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The CQC says that while “Staff were experienced and qualified and had the right skills and knowledge to meet the primary needs of the patient group,” they “did not necessarily have the skills or experience to meet the needs of young people with complex needs.” 19/
The process for gaining consent to treatment & assessing capacity is also criticised. “The records of young people who began medical treatment before January 2020 did not include a record of their capacity, competency and consent,” the report says. It had improved since then 20/
“Staff’s approach to enabling young people to make their own decisions was unstructured and inconsistent although there was some evidence of good practice," the inspectors note. 21/
“However, whilst staff demonstrated their work on helping young people to understand information about treatment, there were very few details on the records of staff engaging in the more difficult task of supporting young people weigh-up the foreseeable risks and consequences”22/
GIDS carried out audits of compliance with their procedure for consent and capacity in March and September 2020. The March audit reviewed 10 records of young people referred for hormone blockers: “only three contained a completed consent form and checklist for referral.” 23/
CQC: “we found no evidence that staff had completed an assessment after the documentation was found to be missing...this meant that staff had still not assessed the capacity and competency of young people receiving treatment, despite being aware that they had not done so.” 24/
The September audit showed improvement, and found that only three out of 29 referrals to endocrinology did not have a complete set of referral documents. 25/
‘Is the service responsive?’ Rating = Inadequate. The CQC noted that over 4,600 young people were on the GIDS waiting list, with some waiting over two years for their first appointment. The regulator insisted waiting times and the service provided overall must improve. 26/
GIDS has a target waiting time of 18 weeks, but “out of 1089 patients being seen by the service, only 13% were seen within 18 weeks. In total 64% of patients waited more than 66 weeks to be seen, including 26% who waited two or more years.” 27/
‘Is the service well-led?’ Rating = Inadequate. “The service was not consistently well-led,” the CQC said. “Staff did not always feel respected, supported and valued. Some said they felt unable to raise concerns without fear of retribution.” 28/
Staff were positive & proud about working at GIDS and many loved their work. But some said "high caseloads and constant external scrutiny meant they worked under relentless pressure." While staff turnover was consistent with the ave for the trust, some still saw 24% as high 29/
The CQC raises the GIDS action plan from March '19 - the result of the Trust’s internal review. The CQC noted that while improvements had been made in some areas, “there were still many areas where improvements had not been consistent.” 30/
CQC notes there is still wide variation in practice with assessments ranging from “two or three sessions to over 25 sessions, with some young people receiving more than 50 sessions.” The CQC confirm staff reports seen by NN that some assessments consisted of two sessions. 31/
The CQC states: "Records of sessions with young people and their parents were often simply descriptions of discussions that had taken place. They did not include any analysis, structured assessment, professional curiosity or clinical decision making.” 32/
‘Is the service caring?’ Rating = Good. Despite criticism levelled above, staff were found to treat young people with ‘compassion and kindness.’ “They understood the individual needs of young people" & supported them "to understand & manage their care...” 33/
22 young people receiving care and treatment from GIDS were interviewed as well as the parents of 13 young people using the service. “Feedback from these people was overwhelmingly positive.” 34/
Responding to the CQC’s findings, a spokesperson for the Tavistock Trust said they took the report 'very seriously. “We agree with the CQC that the growth in referrals has exceeded the capacity of the service.” 35/
It apologised to patients and their families for the length of time they are waiting to be seen, and acknowledged the difficulty this caused. “We very much accept the need for improvements in our assessments, systems and processes,” they added. 36/
“We are determined to get this right for children and young people and will be agreeing a full action plan with the CQC to address further concerns.” 37/
The Trust said it would continue to support Dr Hilary Cass, who has been commissioned by NHS England to undertake an independent review of gender identity services for children and young people https://www.england.nhs.uk/2020/09/nhs-announces-independent-review-into-gender-identity-services-for-children-and-young-people/ … 38/
A link to the full CQC will be posted once available. ENDS
Read the report here: https://api.cqc.org.uk/public/v1/reports/7ecf93b7-2b14-45ea-a317-53b6f4804c24?20210120085141 …
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