Ban on children’s puberty blockers to be enforced
in private sector in England
CQC will check new guidance in Cass report is applied
by private care providers to avoid ‘two-tier’ access to drugs
Denis
Campbell Health policy editor
Thu 11 Apr
2024 20.35 BST
England’s
health regulator will take enforcement action against private clinics that
prescribe puberty blockers to under-18s in defiance of the NHS’s ban on the
controversial drugs.
The Care
Quality Commission (CQC) will check that private providers of care to those who
are questioning their gender identity are applying new guidance recommended by
Dr Hilary Cass.
In an
important report this week Cass warned that puberty blockers have not been
proven to reduce gender dysphoria or improve body satisfaction, may damage a
teenager’s ability to think and reason and also that the rationale for
suppressing puberty at all “remains unclear”.
The
ex-president of the Royal College of Paediatrics and Child Health made clear
her view, which NHS England had already adopted last month, that they should no
longer be given to anyone under 18 on safety grounds.
The CQC
plans to ensure that Cass’s approach is being followed by private clinics, not
just the NHS, amid concern from doctors and campaigners that for-profit outfits
may seek to keep prescribing the drugs and create a “two-tier” approach to the
drugs, with access dependent on wealth.
There is a
risk that “a very dangerous loophole” will allow private clinics to cash in on
the demand from gender-questioning young people to get access to puberty
blockers, one doctor who backs Cass’s plan for sweeping changes in transgender
healthcare said.
In future,
to prevent that from happening, the regulator will check if licensed healthcare
providers are “taking into account the recommendations of the Cass Review” when
it registers and inspects them. Any private clinic found to be issuing puberty
blockers to anyone under 18 could be disciplined by the CQC if a prescription
was found to be a breach of their legal duty to provide “safe care and
treatment”, based on the evidence Cass analysed in her
three-and-a-half-year-long inquiry.
“If a
private organisation registered with the CQC fails to meet the condition of its
registration, then the regulator can take enforcement action,” a Whitehall
source said.
The CQC has
an array of regulatory powers at its disposal including, as a last resort,
withdrawing the registration which grants legal permission for a provider to
operate.
Victoria
Atkins, the health and social care secretary, made clear on Thursday that
private providers would not be allowed to avoid adhering to the new treatment
approach Cass proposed.
Writing in
the Daily Telegraph, she said: “I am clear in my expectation that private
providers must fall in line too [with the NHS’s new approach to puberty
blockers].”
But some
doubt remains as to whether guidelines devised for the NHS can be made
mandatory for private clinics too. “The CQC will expect all private providers
to take into account the Cass recommendations. But they don’t have to. Private
providers aren’t bound by Cass’s recommendations,” a source explained.
However, at
present no CQC-registered private gender care clinic issues puberty blockers.
A CQC
spokesperson said: “Best-practice guidance for gender identity clinics will be
considered by internal specialist advisers during registration and regulatory
assessments.”
One clinic,
Gender Plus, run by the clinical psychologist Dr Aidan Kelly, offers cross-sex
– masculinising or feminising – hormones to 16- to 18-year-olds but does not
provide puberty blockers. Doctors should exercise “extreme caution” before
issuing cross-sex, or “affirming”, hormones to under-18s, Cass said in her
report.
Sue Evans,
a psychotherapist and mental health nurse who used to work at the Tavistock and
Portman NHS mental health trust, which hosted the controversial gender identity
development service (Gids) for gender-confused children and young people, is
challenging the legality of the CQC’s decision in January to recognise Gender
Plus’s hormone clinic as a provider of health care.
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