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

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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. Those discussions are taking place in gender clinics across the world. They took place at GIDS. They're taking place in Europe, and in the United States we're hearing as well. So it was really trying to bring this out of the gender clinics and into wider society because of course, of course, this is an issue for the trans community, but it's also an issue more generally about children and young people. A therapist called Matt Bristow relates what happened when people tried to raise concerns, which suggests the place had a cult-like atmosphere: 'He and others recount how executive members of staff would become teary when criticisms of the service were raised. It would then be made known among the team that "this has made Polly cry", Bristow says. 'I don't think that's appropriate as a management style."' This refers to GIDS director Dr Polly Carmichael, a person many of the sources in the book seem to have been afraid of crossing.

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

So I don't use that phrase, for the very reason I don't think we know yet. I think we know that some people say they've been helped by GIDS, and some of those stories are in the book. And we also know that some people have been harmed by GIDS, and some of those stories are in the book as well. And I think what we don't know yet is the numbers on either side, because we don't have that data. GIDS haven't been collecting data on outcomes. Ever. They've been running since 1989. So we don't know. And hopefully, Dr Cass and her team can start to answer some of those questions. So I personally don't describe it in those terms. But I think it's very striking that a number of the clinicians who were there and were trying to help these young people fear that it may end up being a serious medical scandal because of their experiences. But I think at the moment, everybody would like some certainty, but I don't think we have it.Hannah Barnesis an award-winning journalist at the BBC’s flagship current affairs programme Newsnight. She led its coverage of the care available to young people experiencing gender-related distress, which helped precipitate an extensive NHS review and unearthed evidence that was later used in several sets of legal proceedings. Newsnight’s reporting also led directly to an inspection by the healthcare regulator the Care Quality Commission, which branded the NHS’s only youth gender clinic in England ‘Inadequate.’ The management team of the clinic was disbanded as a result and the work was nominated for an array journalism awards, including the prestigious RTS Television Journalism Awards. Meticulous, difficult, essential; three words I’d use to begin to describe this text. It will take some work to square up the repercussions of the information in the detailed documentation of the fall of GIDS, the UKs only gender specialist unit, with my continued and determined belief in Trans rights. I’m embarrassed to say I knew absolutely none of it prior to reading this and on finishing it I’m incredulous that I knew nothing. Media, T.V. & Radio Media stories, t.v. and radio coverage and representation of “trans kids” and parents 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]

Time to Think by Hannah Barnes review – what went wrong at

We were seeing very haphazard referrals from Irish psychologists operating mainly in the private sector, where somebody was going along, saying, ‘I think I have gender dysphoria,’ and there wasn’t really an assessment being carried out,” O’Shea says. “We began to see more and more disasters,” Moran explains. There were suicides; other people barely left their homes in years. FiLiA: Your book focuses on an incredibly divisive topic, which is how to approach gender dysphoria in children. Why is this such a controversial area of medicine? 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. The trans rights group Mermaids is described as having put some pressure on GIDS and at times to have had a say in hiring decisions.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.

Time to Think review: the book that tells the full story of

The pair started a new service, identifying people who were ready for transition by assessing them before they started hormones. This approach, involving an assessment by a psychiatrist, was criticised as pathologising by the trans community, but they say it has resulted in dramatically better outcomes. An absolute must read for anyone who has heard anything or been involved in the transgender debate. And I wondered a little bit about, do you think that there's something about, like you were saying, we're not really sure if it's a disease, we're not really sure if it's a condition or if it's just a state of identity, but is there something that is almost inherently troublesome with the condition or the question of gender dysphoria and paediatrics itself? That is causing perhaps, less of a focus on child safeguarding? As in, is this a problem with the idea itself? Or is this an issue of different practices locally that seem to be going beyond the scope of what is considered to be reasonable medical practice? Given that these sorts of issues are cropping up in lots of different places? Making sure that we offer the books our customers want to read is the basis of good bookselling and good service means treating all our customers with respect and for them to feel welcome to choose the books they want.”Hannah Barnes’s well-researched book delves into how this situation arose. She speaks to over 60 clinicians: psychologists, psychotherapists, nurses, social workers. It is this forensic approach that makes her findings so devastating. Barnes is not coming at this from an ideological viewpoint. Some of her interviewees are happily transitioned. Others are not. They feel that the risks of the medical pathway they were put on were never explained to them or that they were too young to understand the full implications. One girl asked if when given testosterone she would be able to produce sperm. Additionally, only since 2018 has modern research with all the capabilities it has today – considered this a possibility. SEE here Maternal DES Exposure and Intersex Development in Males – Hormones Matter and here – Geneticists make a new discovery about how a baby’s sex is determined — ScienceDaily. 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). Unsurprisingly, it's always the principled few who push against the current and take all kinds of risks to get the word out. A powerful investigation … The interviews with staff and children — some who have happily transitioned and some who have not — show how complex the issues are. Not a comfortable read but meticulous and thought-provoking’ – Camilla Cavendish, Financial Times, Best Summer Books of 2023

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It is stressed repeatedly throughout the book that many senior clinicians who desperately tried to raise concerns with management and executive members were not only being repeatedly ignored or silenced, but were also very often - if subtly - being told their view was wrong and if they couldn’t get on board with what GIDS was doing, perhaps they should look for another job. An exemplary and detailed analysis of a place whose doctors, Barnes writes, most commonly describe it as “mad”. This is a powerful and disturbing book’ – Financial Times 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. FiLiA: I suppose this is beyond the scope of the book and perhaps something you don't want to comment on, but there is that sort of tension. Like you said, this is a question that's being grappled with in different countries. Different places are starting to look at their own sort of services. So notably, for example, Sweden had Uppdrag Granskning that looked at, in a series of documentaries, what was going on in Sweden on the subject. And that actually ended up changing practice. In a similar way that I think the BBC and other news outlets reporting here in the UK are also now affecting practice in an English context. I don't really know necessarily what's happening up in Scotland.Barnes, Hannah (14 Feb 2023). "Gender Identity, Children and the NHS". The News Agents (Interview). Interviewed by Emily Maitlis and Lewis Goodall. 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. 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.