Trans lobby group Mermaids helped NHS plan treatment for children

A trans lobby group helped to draft NHS plans for treating children questioning their gender, The Telegraph can disclose.

Susie Green, then chairman of the charity Mermaids, was part of a task group reviewing services at the Tavistock and Portman NHS Foundation trans clinic.

The service specification, which outlines treatment for children, included details on how “hormone blockers will now be considered for any children under 12”. The relationship between Mermaids and senior NHS employees is laid bare for the first time in documents seen by The Telegraph.

The Tavistock claimed that it did not have emails or minutes of meetings with Ms Green but after the information regulator threatened court action, it released more than 300 pages.

They show that Ms Green had a direct line to Dr Polly Carmichael, Tavistock’s director, and demanded to be regarded as a professional so she could refer ­children for treatment when their GPs refused. Ms Green, who has no known formal medical training, held an advisory role on two of the studies that the clinic was involved in on the long-term effect of gender identity.

The service specification, which is still available on the NHS England website, was due to be replaced in 2020 but was put on hold when the Government ordered the independent Cass Review into the clinic.

The Tavistock said: “Like many NHS services, GIDS [gender identity development service] works with a range of third-sector patient support groups and charities that have different views about how the service can improve.”

Mermaids said its “primary focus is to support the mental and physical wellbeing of trans and non-binary young people throughout the UK”.

Ms Green said it was “not a secret” that she was involved in the service specification”.

An NHS spokesman said: “We have started implementing advice from Dr Cass and we have held a public consultation on a new interim service specification, which will be published in the coming weeks.”

'The Tavistock were really in thrall to these activists'

They are the documents that the NHS Tavistock gender clinic claimed did not exist. More than 300 pages of emails and minutes that lay bare for the first time the extent of Mermaids’ involvement in England’s only clinic for transgender children.

The controversial transgender charity has long been named by some whistleblowers as one of the reasons why the Tavistock lost its way, with claims that activists pressured staff to prescribe potentially life-altering drugs.

Now The Telegraph can reveal how Susie Green, then chairman of Mermaids, had a direct line to the clinic’s director Dr Polly Carmichael and was able to make referrals even when a child’s GP repeatedly refused.

The documents lay bare the depth of her involvement in the service, including helping to redraft the service specification and advising on a number of trials designed to inform the way they treated young patients.

The Tavistock and Portman NHS Trust had originally refused to release the details of the meetings between 2014 and 2018, relying on an exemption under Freedom of Information law which said it would have a “disproportionate or unjustified level of disruption, irritation or distress”.

When the Information Commissioner’s Office (ICO) asked them to justify that refusal, the Trust withdrew it and said that following “an extensive search of emails … the Trust does not hold the requested information”.

The ICO said that “on the balance of probabilities” it did hold the information and threatened to refer them to the High Court unless they complied with the request from a parent. The Tavistock has now released 322 pages of communications between 2014 and 2018.

They include emails between Dr Carmichael, who still works at the Tavistock, and Ms Green, who has left Mermaids and now works for an online GP which prescribes puberty blockers. In one exchange from 2016, Ms Green contacted the head of the service to question the decision of staff to refuse a referral she had made.

Upset not to be seen as a professional

Ms Green, who has no known medical training, said that she was told “that the referral was not validated or risk-assessed by a professional” and that is why it was rejected.

She added: “I can only assume from this statement that I am not seen as a professional? I am now very confused, as my understanding was that your service would accept referrals from Mermaids, but this statement appears to suggest the opposite….

“If you do NOT accept referrals from Mermaids due to the fact that I am not a professional I would like to know the reasoning behind this? Referral by a non-healthcare professional is acceptable from schools, social services etc, and my understanding has been that Mermaids referrals were accepted.

“Your admin person made it clear that immediate action was needed or this referral would be refused, so can I ask for a level of urgency to be applied to dealing with this issue?”

Dr Carmichael replied: “We do accept referrals from third sector groups and I know that you have helpfully sent in referrals in the past. This continues to be the case. Third sector groups often play a vital role in supporting young people and their families and we greatly value their involvement.”

Referrals 'unsupported by their GP'

Ms Green sent referrals for young people who were “unsupported by their GP” and in one case she sent the referral noting that the GP “has consistently refused to refer”.

The documents show that as early as 2014 she was involved in the “redraft of the service specification” for the NHS’s gender identity development service (GIDs) for children. She was one of the 10 people who attended a meeting.

Others include Dr Carmichael, who chaired the session, Rob Senior, the Trust’s medical director, Prof Gary Butler, a University College London Hospital consultant who is now the clinical lead for the children’s gender clinic, and Bernard Reed, the founder of the campaign group the Gender Identity Research and Education Society.

The minutes show they agreed that they would act as a “task and finish work group” and that “the content of the discussions were expected to remain within the group”.

They noted the initial findings of “research into the age for hypothalamic blocker treatment” which “suggest that the blocker could be prescribed from early puberty”.

The Tavistock has not provided minutes relating to any further meetings of the group, despite notes stating that they would meet two to three times and share details of their review. As a result, Ms Green’s contributions remain unclear.

Greater emphasis on medical treatment

A new service specification was published by NHS England in 2016, which placed greater emphasis on medical treatment for children.

The new specification said for the first time “that hormone blockers will now be considered for any children under the age of 12 if they are in established puberty”.

It also updated the “informed consent” section to state that: “Age alone does not determine capacity to give consent. If it is concluded that a client has sufficient autonomy and understanding of what is to be offered, plus other key eligibility and readiness criteria have been met, they can consent to treatment.”

The involvement with the service specification came as Mermaids were putting pressure on the Tavistock to lower the age for cross-sex hormones to 14, as Dr Carmichael revealed in an interview at the time.

The charity was also calling for a reduction of time that teenagers had to spend on puberty blockers before they were prescribed cross-sex hormones.

In one email chain Ms Green was involved in, her fellow campaigner Mr Reed questioned if there “are proposals to speed up” the process. He noted that children had to be on puberty blockers for six months to a year before being given cross-sex hormones, which they had to wait until they were 16 to access.

In the response in November 2016 Sally Hodges, one of the Trust’s directors, said that “the situation is rapidly changing” as the service had received more money and “Polly Carmichael is in touch with Susie to ensure that you have the most accurate and up-to-date information”.

Gender reassignment at 16

Ms Green, who now works for Gender GP, an online service which prescribes cross sex hormones, had taken her own child – who was born male – to the US for puberty blockers before their 16th birthday. On their 16th birthday she took them to Thailand for cross-sex surgery.

In one exchange she sought “clarity” from Dr Carmichael on whether the Tavistock would treat children whose parents had sought hormone blockers or cross-sex hormones privately either because of waiting lists or because the drugs were not prescribed on the NHS to under-16s.

“This would be a huge weight off parents’ minds,” she wrote. “Many want to access blockers privately for their children due to the distress caused by ongoing pubertal changes and the huge wait to be seen and assessed, but are then caught in a position of having to fund blockers indefinitely themselves.”

Dr Carmichael replied that she was “very sorry to hear that there has been confusion” and said that “individual circumstances vary widely and so it would be a case-by-case basis”.

She said if the child was already seeing an endocrinologist through the Tavistock they would be removed from their care if they started getting drugs privately, though could still have therapy. But she added that patients “may choose at a later date to be referred to the endocrine clinic, if for example they started cross-sex hormone treatment outside the service at an earlier age than the service offers”.

Charity boss invited to take part in research

In 2018, Dr Carmichael emailed Ms Green again to invite her to take part in research which was supported by the National Institute for Health Research (NIHR). She wrote: “We are in the process of submitting an application to NIHR to follow younger service users. It would be great if Mermaids would be involved.”

Ms Green replied that she would be “delighted to look at working with you on the NIHR application and delivery”.

The study looking at the development of gender identity in children aged 3-14 started in 2019 and it was hoped that it would “inform health and education providers”.

Stephanie Davies-Arai, founder of Transgender Trend, said: “The Tavistock were really in thrall to these activists. They were ideologically captured.”

Ms Davies-Arai, who campaigns for evidence-based healthcare, said that she had first contacted the Tavistock in 2016 amid concerns about the treatment they were offering and was told that they would welcome her input as they were keen to hear from different voices.

However, when she emailed Dr Carmichael with concerns, she got no response.

Ms Green said that it was “not a secret” that she was involved in the service specification and she applied to be involved “as the CEO of the largest UK (and probably European) charity to support transgender children, young people and their families”.

She said that she was “pleased” that the new specification “removed an arbitrary age range” for hormone blockers and agreed to consider them for children under 12.