Talk:Gender Identity Development Service

Surprised by the lack of criticism

Is there some sort of censorship stopping the addition of critical thinking about transitioning children? — Preceding unsigned comment added by Aussiewikilady (talk • contribs) 22:19, 17 February 2020 (UTC)

This is not the article for criticising gender theory. This article is about a service provided in the UK, and as such is focused upon the notable events related to the performance of its duties. Koncorde (talk) 10:25, 18 February 2020 (UTC)

Yes. There is across the entirety of wikipedia. 82.10.58.36 (talk) 14:06, 5 April 2024 (UTC)

Resignations

I believe it would be useful for the article to add the information about the resignations obtained via this freedom of information request. Does anyone have any objections to it or suggestions on how best to present this data in the article?--StereoBucket (talk) 15:54, 8 May 2020 (UTC)

@StereoBucket: Be careful not to fall into the WP:NOTEVERYTHING trap. I don't think all the data needs to be included but if you can think of a way to incorporate a few appropriate statistics into the existing text without disruption and with WP:DUE weight, be WP:BOLD and go for it. ArcMachaon (talk) 19:47, 8 May 2020 (UTC)

Poorly written

The "controversy" section is poorly written. For example, I quote:

In October 2019, lodged a legal complaint against GIDS at its satellite site in Leeds.

Who lodged a legal complaint? Or:

The suit describes hormone therapy as “experimental” and that there was “robust evidence” to show long-lasting medical effects of hormone therapy.

That change of tense! That incorrect grammar: "the suit describes... that there was "robust evidence" to show [etc.]"! What about, "the suit describes... there being robust evidence"?

Somebody should change it.

 Done ArcMachaon (talk) 10:27, 21 September 2020 (UTC)

The information about CAMHS is hopelessly confused.

Here's what the article currently says:

"However, CAMHS is organised by local government area" - no. Tiers 1, 2, and 3 CAMHS are commissioned by Clinical Commissioning Groups, not local authorities. Some LAs have close mapping to the CCG, but others don't. Tier 4 is commissioned by NHS England. GIDS is a tier 4 service.

"GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists." - it does not take referrals from all MH professionals. And it also takes referrals from schools, social workers, some charitable organisations.

"GIDS is distinct from CAMHS as is it is nationally run, not by the local authority." This doesn't make much sense. GIDS is a type of CAMH service. Local authorities do not run any CAMHS. The word "run" doesn't make sense in this context - the service is commissioned by NHSE, but it is provided by Tavistock and Portman NHS FT. All tier 4 CAMHS are commissioned by NHSE, this includes *all* children's inpatient MH care, and children's inpatient eating disorder care. All Tier 1, 2, and 3 CAMHS are commissioned by Clinical Commissioning Groups.

"However, in the CAMHS framework it sits in Tier 4, as a highly specialised service.[citation needed]" - citations are easy to find if you'll take a primary source. They'll be somewhat harder to find if you need secondary published sources. EG page 1 of this describes who commissions the various tiers. https://www.england.nhs.uk/wp-content/uploads/2018/02/tier-4-camhs-general-adolescent-service-specification-v3.pdf

I'm not going to edit this because wikipedia is fucking awful. Clearly the transphobes have already had a go at the page, and I have neither the time nor patience to deal with gender critical people. 79.76.93.112 (talk) 20:15, 30 March 2021 (UTC)

Removed Leadership section

The leadership section was a mess - the only useful fact in there was the director's name, so I've moved that to the Infobox. The article might well benefit from someone having another go - a section on the service's leadership/management/organisation might be useful. 3fingeredPete (talk) 15:07, 13 February 2022 (UTC)

I have reverted the removal. I hadn't seen this section, but I still do not think there is any reason to delete the inf. Sweet6970 (talk) 16:14, 13 February 2022 (UTC)

OK, I've had another go - I've kept the section this time. I've removed the claim about Carmichael treating children as young as 3 (this wasn't strictly supported by the citation - the Vice interview says the _clinic_ has treated children this young, but not Carmichael personally). I've also removed the lengthy quote - it wasn't clear to me why this quote had been picked out of the interview, and more concerningly it had been heavily edited - a large chunk of the interview was skipped and replaced with an ellipse, and two of the statements in the quote had been reordered (which isn't very in keeping with MOS:PMC). There isn't much left in that segment, but I think that's OK - we're talking about the director of one service at a specific NHS trust, so it's hardly surprising that there's not much verifiable and encyclopaedic information out there. 3fingeredPete (talk) 19:54, 20 February 2022 (UTC)

Is the Pogust Goodhead announcement due?

A section on speculative legal proceedings by Pogust Goodhead was recently added to the article. Is this really due for inclusion? At present the firm have no signed up patients for the action, other legal experts state it's unlikely that the case will have that many litigants, and GIDS "has not heard from Pogust Goodhead about this matter". Sideswipe9th (talk) 20:22, 11 August 2022 (UTC)

It strikes me as a little bit premature since no case has actually been brought yet. But I am definitely not a lawyer and the announcement has been covered in at least one reliable source. I'm not hugely invested either way. JezGrove (talk) 20:39, 11 August 2022 (UTC)

The text in our article merely reports Pogust Goodhead’s announcement. It does not mention the numbers of possible litigants, which I agree is ‘speculative’. But even if ten patients sue the clinic, this would be significant and should be included in our article. There is an unavoidable problem that, as stated in the sources, it is likely that it will be a long time before we know whether this possible litigation will come to anything. A period of six months is mentioned. My view is that the text as it stands should be left in the article, and the matter should be reviewed in six months, to see whether there are any further/more definite reports. Sweet6970 (talk) 21:57, 11 August 2022 (UTC)

Why should we keep speculative content in an article for six months, on the hopes that better sourcing or further announcements will be available? What content policy or guideline supports that?

If ten patients sue the clinic, it could potentially be significant, but we aren't there yet. Right now all we have is what could charitably be described as a glorified press release of an intent to form a class action suit, which GIDS had not even heard of until they were contacted by media about, and that has uncritically been picked up by The Times and Sky News, and somewhat critically picked up by The Independent. Why is that encyclopaedic content? Sideswipe9th (talk) 22:08, 11 August 2022 (UTC)

It’s not speculative content – it states a definite fact, which is that Pogust Goodhead made their announcement. Sweet6970 (talk) 22:20, 11 August 2022 (UTC)

The firm intends to launch a class action suit. However at present they have no class, they have no signed up individuals or families, and according to The Independent, haven't even begun to contact or have contact with any. It is accordingly speculation to say that they will have a class, even of ten patients. Of course things could change in six months, in which case it might be worth inclusion at that point depending on sourcing, but right now I repeat my assertion that all we have is a glorified press release from a law firm. Sideswipe9th (talk) 22:35, 11 August 2022 (UTC)

Actually, we can be pretty sure the 1,000 headline figure is wrong. Between 2008-2021 GIDS referred a total of 1151 patients for endocrinological treatment, and 1089 of which had known treatment outcomes. Of that 1089 number, only 58 had ceased treatment of GnRHa or gender affirming hormones, the remainder continued identifying as trans. Adding the 51 patients who self-discharged for unknown reasons, that gives a theoretical maximum of 109 patients.

We also know that the rate of detransition is somewhere between 1% and 8% (see sources at Detransition#Occurrence), and of that number the vast majority detransition for reasons other than regret. Based on the numbers, it's entirely possible that the only detransitioner from GIDS who also regretted their treatment was Kiera Bell. Sideswipe9th (talk) 23:12, 11 August 2022 (UTC)

Sideswipe – you are using OR to argue against the news story. But our article does not reproduce the news story – only the basic fact of the announcement. So your arguments are beside the point. Sweet6970 (talk) 10:50, 12 August 2022 (UTC)

Agreed that it's not speculative content. Nobody is denying what our article says, that PG made the announcement, and the Times and also the i (here is the link for future reference Tavistock Centre: NHS gender clinic faces mass legal action after children prescribed puberty blockers (inews.co.uk)) decided it was newsworthy. Warm regards. AndyGordon (talk) 07:39, 12 August 2022 (UTC)

Ok. It's been six months since this was added. In that time it appears as though no patients have come forward, and there has been no further press coverage about this case. I've removed the paragraph now as it is overwhelmingly undue and a borderline prediction of the future that this case will go forward. If it does go forward at some future point, and if that is covered in detail by reliable sources then we can look to covering it as sources do at that time. But from where we are right now, this is fundamentally not policy compliant text. Sideswipe9th (talk) 17:30, 20 February 2023 (UTC)

Drive-by tags

I just removed the probable Wikipedia:HIT&RUNTAGs added to this page. Couldn't see a reason on the talk page for any of them. However, the {{Update}} tag, upon research may have a legitimate basis - I have added the reason to the tag. If you feel this page needs to be re-tagged please write the reason here on the talk page. Thanks ArcMachaon (talk) 21:04, 15 August 2022 (UTC)

Thank you for removing the spurious drive-by tags. I appreciate the your reasons for retaining the update tag, but the article is closely attended to and the Spring 2023 closure was promptly recorded. I am confident the article will be updated in a timely manner without a hatnote reminder, and will remove it accordingly. Cheers! Captainllama (talk) 02:05, 17 August 2022 (UTC)

Service catchment area

Just to note, I've just made two edits ([1], [2]) correcting the text on the referrals catchment area for GIDS. GIDS only accepts referrals for trans youth in England and Wales. Sandyford in Scotland, and Knowing Our Identity in Northern Ireland are responsible for trans youth referrals in their respective nations.

It's a little hard to cite this in text though. Unfortunately there's no one reliable secondary source that I'm aware of that would neatly support this text. Neither clinic receives as much attention in the press as GIDS. However because NHS Scotland and HSCNI are functionally separate from NHS England, I wonder if the existence of the two clinics puts this into WP:SKYBLUE territory? Sideswipe9th (talk) 23:56, 23 December 2022 (UTC)

Thanks for the corrections – your edits certainly make sense. Perhaps the way to deal with this might be to add links to the Scottish and Northern Irish clinics with an explanatory footnote? Sweet6970 (talk) 00:15, 24 December 2022 (UTC)

Yeah I think that approach would work well!

The KOI landing page is pretty barebones though, at least compared to the Sandyford one. It's better than nothing, but I'll try and see if there's a patient/parent info pamphlet published elsewhere on the Belfast Trust site for the service. Sideswipe9th (talk) 00:23, 24 December 2022 (UTC)

Seems KOI provide this pamphlet, accessible through the Education Authority website, to the parents of those referred to the service. Gives a bit more info than the HSCNI website, and may be a more useful citation, or one that should go alongside it? Sideswipe9th (talk) 00:29, 24 December 2022 (UTC)

I think it would be better just to use the ‘barebones’ source for the Northern Irish clinic. We are only trying to support the statement that the Tavistock clinic is for England and Wales, not to give information about Northern Ireland. Have a good Christmas! Regards Sweet6970 (talk) 12:33, 24 December 2022 (UTC)

Deletion of relevant information about legal case 13 February 2023

Come on, Newimpartial. The point is not that I like it – please don’t make insulting edit commentaries. The point is that GIDS were criticised by the judges. The judges thought it was relevant, and this was reported. You may not think it is relevant, but that is not the point. Sweet6970 (talk) 15:58, 13 February 2023 (UTC)

I don't believe WP is in the business of reporting everything that a judge has said about this, and which a single source has reported. My concern is about WP:DUE (well, and WP:NOTNEWS also, tbch). Newimpartial (talk) 16:03, 13 February 2023 (UTC)

Guys, stop edit warring over this. The text added here fails MEDRS. It is making a medical claim about an unpublished study's findings among a group of participants. We only have the journalist's word about what the data demonstrated, and clearly the intention of mentioning it (both in the Times article and on Wikipedia) is to make a medical claim that puberty blockers do not improve mood or psychological wellbeing, along with an implication that GIDS suppressed this unwelcome finding. There are all sorts of reasons why research does not continue or reach publication and Wikipedia doesn't even cite published studies as sources, but wait for reliable secondary sources. There may perhaps be a sentence DUE about GIDS not undertaking/completing/publishing enough research into puberty blockers (if other sources find that criticism relevant) but we can't go into specifics about what that unfinished research may or may not have discovered with this kind of sourcing. -- Colin°^Talk 18:00, 13 February 2023 (UTC)

Colin: I don’t edit medical articles because I am vey conscious of my ignorance in that area. (I thought you might have noticed this.) I have never previously looked at MEDRS because I don’t edit any matter to do with medicine. The material which I restored (not ‘added’ – it has been there since 27 October last year) is not a statement about medical matters, it is a statement recording what the judges said in a legal case. I do not see how this could possibly be interpreted as a ‘medical claim’: judges don’t make medical claims.

WP:MEDRS starts: Biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge.

WP:BMI says Biomedical information is information that relates to (or could reasonably be perceived as relating to) human health. The statement in the established wording of the article is a statement about criticism of GIDS’s behaviour. But if you are concerned that it has a medical element to it, then I suggest it be changed to The judges also criticised GIDS for failing to publish a 2011 study relating to puberty blockers.

Sweet6970 (talk) 18:58, 13 February 2023 (UTC)

It isn't clear in the Times article, but I'm not sure the claim "Early data so far released from that project..." came from the judges, but instead from the journalist's own research, interviews, etc. Either way, early data on an unpublished study is irrelevant as far as Wikipedia is concerned and a High Court Judge is not a medical expert, even assuming the words came from them. Your suggestion meets my criticism wrt MEDRS. Whether the statement is DUE is an argument I'll leave for others, but please don't edit war over it.

I expected to see some mention on lack of research in the Cass Review section. Instead the section gives way too much weight to Javid, and his opinions. Javid knows about as much about medicine as my plumber. Wikipedia is not here to give a platform for Tory culture war rhetoric. It would be better to include more about what Cass reported, and less about what some ignorant politician thinks. -- 19:34, 13 February 2023 (UTC) Colin°^Talk 19:34, 13 February 2023 (UTC)

I have made the change to the wording which I suggested above. Sweet6970 (talk) 20:59, 13 February 2023 (UTC)

Cass Review

Colin has made a comment above about the Cass review section: It would be better to include more about what Cass reported, and less about what some ignorant politician thinks. I had previously found this report from the Association of Clinical Psychologists [3] , which includes:

The publication of the interim findings of The Cass Review in February 2022 found the following:

GIDS took an approach that was predominantly affirmative, rather than exploratory

Assessment was not standardised

Mental health and neurodevelopmental assessments were not conducted comprehensively, leading to ‘diagnostic overshadowing’ whereby gender dysphoria was attended to without taking into account any co-existing diagnoses

Safeguarding processes were lacking

I did not add it to the article because it looks to me like a primary source.

Any comments about adding this to the article?

Sweet6970 (talk) 11:17, 14 February 2023 (UTC)

Their summary of the Cass findings isn't a primary source and could be used if we can agree on either a paraphrase of this or quoting some of it. They go on to offer their own opinions, for which they are a primary source. And from this Guardian article not without controversy. My vote is to ditch the several sentences about Javid and his proposals (did they go anywhere?? the government was in chaos at the time and he resigned soon after that news report). This section should be about the Cass interim report, not what some MP thinks is "bordering on the ideological". -- Colin°^Talk 14:31, 14 February 2023 (UTC)

1) ACP material: I don’t see how we could paraphrase or abbreviate the ACP comments without altering their meaning. In general, I am in favour of full quotes in any contentious matter, because different people read this kind of thing in different ways. It’s not actually that long, if you run it all together, with just semicolons between the comments, rather than on separate lines as they present it in the report.

2) Open letter: We should also include something about the response, as described in your Guardian source. Perhaps something like: In response, an open letter signed by more than forty clinical psychologists described the statement by the ACP as ‘misleading’ and said that it ‘perpetuates damaging discourses about the work and gender-diverse identities more broadly’.

3) Sajid Javid: I’m OK with deleting the stuff about Sajid Javid: as far as I can see, this led nowhere. But I would keep the comment about the Cass Review from the BBC source, and the reply by the Trust.

Sweet6970 (talk) 15:42, 14 February 2023 (UTC)

The Open Letter was criticising more than just their summary of the Cass interim report findings. However, they do also criticise that summary, and therefore I think now that we should be cautious of using it as an accurate summary. It is tricky. One of their criticisms is the lack of context to the remarks, and that's something we may make worse by quoting bits. They also remark that "it is not the role of the [Cass] review to scrutinise existing services" (a quote from the Cass review) and so Wikipedia using those statements to review that service would be improper. These individual bullet points may be something the review wants addressed in new services, but they don't represent a balanced and fair description of the service overall. Perhaps it could be introduced as "Some criticisms that the ACP drew from the Cass interim review were..." and followed with sentence you proposed.

I'm aware that there is a book due to be published shortly ("Time to Think") that is highly critical of GIDS. -- Colin°^Talk 10:12, 15 February 2023 (UTC)

I’m happy with your suggestion for the introduction wording. So I think we now have agreement for changes to the wording? Sweet6970 (talk) 10:40, 15 February 2023 (UTC)

Yes, with the caveat that wiki is never finished. Always room for improvement.

Just to note that this book, Time to Think, is due out on 23rd Feb, though some journalists have copies already. From what I can see, the anti-trans activists love it and are jumping up and down with joy. A more sober review is at The Irish Independent. Obviously I haven't read it, few have, but that review seems very sensible. Always good when a writer admits their experience is just their experience, valid and important it may be. The review complains the book is one-sided, with good evidence as they only seem to interview those who left or otherwise are critical. One of the problems with journalistic writing (the book author is a journalist) is that the approach is that one has a message for the reader (what went wrong at GIDS, say) and everything works towards supporting that message. But then your book will just be used as a weapon by one side and dismissed by the other. I get the feeling that the Independent reviewer thinks much of the book is solidly argued (albeit on one side) but wished it was better. Clearly things did go wrong at GIDS, and we need level headed sensible people to write about that. -- Colin°^Talk 10:50, 15 February 2023 (UTC)

Do you want to make the amendments, or shall I?

Regarding the book review – I can’t read it, as I don’t have access to the Irish Independent. Are you intending to use reviews of the book in this article?

Sweet6970 (talk) 12:36, 15 February 2023 (UTC)

Here's an archive of the Independent article. You can make the amendments. Wrt the book/reviews, this was more of a "heads up". We are likely to see edits made to this page that refer to the book in some way. And once the book is published, more edits that cite it. The book's publisher is small/new but the author is a respected journalist, so it seems likely that, biases aside, it will become an important source. -- Colin°^Talk 13:46, 15 February 2023 (UTC)

Thanks for the link to the Irish Independent article. I have made amendments to our article which I believe are in accordance with our discussion – review welcome. I am glad we have been able to reach agreement on this. Sweet6970 (talk) 15:35, 15 February 2023 (UTC)

Some more reviews of the book: [4] [5] *Dan T.* (talk) 19:06, 19 February 2023 (UTC)

Two things strike me as concerning. The first is about the puberty blocker studies. They are rightly critical of the lack of proper studies about puberty blockers, and claim those that were done didn't have a control. The studies were "tiny" according to the FT review, so the statistical conclusions should be surely that those bad studies don't tell us anything much. And yet we have reviewers claiming they showed the children on the blockers did not improve. Well, without a control, how do you know if they'd have got a lot worse without? And if it was just a pilot of a dozen children, say, how do you really know anything about a referral cohort of thousands? This concerns me as if those bad studies had shown an improvement, they'd have been dismissed on statistical grounds about the poor quality of the studies. But if they seemed to show no improvement, they get accepted despite their dreadful quality. You can't cherry pick findings from bad research. Garbage in garbage out. There is likely a scandal about puberty blockers, doing that much practice without research to back it is not acceptable, but we do need to be very cautious that medical claims in this article are based on MEDRS sources, and not just a Newsnight journalist cherry picking negative results from bad research because it fits their case.

The second concern is both reviews mention money as though that was some kind of malign motivation. They say the department's income increased from 6% to 28% of the trust's income. But they also saw a huge increase in referrals, from 50 per year in 2009 to "October 2020 there were 2,500 children and young people being referred per annum, 4,600 children and young people on the waiting list, and a waiting time of over two years to first appointment." The NHS doesn't exist to make a profit. If there's a rise in income, because of referrals, there's a corresponding rise in costs, of the staff and facilities to see the patients. And clearly that service didn't increase in size quickly enough, as the waiting list just grew longer and longer. The Times reviewer said "No wonder its leaders refused to cap referral numbers". Em, generally speaking the NHS doesn't work like that. As there was only one clinic (a failure being addressed), there was no where else for referrals to go, and a queue built up. That there was a huge increase in referrals is something yet to be explained, but it isn't like they ran adverts on ITV asking for patients. This seems to be a weird angle to take, and I'd be interested if there will be any comment about it in the BMJ or similar. Mental Health is a Cinderella speciality, so I suspect this claim will cause eyes to roll. -- Colin°^Talk 10:21, 20 February 2023 (UTC)

New Statesman review. This is another balanced reviewer, who interviews the author. I'm slightly more encouraged by it and suspect perhaps that some of the newspaper articles/reviews that (will) cite this book may often be using it as an excuse to voice their own opinions/prejudices where the source is actually more nuanced and careful. We'll see when it gets published. -- Colin°^Talk 10:37, 20 February 2023 (UTC)

Barnes

The book by Hannah Barnes seems to be fundamental, and if this article were being written now, she would be one of the most important sources. However, the article was already written before her book was published, and therefore she only appears as a brief afterthought mention. I suspect that the article could be improved a lot by checking each section against her book, adding her as a more authoritative source when she confirms information, and rewriting when she has better insights. Doric Loon (talk) 08:36, 5 July 2023 (UTC)