Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children

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In 1994 GIDS became part of The “Tavi” and by 2009 had a new director, Dr Polly Carmichael. Yet by July 2022, following Dr Hilary Cass’s report, GIDS was deemed neither a safe nor viable option for young people with gender-related stress and it was closed down. At one point, that's how it was described to me. So I think it was very difficult for people to speak out. Lots of different competing emotions. But I don't want to suggest that others who didn't speak to me don't care about these young people, either. I think it's a story about how well intentioned people can go wrong. And an intervention that is well intentioned, can be overused for a group for whom it wasn't intended, perhaps. As someone who knew about this years ago, as people were writing to me asking my former newspaper to investigate it, it would suit my agenda to say this was all down to trans activism. But it’s not that simple. So, as Dr Hilary Cass, who is undertaking a very thorough review of this whole area of healthcare for young people, has said: GIDS, the Gender Identity Development Service, has not been subjected to the level of oversight that one might expect of a service using innovative treatments on children. And the experience of some clinicians was that general concerns were not treated in the spirit that they were intended.

Hannah Barnes review - The Guardian Time to Think by Hannah Barnes review - The Guardian

Hannah Barnes lays bare the whole appalling business in a clinical and forensic fashion. She is fair-minded - she speaks to young people who avow that they were helped by the service, as well as those who were irretrievably damaged. She uncovers a truly appalling management culture, and lays the blame very much with the leadership, although she does not impugn motive (there's some speculation here but no conclusion). What is most inexcusable in this story is the fact that the failures of the early days of the service have simply been repeated down the years. The GIDS not only failed to take account of its own data, learn from it and put in place structures to ensure a safe service for children, it doubled down, allowing pressure from activists to dictate. The service became increasingly ideological, not less. FiLiA: It sounds like these clinicians were put in almost an impossible position and in certain cases, definitely the empathy that you have for the participants in your book shines through. Even though sometimes it's infuriating. Because you kind of wish that you can have a more clear-cut story, of heroes and villains, and so on and so forth. So in that sense, it can sometimes be a slightly frustrating read. But I wondered if you would mind talking to us a little bit about what your discoveries were about the child safeguarding aspects in particular. Because I think one of the other things that this book has that's really important is discussion with Sonia Appleby after she had won her case. Barnes, Hannah (14 Feb 2023). "Gender Identity, Children and the NHS". The News Agents (Interview). Interviewed by Emily Maitlis and Lewis Goodall.GIDS began seeing Irish children in 2012 under the Treatment Abroad Scheme. Three years later, as demand increased, staff started holding monthly clinics in Crumlin hospital. Between 2011 and 2021, 238 young people in Ireland were referred to GIDS. As in the UK, the Irish referrals were overwhelmingly female and had multiple other “difficulties”. When one of the leaders of a service that helps children to access powerful, life-changing drugs comments that what they are doing is “mad”, there is clearly a very big problem.”

Hannah Barnes | Book review | The TLS Time to Think by Hannah Barnes | Book review | The TLS

Time to Think shows what happens when the exponents of an ideology, so certain of its righteousness, capture a field of medicine, silencing critics, refusing even to collect follow-up data on whether its treatments actually work’– The Times Best Books of 2023 So Far Barnes sent the book proposal to 22 publishers. Several publishers praised the proposal, but declined to publish it; one of them on the basis that it was too controversial. On 13 April 2021, the independent publisher Swift Press made Barnes an offer. [5] Reception [ edit ] As distinct from those who would have been genetically female, but were instead born male due to a problem occurring in the endocrine system during their sex development. Is that by the time puberty arrives, almost a decade will have passed, making social contagion an unknown factor that cannot be ignored? Camilla Cavendish of the Financial Times described it as a "meticulously researched, sensitive and cautionary chronicle" and a "powerful and disturbing book" that reminded them of other NHS scandals. [6] Rachel Cooke, writing in The Observer called her work "scrupulous and fair-minded" and, with regard to GIDS, "far more disturbing than anything I’ve read before". Cooke says the account is of a "medical scandal" and "isn't a culture war story", concluding: "This is what journalism is for." [7]FiLiA: I wondered a bit about how it compares to other stories that you've covered in your career, because you've been working in journalism for a while. And this is something you're very experienced in, researching and telling stories so that people can understand them and it's accessible. How does it compare to perhaps other clinical stories that you've covered or aspects in other areas of society? And was there anything that was particularly surprising that you found about researching and writing this book? FiLiA: I just wondered, for example, I think you say in the book, it's quite difficult to get psychologists to speak about something. And in this case, you had a certain cohort of people who are really quite desperate to get their story out. And then you had others who perhaps weren't so happy to have their name on the record, but would also want to be discussing things. And then others who, at least it looked like in the footnotes, there were some people who just didn't want to be participating in the book. And so I suppose from that sort of perspective, was this atypical? Is this what normally happens?

Hannah Barnes Swift Press | Hannah Barnes

Will Lloyd of the New Statesman called it "as scrupulous as journalism can be" and noted "[t]hough pundits will use it as fuel for columns, Time to Think is no anti-trans polemic ". [11] FiLiA: Yeah, that was a line that actually I wrote down because I thought it was such a striking line from one who's working within the medical sphere to even be contemplating it like that. Because obviously from an outsider's perspective, you want to just be able to say, well, of course, you're always going to put the patients first. This shouldn't even be a question. But then it comes to those sorts of human factors and the relationships. I think you at one point characterise the feeling of being within GIDS as being almost like a start-up. But this isn’t to say that ideology wasn’t also in the air. Another of Barnes’s interviewees is Dr Kirsty Entwistle, an experienced clinical psychologist. When she got a job at Gids’ Leeds outpost, she told her new colleagues she didn’t have a gender identity. “I’m just female,” she said. This, she was informed, was transphobic. Barnes is rightly reluctant to ascribe the Gids culture primarily to ideology, but nevertheless, many of the clinicians she interviewed used the same word to describe it: mad. Many of them were same-sex attracted – the same was true for the boys attending GIDS – and many were autistic. Their lives were complicated too,” Barnes writes. It traces various reports made by clinicians raising concerns: the David Taylor review (2005), David Bell report (2018), Dinesh Sinha's GIDS review (2019), Helen Roberts report (2021), and Hilary Cass review (2022).

I want every institution and every politician who pontificates about gender to read this book and ask what happened to all those lost girls and boys – and why they were complicit. Some patients were very clear, from very young, about their identity. But others presented puzzles. How to approach a child professing three alter egos, two with Australian accents? Or one wanting to transition both sex and race to “become” Japanese, or survivors of trauma with compelling reasons for wishing to leave their old selves behind, or kids with complex mental health diagnoses? To begin with, the extent of the GIDS’ involvement with the pressure groups Mermaids, GIRES and Gendered Intelligence right from the start is staggering. These are political campaign groups, two of which are run by parents, with very set ideas and beliefs based on the unscientific concept of innate gender identity. They are not politically impartial. As Mermaids became more politicised and extreme in their belief in gender identity ideology, so did the GIDS. As numbers increased, the caseload per clinician increased beyond safety levels. In 2015, in an attempt to calm the over-worked clinicians, an organisational consultant was called in. The subsequent report warned that GIDS was “facing a crisis of capacity to deliver effectively on an ever-increasing demand for its service” and recommended immediate action to cap referrals. This was ignored by GIDS director, Polly Carmichael. The caseloads continued to rise, first 50, then 70, , 90 or 100 patients each. One clinician reported an astronomical caseload of 140 patients. With some caseloads comparative to the size of a small primary school it is little wonder that clinicians had difficulties recognising their patients when they arrived for their second appointment.