Puberty blockers given to children without proper checks, doctors warn

The governance of Scotland’s contraceptive services for children is “complex and unclear”, an independent NHS report has concluded.

GPs in Scotland stopped prescribing the controversial drug to new patients in April following a review of children’s sex services in England by Dr Hilary Cass.

Children who were already taking the medication — which Cass said had not been proven safe or effective — were allowed to continue their treatment. However, research commissioned by health workers has revealed confusion about who exactly is responsible for the service children receive.

• Virginity blockers have been stopped for children in Scotland following the Cass review

All young people were initially assessed by one clinic, Sandyford in Glasgow. The experts present were examined Children’s “dysphoria/incongruence” is then referred to pediatric hormone specialists – endocrinologists – at NHS Greater Glasgow and Clyde or NHS Lothian where puberty blockers can be prescribed.

The report, dated March 2024 and commissioned by Rhoda Macleod, head of sexual health services at Glasgow City Health and Social Care Partnership, revealed confusion over how NHS Greater Glasgow and Clyde was being accountable to patients. of Sandyford who live in other parts of the country. .

According to the report, NHS GGC did not have the information about medicine and childcare it was referring to in Edinburgh on gender issues.

In the west of Scotland, where care is provided entirely within the NHS GGC, the report said that the assessment, diagnosis and care of children under 16 with gender nonconformity is not included in the government’s other children’s services.

• Sandyford whistleblower warns of ‘fear of challenge’ by doctors

The report says: “There is currently a lack of clarity and understanding about where clinical management responsibilities lie for this small but important group of patients across Sandyford services, GGC, GGC and NHS Lothian’s critical services are currently not responsible for the above risks.”

It is not the first time that questions have been asked about who is in charge of this group of patients. In October 2022, Jennifer Armstrong, NHS GGC medical director, and Tracey Gillies, NHS Lothian medical director, raised the issue in a letter to Scotland’s chief medical officer, Sir Gregor Smith, saying they requested a “medical regime” review. provisions”.

Retired businessman Sir Ewan Brown – a vocal critic of Scottish government arrangements – said there were “George Orwell elements” in the report, referring to seemingly contradictory statements about which part of the NHS of Scotland which should oversee their care.

According to the report, there are 43 young people attending NHS Scotland clinics who are receiving treatment.

Brown said he considered the report’s conclusions “serious” because the health care field was complex, sensitive and controversial. “I would put it very high in the category of things that the board should be on top of,” he said. “As it is clear that Glasgow has been given the responsibility they have to carry it out.”

One NHS consultant, who has an interest in the field, asked if all drug patients were properly monitored.

He said: “Because of the concerns I’m surprised they don’t check all the patients who are currently being given anti-virgin hormones to see if they were prescribed correctly in the first place.

In a statement, NHS Greater Glasgow and Clyde said it was committed to providing the best possible clinical care for people accessing gender services. It added: “Clear medical governance arrangements are now in place between NHS GGC and NHS Lothian in relation to patients attending NHS Lothian children’s services.”

Adolescence has become increasingly controversial in recent months. Cass recommended that they no longer be ordered — and governments on both sides of the border agreed.

• Doctors were ‘scared’ to treat children with gender identity, says Cass

A study of 50 subjects showed that the treatment may affect bone health and height, but no conclusions can be drawn about the possible effect on gender dysphoria or mental health.

Smith, in his response to Cass’s review, said that access to gender identity services for young people should be “through medical referrals” in the same way as other professional services. children and young people.

Many referrals to Sandyford were parents of children who said they had gender identity issues, not doctors.

The Scottish Government said the self-presentation ban would “ensure that both services have the medical information they need before a patient’s first appointment and the referring doctor will be able to the certainty that the person referred receives care for any health problem he may face”.