:00we'll give you what you need and it is
25:02described as a need another one of the
25:04KnockOn effects presumably of the um the
25:06long waiting lists and the the shutting
25:08down of the Southern Hub not the
25:10shutting down the the shelving of it for
25:12now the stalling of it um is that um
25:15presumably other suppliers will be
25:17popping up yes so um that does seem to
25:20be happening
25:21so I think a month or so ago um it was
25:24in the news that there was a new private
25:27provider called called uh gender plus um
25:30had arrived on the scene and it was run
25:33by Dr Aiden Kelly who had been at jids
25:36and um it was also if you look at the
25:39staff list on their website there are
25:41people who describe themselves as
25:44working at jids in December so I would
25:45say there's a crossover of jids Staff um
25:48and they are very keen to see um
25:54children who are on the waiting list as
25:56far as I can see it's a bit unclear what
25:58exactly they're offering I must admit
26:01because in the they told the times that
26:03they were preparing to be able to
26:05prescribe hormones to
26:07teenagers on their website they say that
26:09they are not yet regulated by the Care
26:11Quality commission I think they would
26:13have to be regulated by the Care Quality
26:15commission if they were to offer
26:16hormones so hormones is different from
26:17puberty blockers yes it is um and so
26:21they haven't ever said explicitly as far
26:22as I can tell that they are interested
26:25in offering puberty blockers but yes so
26:27there's there's private a growing
26:28private Market to take up the slack here
26:31and quite often people involved are
26:34people whove worked for jids or are
26:35working for jids is there any um do you
26:38detect any concern that this is
26:39happening um that this this growing
26:41Market that the the children that the
26:44waiting list is growing that the
26:45southern now has well I think um you
26:48could in in uh in the NHS England's
26:53interim service specification um it's in
26:56sort of bold red letter ing that um they
26:59strongly advise against procuring puy
27:02blockers or hormones from an
27:05unregulated source and do you know
27:07anything about the the education um
27:09services that that um Gary was supposed
27:11to be
27:12overseeing they were so what were they
27:14formulating in great Orman Street as far
27:16as you well they were formulating
27:18training materials for clinicians who
27:20would then be working on the ground with
27:22um patients and all what I know about
27:25that is that there was deep Discord
27:27about what should be in the training
27:29materials um whether there should be
27:31anything about affirmation whether there
27:33should be anything about puberty
27:34blockers because actually cass's
27:36guidance is that um the service should
27:39be psychosocial not endocrinological and
27:41there'll be different service
27:42specifications for puberty blockers
27:44coming out later but you know it's not
27:45the remit of the According to some
27:48anyway it's not the remit of this team
27:49to produce um advice about puberty
27:52blockers um but I believe that there was
27:54some Discord about that and meanwhile up
27:57north what's happening there that was
27:58always supposed to um be opened later
28:02than the southern Hub the southern Hub
28:03was supposed to start first so I think
28:04that April 2024 was the um date
28:09mentioned for the northern Hub I mean
28:11what I know there is that the leads um
28:13Children's Hospital seems to be involved
28:16and that's the Endocrinology Department
28:18that was involved in the satellite
28:19clinic in leads that was associated with
28:21jids um I also know that both hospitals
28:25again are part of very ious kite Mark or
28:28Charter Mark um trans activist uh
28:32schemes for instance the Northwest um
28:35has one called the Navajo kite Mark or
28:37the nav Navajo Charter Mark scheme and
28:40the older just got accredited it's hard
28:43to get a grasp on what accreditation
28:45means because I've had to look around I
28:46can't find anything but I did find a
28:48Navajo newsletter from 2019 that was
28:51repeating outdated facts about um
28:54children who are trans identified
28:56committing suicide
28:57um saying that half of trans identified
29:00children attempt suicide I mean that's
29:02just not true so and it also had like um
29:06you know Banner making workshops for
29:08Trans Pride advertis so it seemed like a
29:10quite a trans activist approach that
29:12they were adopting and now they are
29:13accrediting all the hay so I'd be
29:15interested to see how that's going to
29:16filter down to affect the work of those
29:18in the northern Hub who are trying to
29:19resist affirmation and how do you see it
29:22resolving
29:23itself this
29:26um well because obviously there there
29:28are there are troubled children um
29:30waiting this are
29:32growing yeah I mean I think I mean this
29:34is my opinion having observed it um that
29:40there obviously to me it seems like
29:41there's a bit of naivity amongst n NHS
29:44managers about the Deep intractable
29:47ideological differences between
29:50clinicians in this area I mean there's
29:52huge differences about treatment and
29:55about how how things should be done so
29:57so I think managers need to become a bit
29:59more Savvy about what's you know the
30:02sorts of people that are involved in
30:04this area because it tends to attract
30:06activists well and it's problematic
30:08isn't it because the guy who's at the
30:10head of um the national program board
30:12for gender Services James Palmer Dr
30:15James Palmer so he's the head of head of
30:17gender Services basically both adult
30:19and children in the NHS in NHS England
30:24and um he's been there for years so he's
30:26been there through all of the um
30:29problems that jids had and I did speak
30:31to a couple of people who said um they
30:34can't really understand why um he hasn't
30:37more Focus hasn't been on him but anyway
30:40what what did they say well they said
30:42that you know he the the blame is
30:44focused very heavily on poly Carmichael
30:47but you know he was in charge throughout
30:48and he's still in charge of basically a
30:50system where you've got one uh service
30:52specification for children that is quite
30:54cautious and exploratory and then you've
30:56got one for 17y olds plus which is
30:58incredibly gung-ho and uh affirmative so
31:02you know let's hope that they're going
31:03to look at that but a few years ago he
31:05gave an interview I think to the
31:07Westminster Forum where he said some
31:10strange sounding things not very
31:11cautious sounding things about how he
31:14thought that the NHS should prepare for
31:16a scenario one to where 1 to 3% of the
31:19population um presented with some kind
31:22of gender issue and he said it was just
31:25obviously a good thing that patients
31:27were getting younger and younger in the
31:29in jids um because surely it was a good
31:31thing if you know that the clinicians
31:34were able to help them as early as
31:36possible and by help them at that point
31:38it meant put them on drugs affirm them
31:41put them on drugs so he doesn't seem
31:43from that maybe his attitudes have
31:44changed since then but you know at that
31:46point he seemed to not really understand
31:48the complexity of these these patients
31:50and the fact that affirmation might not
31:51be the right thing for them so I suppose
31:54possibly um the fact that southern has
31:56been paused is therefore a good thing if
31:59it means that well if it means they can
32:01iron out these issues I would say yes um
32:05what's your feeling from having spoken
32:07to people about ironing out issues is it
32:09well I'm afraid I don't know I mean I I
32:12just I don't have complete oversight of
32:14the whole thing but I think that um Cass
32:17seems to have like for instance I
32:18believe that the training materials are
32:20due have to be signed off by um senior
32:23clinicians that are not directly
32:25involved in the hub for instance so is
32:27to be hoped that um there are
32:29independent review boards that who who
32:31are not who are composed of of
32:34Pediatricians and psychiatrists that are
32:36not already immersed in the gender
32:39debate that can actually apply um
32:42standard methodologies about evidence um
32:45to this area because I think what seems
32:48to be happening is quite often anyone
32:50who has a history of affirmation is just
32:53um is unable to to think otherwise
32:57about this area and it seems like a bit
33:00of flexibility and thinking would be
33:01useful so there there an element of Hope
33:03then in terms of well things are
33:05definitely better than they were yes um
33:08I think it's all to play for we've
33:10talked about um the clinical side of
33:11things but um did have you spoken to any
33:13did you speak to any parents did any
33:14parents come to you while you were yes I
33:17spoke to um a number of parents um some
33:21some were Anonymous in fact nearly all
33:23were Anonymous were they Keen to talk to
33:24you or they anxious or um yes these ones
33:27very keen to talk to me I mean these but
33:28these are people who are have been
33:30horrified by jids who feel very upset
33:34and frustrated about the way um jids has
33:38um has been and this the old the old
33:41jids the old jids but I mean
33:44yes I I spoke in particular to a mom who
33:47is currently seeking a judicial review
33:49against NHS England she has on the
33:51record she's on the record yes she's on
33:54the record and she's um happy to be be
33:57on the record she thinks it's very
33:58important so it's quite Brave of her but
34:00um her has she has a child who is trans
34:03identified and is being affirmed by an
34:05estang partner and is on the waiting
34:08list um and will probably be seen by
34:11Adult Services soon so she's very
34:14worried about that so the Jud judicial
34:16review that she wants to bring she and
34:18another parent is about these um this
34:23vulnerable cohort of 17 to 25 year olds
34:26I mean it should is worth saying that in
34:27in in
34:29um it's established practice in other
34:32areas of mental health to treat 17 to
34:3425-year-olds as a specific pathway
34:36that's not quite adult or it's not adult
34:38in the same way and in fact as somebody
34:40said to me it's a beautiful irony that
34:43the Tavo the home of jids has a 17 to 25
34:47year old pathway in cams in Child and
34:49Adolescent mental health but um but not
34:52in not in gender Services as as usual
34:55it's exceptional ised but these you know
34:57emotional maturity is still to fully
34:59developed prefrontal cortex is yet to
35:01grow in properly you don't want to be
35:03making decisions too hastily um so
35:06that's this mother was absolutely
35:08distraught Anna about you know what's
35:11going to happen to her child when she
35:14gets to the adult service one of the um
35:16people who
35:19um sounded an alarm Bell early on was
35:21David Bell um what does he think about
35:24what happened what what the future for
35:25Jin looks like what did he well he he he
35:29expressed concern on in a couple of
35:32areas one of them was um the way well he
35:37actually was um quite scathing of the
35:39fact that poly car Michael is still head
35:40of jeds given what he thinks of as the
35:43failures of the service on her watch
35:45that he thinks have been manifest
35:46through the judicial review through B's
35:49book and through the cast review in fact
35:52um he was also scathing about Gary
35:54Butler's involvement in the new um Hub
35:57Southern Hub again he said you know this
36:00is a person who was involved in a what
36:03he considers to be a failed service that
36:05you know when there are failures in he
36:06thinks safeguarding recordkeeping um all
36:09sorts of things um so he doesn't really
36:12understand why Butler is present um in
36:15the new Hub and he was also expressed
36:19grave worry um about the 16 and 17 year
36:23olds what's going to happen to them
36:24given the way the Adult Services are and
36:25given this complete
36:27um disparity between the approaches well
36:31the the the preferred approach or the
36:32idealized approach in the child
36:34Children's Service which is the one that
36:36Cass would like to enact and the way
36:39things are in The Adult Services where
36:40as far as we can see no one is reviewing
36:43that at the moment why is that is it
36:46Untouchable I don't think it's
36:47Untouchable I mean surely it can't be
36:50the
36:51NH um touchable but I suppose
36:55um that you would definitely want to
36:57start from all sorts of reasons you
36:58would want to start with the CH
36:59childhood service first um because they
37:02are the most vulnerable cohort um I and
37:06I suppose as if Cass cass's vision is
37:10enacted then that will be it will become
37:13more and more insistent that there has
37:14to be some kind of KnockOn effect on the
37:17adult service because for a start
37:18there's supposed to be a transition a
37:20managed transition between the childhood
37:22and the adult you know you're supposed
37:23to um cast talks about what that would
37:25look like in ideal
37:27scenarios there would be like children
37:28with very or 17y olds with very complex
37:31presentations would be managed carefully
37:33into the new service but there's no
37:35suggestion to me anyway that looking on
37:37that the adult servic is particularly
37:39geared up for children with complex
37:40presentations it seems very affirmative
37:43so um I think this the problems of the
37:46adult service will become more and more
37:48apparent I think but and I don't think
37:50it's intractable but I do think that the
37:52the level of ideology in these services
37:54and the Adult Services in particular is
37:57hard and well it's worrying isn't it
37:58because the the children are just going
37:59to not the children the 17year olds the
38:0116y olds are just going to be rushed
38:04through if there a problem with what's
38:05happening with the children's area I
38:08mean they they're still actually adult
38:09waiting lists too so but the thing about
38:12the the letter sent by um James Palmer
38:15to all 17-year-olds is that you can you
38:17can be moved onto the adult list but you
38:18can retain the start date of the child
38:21the when you first joined the child the
38:23children's list or the Minor's list so
38:27that bumps you up so um if you've been
38:29on the uh childhood list for two years
38:32it you'll be counted as if you've been
38:33on the adult list for two years so yeah
38:36that's quite worrying it seems like
38:37there just um significant ideological
38:40struggle within the operation altogether
38:43although there is hope uh in that um the
38:47teaching implements will be regulated by
38:50Outsiders once they see fit to pass pass
38:53those on do you think that that is did
38:55did anyone you speak to give the
38:56impression that there's a well surely
38:58there's a strong wish to push things
39:00forward to make it work yes I mean I
39:02think they I think so I think um many
39:05people involved in in in the
39:07construction of the new services are
39:08aware of the urgency of this and really
39:11do want to produce something that um is
39:14beneficial to I I think everyone wants
39:15to produce something that's beneficial
39:16to the patients but you know um some of
39:19them uh want to connect that up with
39:22pediatric practice more generally I
39:24would say you know people who we'
39:26learned the lessons from jids now
39:28involved in constructing the new
39:30Services um and you know Cass is clearly
39:35deeply involved in um keeping oversight
39:39of the whole thing so to that extent I
39:41think there's a lot of positives to be
39:44taken away here um yes so Kath thank you
39:48so much for spending so much time
39:50digging into this it's really important
39:53issue it's a fascinating read um it's
39:56clearly very interesting to see how this
39:59is going to develop um and I'm going to
40:01watch it with great interest and thank
40:03you very much thank you thank you to
40:06Kathleen stock for joining us here at
40:08unheard and for her fascinating insights
40:11into what's happening in our gender
40:13identity services at the moment in
40:15Britain we shall watch the developments
40:17with great interest do read her
40:19investigation and subscribe to
40:23unheard

About this transcript

This page contains the full transcript of Kathleen Stock: Inside Britain's new trans clinics by UnHerd, generated from the public captions YouTube serves with the video. The transcript has 7,089 words across 1,015 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to translate the transcript into 100+ languages.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, translation to 100+ languages, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.