We welcome the publication of the revised interim service specification for children experiencing gender incongruence. In particular, we welcome the way in which the specification now focuses more on the experiences, perspectives and best interests of trans and gender questioning children, and requires close collaborative working between children, families and the multi-disciplinary team.
We also welcome the specification being more clearly aligned with relevant international clinical standards, in particular WPATH Standards of Care 8. Despite this, there are some outstanding areas of significant concern:
The specification does not set targets for waiting times. Currently waiting times for a first appointment are over 3 years, which is unacceptable for a child in distress and for their families. Providers must be held to account for improving service access.
The specification is not clear enough that children with co-occuring conditions should not be disadvantaged or discriminated against when seeking gender affirming healthcare.
The specification states puberty blockers will only be prescribed to children who consent to participate in a medical research protocol. This cannot be right. Treatment should be based on clinical need, and coerced participation in research is unethical.
Finally, the specification rightly focuses on open and reflective practice, and recognizes the way in which a child’s gender identity can develop and change over time. However, it is not clear enough that care is also needed to ensure that practitioners do not pressure trans and gender questioning children towards a particular outcome.
Trans and gender questioning children and young people in the UK deserve the best possible standard of care. They deserve to get that care from well qualified, effective and compassionate professionals. And they deserve to get that care in a timely manner.