Today I’m going to take a look at NHS England’s Interim Specialist Service for Children and Young People with Gender Incongruence, published 9 June 2023.

In the very title we have a problem. What do they mean, ‘with’ gender incongruence? If they were writing about, say, children and young people with diabetes or appendicitis it would be perfectly clear. But they’re making a huge assumption in talking of someone with gender incongruence.

What is this strange affliction? They tell us in a highly amusing section headed ‘Terminology’ where we find:

     Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex.

I could not believe I was reading this.

Apart from the difficulty in judging whether the individual has marked incongruence and a strong desire, etc., as opposed to having just ordinary incongruence and desire, how can they talk of ‘assigned’ sex? Sex is not assigned. It is determined at conception, recognised at birth as male or female, and registered accordingly.

There are doubtless many children and young people who are unhappy, disturbed, distressed, upset, miserable, or worried for any number of reasons: emotional or physical abuse or neglect, difficulties at school, bullying, etc. Anyone suffering from these serious problems may need the care and support of social and mental health services.

In the case of so-called gender incongruence, however, the assumption is that this is an entity found in nature. But as I have pointed out before, this concept, which appears to be the same as gender dysphoria, is entirely subjective: it’s an idea, sense, feeling, belief, or delusion that one was born in the ‘wrong’ body. Therefore, let’s change the body, insofar as this may be desired and possible, to fit an idea in the mind, rather than helping people to accept their reality.

This is the problem with The Service, even – or especially – if it ‘adopts a holistic multi-disciplinary integrated approach.’ They could have arranged these buzz-words in any order, such as

  • an integrated multi-disciplinary holistic approach
  • a multi-disciplinary holistic integrated approach
  • a holistic integrated multi-disciplinary approach

or similar babble.

Furthermore, if The Service is of a particular kind it would be reasonable to capitalise the definite article and the word ‘service’ at the beginning of a sentence, as in  ‘The Service will provide care…’, but these two capitalised words also appear in the middle of sentences:

     Providers delivering The Service must…

We’re back in the days when milk in glass bottles was delivered to your doorstep.

Furthermore, for providers to be allowed to deliver The Service, they must meet stringent qualifications:

     Providers must be an established specialist tertiary paediatric unit with a strong partnership with mental health services; be an established academic centre with a strong track record of research in children and young people; and have robust safeguarding frameworks in place. (Emphasis added.)

It seems potential providers must not only have robust safeguarding frameworks (note the plural) but have them in place as well! And I should jolly well hope so.

Just in case the competencies and experience needed by the multidisciplinary team or teams involved in caring for Gender Incongruence in Children and Young People are not clear from perusing the body of this document, they are elaborated at the end. But whether it’s an appendix or one of a number of appendices is unclear. It’s written thus: ‘Appendix A MULTIDISCIPLINARY TEAM COMPETENCIES AND EXPERIENCE’

Since there are no appendices B, C, D, etc., the indefinite article presumably belongs to the rest of this string of words, in which case it’s redundant and confusing. Perhaps they’re trying to say, ‘Appendix: Multidisciplinary team competencies and experience’, whatever that means.

This is not just nitpicking. If it’s so carelessly written, how can we trust what they tell us they’re trying to do? Perhaps the document was written by AI (artificial intelligence).

I’m inclined to think this was indeed the case, because if we take just one of the nine bulleted points in the appendix, all of which begin with the word ‘Understanding’, we find:

  • Understanding of approaches to care that are delivered by NHS specialist gender services, and support needs and support options for children and young people who have degrees of gender incongruence

All clear?

What is not clear, however, is how firmly the above-mentioned safeguarding frameworks are in place, since a little further down the page we find:

     The approach for onward referrals to endocrinology clinics are [sic] described in separate NHS England clinical commissioning policies for puberty suppression hormone treatment and gender affirming hormone treatment. (Emphasis added.)

So they’re still at it! Some patients, that is, children and young people up to their 18th birthday, could be guinea pigs for potentially hazardous experimental hormone treatment for puberty suppression and gender affirmation!

In my unhumble opinion such treatment is unethical and should be illegal.

Text © Gabriel Symonds

First published 11 June 2023