All eyes on the NHS

Blinded by ideology, the NHS is taking a dangerous detour from medical ethics

Last week the NHS released its interim clinical policy for blocking puberty in children who have “gender incongruence/dysphoria”. A public consultation is now open on the policy and it is essential that the public strongly oppose the plans. The NHS cannot be allowed to build clinical practice upon the unevidenced belief that some children are born in the wrong body and therefore require medical mutilation. This belief is undoubtedly based upon sexist stereotypes, as the NHS writes in the consultation documents: ‘Gender variant behaviours may start between 3 and 5 years, the same age at which most children begin showing gendered behaviours and interests.’ 

The plan is presented in a brief introductory document that obscures its full horror, leading many to mistakenly think the NHS will exercise plenty of caution in the use of puberty blockers. The NHS should not be administering them for gender dysphoria at all - the evidence to justify them does not exist and the consequences can be devastating. 

The extent of the plans are exposed in the consultation’s accompanying paperwork, particularly the Equality Impact Assessment (EIA), which reads as though it was written by a transactivist. Replete with ideological terminology like sex “assigned at birth”, the policy blindly accepts the fantasy that everyone has some sort of gender identity that may or may not match their biological sex. No medical professional should deliberately inhibit any child’s normal growth without clinical need. Gender identity is not a clinical need; it’s a socially constructed sexist fantasy. Gender dysphoria is not the fault of a child’s healthy body; it’s the fault of societal dysfunction. 

At the same time, the NHS fails to provide clear diagnostic criteria, with no definition of early onset or late onset gender dysphoria. What is clear is that the NHS has an off-label treatment for which it appears to be manufacturing a disease. The documents state ‘The Research Oversight Board will determine the definitions of early and late onset gender dysphoria in due course’, meaning that after the consultation has closed, a panel will develop the gender related conditions for a study in which they will stunt children’s physical development and inhibit their healthy genito-urinary and sexual function in adulthood, including possible sterilisation, likely locking them into lifelong medicalisation.

The numbers of children the policy will affect are staggering: ‘For children and young people who, at the point of the proposed clinical commissioning policy takes effect, have been referred into an endocrine clinic but have not yet been assessed by a consultant endocrinologist for suitability of GnRHa or who are already administering GnRHa through an NHS prescription, there is an expectation of consideration for treatment…In these cases it would be for the consultant endocrinologist to consider with the child or young person and their family whether to continue with off-label prescribing within the current clinical pathway.’ The plans are therefore to placate the demands of transactivists, and not to meet clinical need nor ensure patient safeguarding. There are also plans for some children to be prescribed cross sex hormones without the requirement for puberty blockers.  

As outlined in the Equality Impact Assessment around 8000 children currently on waiting lists may be eligible, including 6000 aged under 16. Any child can be considered an exceptional case - perhaps if they’re “assigned male” and like pink too much or “assigned female” and hate their changing adolescent body to the point of self-harm, or have a sufficiently demanding transactivist and homophobic parent. It’s unclear what could possibly make any child exceptional enough to maim, as the policy doesn’t clarify this. 

The plans defy humanity, reason, rationality and all ethical and safeguarding principles. The NHS should not be entertaining the idea of giving any children puberty blockers for gender dysphoria. First, do no harm. Worse still, the EIA explains the children most likely to be affected are female, autistic and care experienced, many of whom have histories of sexual abuse, mental health issues and other co-morbidities. Worryingly the EIA also glosses over sexual orientation, despite the disproportionate representation of LGB youth in the Tavistock’s patient cohort. It wouldn’t be unreasonable to recognise the NHS’s plans to continue issuing puberty blockers as eugenics and gay conversion therapy by stealth, with the most vulnerable children at greatest risk. For these children, puberty is presented as an undesirable symptom of an undefined disease. Society and the NHS used to recognise puberty is a healthy and important part of being human. 

Thanks to the Cass review, the NHS has been forced to acknowledge there is no evidence for its dangerous plans. There will therefore be a study, with recruitment of children from 2024. Whilst there is an absence of robust statistical evidence for the use of puberty blockers, it is deeply unethical to harm children to get it. Given the premise of the plan and associated study is ideologically-driven by the notion that a child may be born in a body mismatched to their gendered soul, it is unlikely to be scientifically sound, and where any ethics or safeguarding board is similarly captured, children are at risk of irreversible damage. Despite the plan repeatedly stating it is “rational”, it is far from it, and dangerously ideologically driven to its core. 

It should come as no surprise that the Equality Impact Statement is where trans rights activists within the NHS can find all the loopholes that will allow them to use taxpayer funds to stunt the growth of any vulnerable, confused and abused child in the name of gender identity. Clinical practice should be based on clinical need. Given the NHS is unable to sufficiently specify the disease for which it will administer puberty blockers, there is no clinical need. 

No child is born in the wrong body, no one can change their biological sex, and no child deserves to have their healthy body maimed by ideologically-driven, sexist or homophobic doctors, nor anyone else for that matter. Clear protections should be put in place to prevent iatrogenic harm and safeguard children, with appropriate mental health support. However, in place of that the NHS interim care plan presents a framework for medical abuse and a plan to medically mutilate potentially thousands of British children in the name of gender identity. The plan does not exercise sufficient caution. It is a commitment to the sexism that is “gender incongruence” and to the iatrogenic harm of healthy children, often called “trans healthcare”. No child should be made to suffer for society’s ills - and British society (if not the world) is suffering such a sickness that the NHS plans to continue halting children’s healthy growth for the sake of sexist stereotypes. 

This is an exceptionally important front. If the NHS is to determine that divergence from sexist stereotypes requires medical intervention, the cascade of consequences for everyone will be profound. Once this policy and its premises are embedded in NHS clinical practice, it’ll be very difficult to remove. 

The consultation is now open and closes November 1st 2023. It requires a strong response from everyone - with or without a medical background. No child is born in the wrong body. No one can change their biological sex. The NHS must deliver evidence-based healthcare free at the point of clinical need; not iatrogenic harm, free at the point of ideological demand. Read the plans and respond to the consultation here.