Gender Identity Development Service
The Gender Identity Development Service was a nationally operated health clinic in the United Kingdom that specialised in working with transgender and gender diverse youth, including those with gender dysphoria. Launched in 1989, GIDS was commissioned by NHS England and took referrals from across the UK, although it was operated at a Tavistock and Portman NHS Foundation Trust site. GIDS was the only gender identity clinic for people under 18 in England and Wales and was the subject of much controversy.
In the late 2010s, the GIDS became controversial because of growing public attention on trans issues and concerns about the service, including a huge increase in patients and a lack of longitudinal evidence to support the treatments it gave. Some of its most prominent critics were gender-critical psychotherapists and psychoanalysts who argued against gender-affirming care for minors altogether.
By 2020, a large increase in referrals led to waiting lists in excess of two years. Between 2020 and 2021, GIDS stopped offering hormonal treatments to youth following the judgement in Bell v Tavistock, until the decision was overturned on appeal. In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres, following the release of the interim report of the Cass Review, in order to reduce waiting lists and provide better quality care to young people. The service closed in March 2024.
History
Pre-establishment
GIDS was a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. It mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children's department, which developed many works by James Robertson and John Bowlby on attachment theory. In 1959, it opened an adolescent department and in 1967 it was absorbed into the London Child Guidance Clinic.Early years
The Gender Identity Development Clinic was founded in 1989 by Dr Domenico Di Ceglie, a child and adolescent psychiatrist. It was one of the first child gender services in the world. After its opening, "it got two referrals over the whole year". It was initially based at St George's Hospital before moving to the Tavistock and Portman NHS Foundation Trust in 1994. The clinic saw 12 patients that year, increasing to 24 two years later. The last word of the clinic's name varied over time, shifting to Unit before being standardised in the late 2000s as Service.File:Sigmund Freud statue, London 2.jpg|thumb|A statue of Sigmund Freud in front of the Tavistock Centre, at which the GIDS was based.
In its early years, the service took a primarily psychoanalytic approach reflecting object relations theory, drawing from Di Ceglie's training. Di Ceglie described the children referred to the clinic as suffering from "atypical gender identity organization". In the early 2000s, some of Di Ceglie's colleagues at Tavistock published articles in The Guardian arguing that medical transition was a form of "mutilation" and that rights won in the European Court of Human Rights for transgender people were a "a victory of fantasy over reality".
Di Ceglie estimated in 1993 that only 5% of his patients would "commit themselves to a change of gender". Puberty blockers were considered a usable option by the end of the 1990s but only for patients aged 16 or over who had first tried extensive therapy. In 2000, a retrospective audit led by David Freeman looked at the records of 124 patients the service had seen since opening. The audit showed it was very rare for young people referred to GIDS to have no associated problems, that children do not "grow out of it" and that problems increase with the onset of puberty.
In 2009, Dr Polly Carmichael, a consultant clinical psychologist, succeeded Di Ceglie as the clinic's director. In that same year, GIDS became a nationally commissioned NHS service.
Expansion in the 2010s
In 2011, in response to changing international standards for gender care, the clinic began a research study allowing a "carefully selected group of young people" to receive puberty blockers after the age of 12. In 2014, prior to the study's completion, the clinic received NHS approval to offer them without mandating enrollment in a research study. In 2012, the service was extended to a satellite site in Leeds. Endocrine support was also extended to Leeds Children's Hospital at the Leeds General Infirmary site in 2013.In 2011, a patient satisfaction survey found the majority were satisfied, but a quarter expressed dissatisfaction with long wait lists. Other concerns included geographic inaccessibility and the requirement for real-life experience.
Between 2014 and 2015, 697 youth were referred to GIDS and in 2015-2016 1,419 were. In September 2015, GIDS overshot its 18-week waiting time target for the first time. The same year, an external report by Femi Nzegwu stated that GIDS was "facing a crisis of capacity" and recommended capping referrals. By 2016 average wait times rose to nine months.
In 2016, the Women and Equalities Committee released a report which said that a number of trans advocacy groups had raised concerns that patients could not access treatment quickly enough and under current protocols and that Gillick competence was not being observed. They also heard that the requirement that youth complete 12 months of puberty blockers before being prescribed cross-sex hormones was unreasonable as youth certain of their gender identity were unable to mature physically at the same rate as their peers. Re-assessment on transfer to adult care was also highlighted as an issue.
In February 2019, it was revealed that the National Institute for Health Research had announced a £1.3 million grant for a voluntary study following young people referred to GIDS, to compare outcomes for those who elect to medically transition and those who do not.
In 2020, over 2,000 children were referred to GIDS and in 2021 this rose to more than 5,000, leading to waiting lists of over 2 years. In January 2021, the Care Quality Commission rated GIDS as "inadequate", the worst rating possible, citing long delays, high caseloads, deficient record-keeping, and poor leadership.
Criticism
In the late 2010s, the GIDS came under increased public scrutiny because of growing public attention on trans issues, an "exponential" increase in its number of referrals, and the "ballooning" of its waiting list. Critics raised concerns about the service, including the role of trans advocacy groups in clinical decisions, a lack of longitudal studies supporting the prescription of puberty blockers to TGGNC youth, and allegations of rushed treatments without sufficient prior consultation and assessment. In November 2018, parents of 17- to 25-year-old patients complained in a letter to the Trust board that their children were transitioning too quickly and they felt psychosocial factors made them want to transition.In 2022, a series of news articles published by The Daily Telegraph reported concerns that the transgender youth charity Mermaids may have exerted undue influence on GIDS' clinical decisions, particularly concerning the prescription of puberty blockers and cross-sex hormones to minors. However, in October 2024, an inquiry by The Charity Commission found no evidence to suggest that Mermaids had inappropriate influence or ties to GIDS. A report by Sky News found that, between 2016 and 2019, 35 psychologists resigned from GIDS' London branch. Six of these psychologists voiced concerns there was an "over-diagnosis" of gender dysphoria and a push for early medical intervention.
Gender-critical opposition
Some of GIDS' most prominent critics included psychotherapists and psychoanalysts such as David Bell and Marcus and Sue Evans. Several expressed "gender-critical" arguments beyond concerns about the quality of the services provided at GIDS, opposing gender transition in its entirety, particularly in young people,. GIDS received criticism from prominent figures associated with the UK's gender-critical movement, such as Graham Linehan. The gender-critical movement united behind the case of Bell v Tavistock.Bell report
Dr David Bell worked at the Tavistock Trust as a consultant psychiatrist for 25 years. In 2018, while a staff governor, and in response to concerns shared with him by GIDS staff, he submitted an internal report on GIDS to the trust's leaders. The report was highly critical, saying GIDS was "not fit for purpose", could result in "damaging consequences" to children's lives, and failed to fully consider a child's mental health background.Since releasing his report, Bell has said that some children who identify as transgender might resolve their gender dysphoria without the need for gender-affirming care if other troubles, such as internalised homophobia and intergenerational trauma, were addressed. He further suggested that most transgender children would desist and that, while he thinks that medical transition is the "only reasonable option" for some people, it would be preferable to help a patient without doing so.