Poor record keeping is what happens when a service is overrun by demand with 5k people on waiting lists.
As for selectivity, on the contrary, you are misrepresenting the report to push your own narrative. You can read what Dr Cass has to say on the matter here -
https://cass.independent-review.uk/entry-8-beyond-the-headlines/
This certainly is not the case of a clinic being shut down 'in disgrace because of how poorly they've handled the care of those referred to them.' She says in her statement:
'In medicine, when there is controversy or doubt about treatment decisions, the immediate reaction is to blame individuals, and sometimes organisations. However, the most important way to reduce risk, improve decision-making and manage uncertainty is through safe systems. The purpose of my Review is to be forward-looking and define what a safe system of care should look like, and how to support that care with the best evidence.'
You're doing the exact thing she is talking about in the bolded section.
She in fact praised the staff working at Tavistock: '
The staff working at GIDS have demonstrated compassion and a strong professional commitment towards their patient population. Their experience and continued engagement will be essential in ensuring a smooth progression to the new service model.'
This is exactly what the Cass report proposes as part of the recommended regionalised services. The whole report is aimed at improving healthcare for young people, not reducing it.
You're deliberately misleading people here.
Firstly, I've not suggested the answer is to simply pull care. As you've quoted me saying, we should want the care to be extensively reviewed by medical experts. As things stand, this isn't the case. As a result, it's effectively experimental treatment.
Secondly, you're again being very selective. That link isn't even part of the interim report. It's essentially a blog post written to support medical colleagues receiving backlash. I'm also not talking necessarily about individual staff members, just as the interim report isn't, but the failings of the structure as a whole. I don't doubt that those working within it have been doing their best, but if the structure and processes are deeply flawed, their best will still be shoddy care.
Thirdly, I'm not misleading anyone. I'm simply summarising the findings of the interim report.
These are just from the key points section before the actual interim report:
- We need to know more about the population being referred and outcomes. There has not been routine and consistent data collection, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.
- There is lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response.
- Because the specialist service has evolved rapidly and organically in response to demand, the clinical approach and overall service design has not been subjected to some of the normal quality controls that are typically applied when new or innovative treatments are introduced.
So straight away we have it acknowledged that a) they don't really know what they're treating (second bullet point), b) the treatments are essentially experimental and haven't been subject to proper review and quality control (third bullet point), and c) children have been put on these courses of experimental treatment with little regard for the outcome, because they've simply not recorded it (first bullet point).
It's immediately a very damning report of the levels of care provided, and while I have sympathy for NHS waiting lists, this isn't a phenomena exclusive to gender services. It being busy isn't and shouldn't be an excuse.
Again, before we get to the actual report:
At this stage the Review is not able to provide advice on the use of hormone treatments due to gaps in the evidence base.
And here's a line from the "A letter to children and young people section":
We know quite a bit about hormone treatments, but there is still a lot we don’t know about the longterm effects.
Here are some key bits from the summary, which is essentially the same as above:
Many of the challenges and knowledge gaps that we face in the UK are echoed internationally, and there are significant gaps in the research and evidence base.
The Review is not able to provide definitive advice on the use of puberty blockers and feminising/masculinising hormones at this stage, due to gaps in the evidence base
At primary, secondary and specialist level, there is a lack of agreement, and in many instances a lack of open discussion, about the extent to which gender incongruence in childhood and adolescence can be an inherent and immutable phenomenon for which transition is the best option for the individual, or a more fluid and temporal response to a range of developmental, social, and psychological factors.
Children and young people can experience this as a ‘clinician lottery’, and failure to have an open discussion about this issue is impeding the development of clear guidelines about their care.
Evidence on the appropriate management of children and young people with gender incongruence and dysphoria is inconclusive both nationally and internationally.
A lack of a conceptual agreement about the meaning of gender dysphoria hampers research, as well as NHS clinical service provision.
A lack of routine and consistent data collection means that it is not possible to accurately track the outcomes and pathways children and young people take through the service.
What have I said that's misleading in relation the above?
Still in the summary, there are additional concerns about the service provided in relation to affirmation, overlooking other issues, and general awareness or assessment of progression:
Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters
many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.
From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach
there does not appear to be a standardised approach to assessment or progression through the process, which leads to potential gaps in necessary evidence and a lack of clarity
There has not been routine and consistent data collection within GIDS, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.
Internationally as well as nationally, longer-term follow-up data on children and young people who have been seen by gender identity services is limited, including for those who have received physical interventions; who were transferred to adult services and/or accessed private services; or who desisted, experienced regret or detransitioned.
There has been research on the short-term mental health outcomes and physical side effects of puberty blockers for this cohort, but very limited research on the sexual, cognitive or broader developmental outcomes.
Much of the existing literature about natural history and treatment outcomes for gender dysphoria in childhood is based on a case-mix of predominantly birth-registered males presenting in early childhood. There is much less data on the more recent case-mix of predominantly birth-registered females presenting in early teens, particularly in relation to treatment and outcomes.
Aspects of the literature are open to interpretation in multiple ways, and there is a risk that some authors interpret their data from a particular ideological and/or theoretical standpoint.
I've separated this next bit because I think it warrants it's own space. I don't think it warrants further comment and speaks for itself:
There is limited evidence of mental health or neurodevelopmental assessments being routinely documented, or of a discipline of formal diagnostic or psychological formulation.
Same again for this bit:
Of 44 submissions received by the MPRG, 31% were not initially assured due to lack of safeguarding information. And in a number of cases there were specific safeguarding concerns. There do not appear to be consistent processes in place to work with other agencies to identify children and young people and families who may be vulnerable, at risk and require safeguarding.
This is probably one of the more concerning summarised findings:
Appropriate clinical experts need to be involved in informing decision making.
Who has been informing decision making for clinical treatments if not "appropriate clinical experts"?
Another concerning finding:
Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.
NHS endocrinologists do not systematically attend the multi-disciplinary meetings where the complex cases that may be referred to them are discussed, and until very recently did not routinely have direct contact with the clinical staff member who had assessed the child or young person
Children with neurodiversity or mental health problems
are not routinely given therapeutic support in advance of starting hormone blocking treatment in the NHS process. Not only that, but the medical professionals charged with administering these hormone treatments were not even privy to the details of the children they were treating. This is staggeringly negligent.
If you want, I can continue through the main body of the report, but I think the summarised findings are adequate enough to demonstrate how awful this service has been.
Again, I'm not misleading anyone. However, your selective picking of choice quotes (that don't all even come from the report) is incredibly misleading, particularly when you paint a picture of a clinic simply overwhelmed by its waiting list, and not one operating without necessarily following adequate medical process and safeguarding practices, which is what the interim report has found.
