A UK healthcare scandal is emerging that deserves to be headline news. Thanks to the dogged efforts of Jo Maugham’s Good Law Project, we now know this: the withdrawal of access to gender-affirming healthcare is killing trans young people, and the NHS and Hilary Cass (author of the transphobic Cass Review) have obfuscated the facts.
In the seven years before 2020, one young person died while on the waiting list for Gender Identity Development Services (GIDS). In 2020, the outcome of the landmark Bell v. Tavistock case led to the NHS freezing prescriptions of puberty blockers to children under the age of sixteen. Since then, at least sixteen young people on the waiting list have died.
“The withdrawal of access to gender-affirming healthcare is killing trans young people, and the NHS and Hilary Cass (author of the transphobic Cass Review) have obfuscated the facts.”
In a thread on X, Jo Maugham reports that a verified NHS whistleblower wrote to both Cass and a director of the Tavistock gender clinic, alerting them to this alarming increase in deaths. Their entreaties were roundly ignored. A second whistleblower has revealed that when staff at the Tavistock planned an open letter expressing their concerns about patient deaths and the ongoing risks, managers threatened them with disciplinary procedures.
I have now seen further evidence that, since the Bell decision in the High Court (1 December 2020), there has been a huge increase in deaths of young trans people on the NHS waiting list – and that NHS management has sought to suppress that evidence.
— Jo Maugham (@JolyonMaugham) June 20, 2024
CW: Suicide 🧵
“Since 2020, at least sixteen young people on the waiting list for Gender Identity Development Services (GIDS) have died, a stark increase from the single death recorded in the seven years prior.”
In his thread, Maugham provides detailed evidence that the reporting of deaths by suicide in the Tavistock’s board meeting minutes became less clear and precise after 2021, which means it is likely that there have been more than the sixteen that he can identify with confidence. He also notes that this count does not include attempted suicides.
Rowan Fortune has previously reported for Anti*Capitalist Resistance on the transphobic bias and murderous negligence of the Cass Review. In the government-commissioned review, Dr Hilary Cass – who has no professional experience of working in trans healthcare – used a biased selection of evidence to do a hatchet job on every form of care and support for trans youth that doesn’t effectively amount to conversion therapy.
Among other things, she wrote that there is ‘an extremely narrow window’ for the safe and worthwhile prescription of puberty blockers in young people, even though they have been confidently prescribed to children for decades as a treatment for precocious puberty.
The Good Law Project asked Cass for comment on the spike in suicide rates after the withdrawal of access to puberty blockers, and the apparent cover-up. Cass’s team responded by highlighting paragraph 5.65 of the Review:
5.65 The Review met with The Tavistock and Portman NHS Foundation Trust to discuss deaths of patients (where known) who had been referred to or were currently or previously under the care of GIDS. The patients who died by suicide between 2018 and 2023 were described as presenting with multiple comorbidities and/or complex backgrounds. […]
While this paragraph acknowledges that young people have died by suicide while on waiting lists, it does not mention the withdrawal of access to puberty blockers, and implies that ‘multiple comorbidities and/or complex backgrounds’ were responsible for the suicides. In other words, this throwaway mention of the deaths of children and young people does not come close to addressing the negligence of the state and the NHS, or the impact of continuing on the current path.
Those of us who are trans or who move in queer circles know in our bones that waiting lists destroy lives. All of us have seen friends and loved ones crushed by the grinding gears of NHS bureaucracy, by the interminable delays, the faceless gatekeepers, the suspicion and disbelief that permeate the route to essential care. We know that trans people face insurmountable obstacles to treatments that are routinely offered to cis people.
They are subject to a degree of condescension and dismissal that would not be tolerated in any other area of medicine. When they do manage to clear the initial barriers and access a care pathway, the system treats them as less than human, holding them at arm’s length while simultaneously scrutinizing and violating them, body and mind.
For children and young people, these hurdles and violations are only part of the suffering being meted out by this cruel system. Without access to puberty blockers, many trans youth are forced to go through changes to their bodies that they know could lead to needing more drastic medical interventions when they are older.
Imagine watching your body change irreversibly in ways you don’t want, while being denied access to safe, effective drugs that could slow these changes and give you time to make decisions that will impact the rest of your life. Imagine going through this while trying to manage the emotional and cognitive turbulence that accompanies every teenager’s journey through puberty. Imagine that very distress being used as evidence that you don’t know what’s best for you.
Horror and heartbreak are natural responses to the confirmation that trans youth suicides have spiked as a result of the withdrawal of access to puberty blockers – but it comes as no surprise. The NHS’s attempt to hide and obfuscate the link between withdrawal of services and trans deaths is disgusting and infuriating – but it is also wholly predictable, given the contempt and disregard for trans people that decision-makers have repeatedly shown.
“The NHS’s attempt to hide and obfuscate the link between withdrawal of services and trans deaths is disgusting and infuriating – but it is also wholly predictable, given the contempt and disregard for trans people that decision-makers have repeatedly shown.”
After all, despite the Court of Appeal overturning Bell v. Tavistock in 2021, the NHS never reversed its ban on prescribing puberty blockers to under-sixteens. And since the final Cass Review was published in April this year, the government has doubled down on its suppression of care for trans youth: in May, the health secretary Victoria Atkins banned UK young people from accessing puberty blockers from legitimate prescribers elsewhere in Europe. With no other option remaining, many of these young people will consider buying unregulated drugs online – or, in desperation, ending their own lives.
It is right to grieve, because children and young people have died. It is also right to be enraged, because their deaths are the result of deliberate choices made by the state and the NHS. The state’s way of managing trans healthcare – indeed, of responding to trans people’s very existence – is violence. This violence manifests in myriad ways: the indifferent denial of life-saving healthcare, the aggressive suppression of trans protest, and the brutal policing of trans lives.
The Cass Review sanctions the continuation and escalation of this violence against trans children. Let me say it again: the Cass Review sanctions violence against children. It is, as Rowan Fortune so aptly writes, social murder underwritten by the state, and we are seeing the consequences of this permission playing out in our health service and in the lives – and deaths – of trans youth. So as much as we are grieving, it is time to harness our rage.
Main Image >> Steve Eason
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