Trans clinic: Trust doesn't rule out 'affirming' children with gender issues - after minister suggested that wouldn't happen

Mike Nesbitt says clinicians will try to decide what is in the best interests of each individual using the service – and that it is important that his department is “really clear” about what the service does.

However, Belfast Trust – who will run the service – has declined to say that the clinic won’t be affirmative if a child presents there saying that they are transgender, saying it will “continue to be individualised”. But it says it will be “in keeping” with the Cass review of gender services.

The service will accept children and take them through to adulthood if necessary, when medical interventions will be possible – adding to concerns about a model which affirms a trans identity at a young age.

A number of Mr Nesbitt’s Ulster Unionist MLAs believe the service should not reinforce the idea that children are the opposite sex. In yesterday’s News Letter, the party’s new MLA Jon Burrows said he would support someone who is dealing with gender dysphoria who needs “specialist counselling” – but said that is “entirely different from affirming someone’s gender”.

The practice of affirming the gender of children in such services – rather than approaching the issue neutrally – is supported by LGBTQ+ lobby groups, but experts warn that it closes off exploration of other issues.

The UUP leader has been under pressure over the past fortnight to explain why there is no lower age limit on referrals, and there has been little detail from his health department about what has or will change under the new service.

The health minister has also told the BBC that he is “asking questions” about how a 5 year old was let into the service “a good number of years ago”.

The Cass report said that the existing evidence for both medical and other interventions is weak, and that clinicians could not be certain which children and young people would persist with a trans identity in adulthood – and for most, a medical pathway would not be the most appropriate. Its recommendations included a regional network of centres to provide continuity of care for 17–25 year olds as well as extra resourcing.

Speaking to the BBC’s political reporter Brendan Hughes, Mr Nesbitt said “we have to make clear to people exactly what the service is and what it is not”.

He said: “It started in 2014 and what we've done is we have amalgamated the two services, one for children and one for adults, because often when you're moving from child services to adult services, you actually find yourself at a bit of a cliff edge, and you maybe feel you have to start again on a very long waiting list.

“We're putting a huge emphasis on psychologic and psychiatric health, so don't be thinking that because somebody comes in and says ‘I want to join this service’ that it's going to be affirming them in terms of what they want. There will be a lot of work put in to try and decide what is in the best interests of everybody who approaches this service.

“It is true that a good number of years ago, a five year old was led into the service. I'm still asking questions about how that happened and what happened there. I'm also asking about who knew what in terms of ministers over over the years, because I think it's, it's important that we're really clear about who did what and what this service does and does not do”.

The News Letter asked Belfast Trust whether clinicians working at the Lifespan gender identity service will operate under new clinical guidance post the Cass Review. A spokesperson said the trust “will continue to work with the Department of Health and the Strategic Planning and Performance Group on the newly established service, including implementing national learning from the Cass Report across Lifespan. The Trust will also represent Northern Ireland within the UK Research Oversight Group and the Gender Incongruence and Dysphoria Steering Group”.

Asked if the service is still 'affirmative' if a child presents saying they are trans, Belfast Trust said: “The range of treatment and support provided by this service will continue to be individualised, clinically appropriate, and reflect a step-by-step approach in terms of psychological support and assessment, in keeping with national and international guidelines, including the recommendations of the Cass Review”.

The same questions were put to the Department of Health, but there was no response at the time of writing.