Who Trolled Amber? - The Tavistock - Episode 5: The noise

Episode Date: September 18, 2023

The public debate around the work of the Tavistock is getting louder. Kiera Bell wins a landmark ruling at the High Court which halts all new referrals for puberty blockers for under 18s on the NHS in England and Wales. She was prescribed puberty blockers at 16 but later decided she wants to detransition. The Tavistock appeals and the ruling is overturned. But for many people the narrative of the Gender Identity Development Service is now set in stone. Listen to the full series today. For the premium Tortoise listening experience, curated by our journalists, download the free Tortoise audio app. For early and ad-free access to all our investigative series and daily and weekly shows, subscribe to Tortoise+ on Apple Podcasts.If you’d like to further support slow journalism and help us build a different kind of newsroom, do consider donating to Tortoise at tortoisemedia.com/support-us. Your contributions allow us to investigate, campaign and explore, and to build a newsroom that is responsible and sustainable Hosted on Acast. See acast.com/privacy for more information.

ACAST powers the world's best podcasts. Here's a show of glamour and scandal and political intrigue and a battle for the soul of a nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. Acast.com I'm delighted at the judgment of the court today.

It was a judgment that will protect vulnerable people. It's the 1st of December 2020 and Kira Bell has just emerged from the High Court in London. I wish it had been made for me before I embarked on the devastating experiment of PPE blockers. My life would be very different today. She reads a statement in a quiet, low voice and struggles to be heard above the passing traffic and clicking cameras. Complacent and dangerous culture at the heart...

But everyone is listening, because Keira Bell has taken the Tavistock to court in a landmark case. This was a victory for Keira Bell who as a teenager was prescribed puberty blockers and cross-sex hormones before deciding she wanted to transition back. And a panel of three judges has ruled in her favour. ruled in her favour. And today, three judges at the High Court agreed that children under the age of 16 were unlikely to be mature enough to consent to taking hormone-blocking drugs, delaying puberty. In a landmark ruling, a judge said her case had shown it's doubtful 14 and 15 year olds could understand long-term risks of treatment, and highly unlikely children under 13 can give competent consent. That ruling, that it's highly unlikely that a child can give informed consent to treatment involving puberty blockers,

has an immediate effect. It effectively halts all new referrals for puberty blockers for under 18s on the NHS in England and Wales. This is when everything in the story of the Tavistock shifts. In the minds of its critics, it's the moment when the Tavistock's reputation is sealed as a clinic that fast-tracks children onto puberty blockers without exploration. That's what Keira Bell says happened to her. She was 16 when she was prescribed puberty blockers and 17 when she began taking testosterone. A few years later and after surgery, she decided to detransition.

Although you've probably heard of Kira Bell, her story is actually quite unusual. There's not really good evidence that there are many other young people who have medically transitioned and regretted it. In my reporting, I've talked to and heard of young people who have come out as trans, then their identity has evolved and changed again, but none who've already been through hormonal treatment. By late 2020, the narrative of a clinic operating on the edge is taking over. The noise around the clinic is getting louder and louder. Well, how is it possible that there's been this huge swing in which sex is born this way? He's playing whack-a-mole with transphobes. See you, transphobes.

Extraordinary revelations coming out of that place. You know, 15 years of encouraging children to change gender, giving them puberty blockers, drugs that will affect them for the rest of their lives. So let's call it what it is. It's a fad. It's becoming impossible for those working there to ignore it. The noise is also affecting those at the heart of this story. And hearing you describe it as the noise sums it up so well, because it is like this really annoying static from a TV or a satellite that is just always there. And you're just like, I want to get rid of it.

How did it all get so nasty? How did the work of a gender clinic for children and young people prompt such extreme reaction? I studied history and learned about the social, political and economic factors that led to historical events. But one thing I never understood was how the really bad things were allowed to happen. And now I understand how very bad things can happen. how very bad things can happen. I'm Polly Curtis, and from Tortoise, this is The Tavistock. Episode 5, The Noise. We couldn't get a snowman.

We never did. We wanted a snowman. We wanted a snowman. This story changes people. Emma was changed by her daughter coming out as trans. Emma's not her real name and her words are spoken by an actor. When it happened to us, I saw it as a teenage rebellion. I was a teenage rebel who caused my parents hell,

particularly my mother, and I thought, OK, this is it um i have to play it cool so i played it cool and it's my kid and i love her and what's a playing it cool look like okay well thanks for telling me we love you very much whoever you are, and I'll be here for you. I gave her a big hug and then I thought this is going to be another one of those phases. She says it all began after a talk by a trans speaker at her child's school. This was a presentation for 13-year-olds. It was kept secret from parents. I didn't find out about it until nine months later, by accident.

But working back, my daughter then spent two weeks of really intense time on the internet. And it was two weeks after that that her child came out as trans and asked to get a referral to the Tavistock. Emma, still mindful of the possibility of teenage rebellion, wants to be able to say yes. So I looked up the Tavistock and they talked about an individual approach with no foregone conclusion and that every child is unique and that they would take time. So that sounded good. And it's the NHS, so of course it's good. And the second thing was there was a very long waiting list. It was 18 to 24 months.

What year was this? This was in 2019. So I thought, OK, great, long waiting list. So I will say yes, and then this will pass. So we got a GP appointment it is really easy to get referred to the Tavistock. There was a short conversation about names, pronouns, hairstyle, clothes The GP, after referring to the Tavistock in this quick appointment, said to me, I am totally against paediatric transition. There's no evidence to support it. And I said, why did you make the referral?

And she said, I risk losing my job. She said she had colleagues who'd been reported to their medical association for not referring. So that was the first, like, kind of weird thing. You can probably guess by now where this story goes next. Emma goes online to find out more. I looked on the internet, of course, and then the algorithms take you to mermaids. Mermaids comes up top. And then it's basically, are you an amazing parent? Do you love your child? Do you want to be part of this wonderful community? And, of course, I want all three of those things.

But when I read more, then, to qualify, you have to go for these treatments, which, to me, sounded a bit, wait, hold on a minute, let's figure out what's going on. She starts digging. She's looking for studies or evidence. It doesn't go well. Everyone I asked for help told me that I was a bigot, basically, harming my child, that I'm a risk to my child and that my child was likely to, was at risk of suicide.

And what did that do to you? Well, you think, is it true? And then you do more research and then there are no studies that say this. There's no evidence to show that it helps mental or physical health. There's no evidence to show that it helps mental or physical health. There's no evidence to say it doesn't help. But either way, there's no evidence. And there's no data. There's no long-term data.

Emma doesn't think what she's looking for is unreasonable. Certainly not radical. She just wants some data. But it leaves her feeling isolated what can you say about how this has affected your family i wouldn't wish this on anyone even the people who have been really horrible i wouldn't wish this on them either i saw someone said this on twitter i think they were trying to describe what it's like as a parent. And they said, the house is on fire. You are trying to rescue your child.

And everyone you know is lighting matches. And what are the matches? The matches are telling your child that they're the opposite sex and that they should make all these changes. What I hear from Emma and from so many other parents is a devastating sense of isolation. Emma joins a group for parents of trans adolescents. It's called the Bayswater Support Group. So we support each other because we find that when we ask for help, we're told that this is our fault and that we're bad parents and that we just need to do this, transition our children right away or they're going to kill themselves, which is quite odd.

As Emma is trying to find some evidence or data about puberty blockers to help her decide the right course of action for her child, the Kira Bell case reaches the high court. I thought, now I'm finally going to understand. I'm going to, like, find this answer I've been searching for. But when the Tavistock witnesses were asked for the data, they were like, the dog ate my homework. And I was like, oh my God, even they don't have it. This is a court case with QCs and the High Court, and this doesn't exist.

And I was really shocked. The studies or records that Emma has been searching for, they simply don't exist. Emma never thought she would go from being a liberal parent who took her kids on pride marches to opposing trans ideology. But she does. This story changes her. Everything that I thought was real and true

has kind of fallen away. The whole scaffolding of my life fell away. It's been a very destabilising experience. What are the examples of the scaffolding? Kind of the values I held that I thought society held or that I thought my part of society, The like, progressive, remain, you know, nice progressive values. Yeah, that's all collapsed. Thank you. So, yeah, it's kind of hard to find us.

We would not have found this. We were talking to some colleagues in the States yesterday who were saying they're getting increased bomb threats and stuff. Really? Yeah. The States is getting really rough right now, obviously. The States is really... Mermaids is a charity set up to support gender-questioning young people. It is currently under investigation by the Charity Commission over safeguarding issues,

accused of supplying chest binders to teenagers against their parents' wishes. That chat, as we arrived at their offices, about bomb threats in the US, hints at a sense of being under attack and beleaguered. So to start, can you just start by introducing yourself for the tape? Great. So hi, my name is Kyle Doherty. I use they, them pronouns, and I'm the head of policy and research at Mermaids. Thank you. And when we look to your profile, you describe yourself as genderqueer. And do you mind me just asking you to explain what that means? Yeah. So for me, I mean, it means something different for everyone. For me, it means I don't identify as a man or a woman, but find myself somewhere on the spectrum in between.

I really, you know, don't feel that any specific label or binary applies to me. Mermaids has been around since 1995, when it was formed by a group of parents who were at a loss as to how to support their gender-questioning kids. Its relationship with the Tavistock has had its ups and downs over the years. They collaborated on things like support groups in the early days, and some people argued they got too close to one another. But Mermaids has also criticised the Tavistock for not referring children for puberty blockers

quickly enough. The charity now sees itself as a critical friend of the Tavistock. Well, I think most of our concerns are around the waiting list. So right now, the waiting list is at 2.9 years just to access a first appointment, which is really shocking. And I think it's just so everyday for us that sometimes I forget the gravity. Mermaids believes that being trans is not a condition or a problem that needs solving. It's just a reality for someone. Any other problems tend to stem from how the world deals with that. I'll let Kai explain. But that higher levels of self-harm or depression or hate crime and other things,

they're all interlinked with how it is to exist in the world as a trans person, exist in a transphobic world, frankly, where the media you might consume, the ways in which politicians are talking about you, the ways in which sometimes your own ways in which politicians are talking about you, the ways in which sometimes your own schools and religious leaders are talking about you, make you feel like something is wrong. And that is the cause of the depression, not you being trans. I'm worried that if it's assumed that there are no other issues going on for gender questioning people, then other important factors may be missed.

You need to understand someone's whole context, but the service isn't about fixing someone. It's about people going to get around their gender dysphoria and providing support for that. It has not been our experience that people have kind of missed glaring other contexts because they're so focused on the gender dysphoria. It's definitely a boogeyman kind of argument. I try again. But the question that I find really hard to ask as someone who is supportive of all people's rights is, for some people, might being trans actually be looking for an answer to something else that they're really unhappy about. So they might be unhappy with their body or they might be unhappy with

how they're loved or how they're cared for and they're looking for an answer and being trans might provide them with a community but they might see an answer in that so i think in that sense the the basis of the question is playing into a fear-mongering that doesn't actually have a base in evidence it is about saying well there must be something going wrong there this can't be that straightforward there must be some nefarious reasons why people are transitioning um which can only for me come from a point of view of assuming transitioning and being trans is a bad thing right there must be something going wrong to make this happen i try explaining to kai that that's really not what i'm saying i'm trying to consider the fact that

different things could be true for different people. I guess, I mean, my question wasn't, is that the case? It's just that might it be the case for some people? And I think one of the things I'm trying to do with this podcast is get beyond the kind of binary arguments and say, lots of things might be true at the same time and actually making big generalizations about a big group of young people loses the individuality in that. You might hear some defensiveness in my voice and in the work we do because it isn't just a conversation for us. And it's not just a conversation for us. And it's not just a conversation for the children, young people and families we talk to. Because it means when there

are these conversations, it can lead to court cases that temporarily eliminate their access to prescriptions that they need. In the case of only two years ago, it means that schools are feeling emboldened to not even allow young people to come in and use their name and pronoun at no pain to anyone else it means such heavy and intense things to us that when these kind of just asking questions dog whistles are brought up by some nefarious agents which you're i'm not not including you in, it really detracts from actually what is the core issue for me. And this is just a public health issue. And usually you don't have, in say, cancer treatment, all that many people who have no experience in cancer getting involved. But there's something about this issue where people who do not have the lived experience of either

supporting a trans person or being a trans person are quote-unquote just asking questions in this way that detracts from actually the policy issues I'm here to talk about which is about we need more capacity we need a staff workforce pipeline to allow for these clinicians to be well informed and good at their jobs. Is it dog whistle to ask if there could be different things going on for different people? I don't think so. To me, it demonstrates the impossibility of moving forward if people will only exist in entrenched positions on both sides. Here's a show that we recommend. Hi, I'm Una Chaplin, and I'm the host of a new podcast called Hollywood Exiles.

It tells the story of how my grandfather, Charlie Chaplin, and many others were caught up in a campaign to root out communism in Hollywood. It's a story of glamour and scandal and political intrigue and a battle for the soul of a nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow and monetize their podcasts everywhere. ACAST.com

Everywhere. AKS.com. After talking to Emma and then Kai, I'm left with questions in my mind about JIDS. If the argument outside the clinic has been getting more radical, is there a possibility that the clinic, or parts of it at least, has at some point been captured by an ideology? At every NHS trust, the first port of call for a journalist is the press office, and the Tavistock is no different. But when the journalist Hadley Freeman got in touch about a piece she was writing, she didn't get the reaction she was expecting. It's fair to say that Hadley is a reasonably loud voice in the noise surrounding the debate on gender. She is a prominent gender-critical feminist who's been questioning

the work of the Tavistock. Her interest in jids is very specific and born out of her own experience. When I was younger, I was anorexic for a long time, and I was in hospital for three years between the ages of 14 and 17. And seeing all these girls suddenly around where I live in North London wearing very baggy clothes, you know, their painfully flat chests, by which I mean their chests were artificially flat, sort of shrinking into themselves, it sort of echoed in my head with experiences in my past.

Hadley has just finished writing a book on anorexia. And I did wonder if the reason there were so many teenage girls now expressing gender dysphoria, if this was a kind of new version of anorexia, because it seemed to have a lot of overlaps in terms of body hatred, body alienation, a fear of becoming a woman, which is what anorexia really is at root about. Anorexia always comes on in adolescence. She spoke to some former employees of the Tavistock, but obviously the people she really needed to speak to were the clinicians working at JIDS now.

So she got in touch with the press officer. So here's what I'm writing about. Here's what I've heard from your doctors. What do you say? What do you say on behalf of JIDS? And he said, well, that's all very interesting, but we are not going to speak to you because on December something something of last year, you posted a tweet comparing us to Nazis. And I was really surprised on multiple levels. And then he read it out. And I realized he was talking about a conversation I've been having on Twitter. This wasn't addressed to my followers. You'd have had to click specifically on my tweets to see it. It was around the time of the Keira Bell case, and inevitably Twitter

was on fire. To some people, the three judges in the case were now the enemy. The barrister, Jolianne Morn, paraphrased the famous Pasta Nimola poem by saying, first they came for the trans people and perhaps you didn't speak out because you were not trans. And I replied, the difference is that the Nazis medicalised children and these judges were trying to stop it. Which is a tweet I stand by. That is factually correct. It might be factually correct, but Hadley acknowledges it wasn't temperate. To be honest, comparing anyone to Nazis on social media is always a bad idea. media is always a bad idea. Hadley says her tweets delete automatically, so she was surprised that eight months after the Twitter exchange, the press officer had found it. He said, oh no, we saw it and

we saved it. So they have like files of what people say. And I said, that's really odd that an NHS trust sits around saving tweets. And he said, well, you know, you compared us to Nazis, which I would say I didn't exactly, but sure, if we're going to go with that analogy. And I said, I understand why you're upset, but isn't the best way to bridge this divide between the sides here, so to speak, is for us to talk to each other. And I would like to talk to you. He said, well, no, no, none of our physicians want to talk to you. And what do you take from that? What I felt at the end of that was I'd written previously about the Scientology, the Church of Scientology, and they were exactly the same. When I would try to get responses from them due to various things, they would say, no, we saw this thing you once wrote 15 years ago in which you made a joke about Tom Cruise, or we saw your social media.

It's a cult. It's a cult attitude. You're either with us or against us. If you say anything critical, we won't talk to you. I've never had that experience from a publicly funded body. Neither have I. But I did when I first rang the Tavistock press office, who similarly said they had researched my tweets and found that I hadn't tweeted about them before. For a publicly funded institution to refuse to answer questions from critics is unusual. At one point, they tell me they won't work with journalists who are also talking to the Tavistock's whistleblowers, which arguably means they won't work with anyone who reports in a rounded way.

Safe to say I don't agree with them on this. The Tavistock said in response that they had responded to over 100 media inquiries in the past year alone. A spokesperson said, Our clinicians are extremely busy. Their time is very valuable. Our waiting times are too long and we do not have the capacity to accommodate every request. On occasion, we may decline requests, including those that are not about the service or those made by international outlets. Even so, that vetting of who they will or won't speak to suggests an institution under siege

and not behaving like any other NHS service. In January 2021, there's another blow to the Tavistock's reputation. The Care Quality Commission, that's the body that inspects the NHS in England, issues an absolutely damning judgement of jits. The report isn't focused on puberty blockers. In fact, it goes out of its way to say they're in line with the best practice on that. It's mainly about the effects of the waiting list.

At this stage, there are 4,600 people waiting for a first appointment. The report concludes that... Many of the young people waiting for or receiving a service are vulnerable and at risk of self-harm. I put that concern to Polly Carmichael. You know, there just are some realities that mean, unfortunately, hugely unfortunately for the young people waiting on our waiting list, you know, that there isn't an immediate solution,

there isn't a workforce out there. The CQC was also critical of how the service was run. Caseloads were too high, staff under too much pressure. JIDS didn't properly record whether young people had consented to treatment. Record keeping was poor. Did you undervalue the data at points, did you undervalue the record keeping? So I don't think those things have been undervalued. So certainly in terms of data collection, there has always been data collection. But, you know, obviously there's different sorts of data and it's how it's reported.

So, you know, we've always had to report some outcome data to our commissioners. So do you dispute what the CQC said? No, I'm certainly not disputing what the CQC said. I think, you know, there's always room for improvement. And I think it's a fair comment that, you know, within a multidisciplinary team with a range of professionals, with a range of professional backgrounds and trainings, there may be inconsistency then around how things are recorded. Polly says they've improved their record keeping since then. There's another interesting line in the CQC report. Staff did not always feel respected, supported and valued. Some said they

felt unable to raise concerns without fear of retribution. I think back to what Polly said about people working in abortion clinics who don't agree with abortion. Polly says that some people's views were incompatible with the service so whilst you know i respect that people have different views there you are right is ultimately a line where if those views are incompatible with the way in which or the nature of a service that's offered then you know it's not going to work in that service. But isn't that a bit like the binary black and white nature of the external debate playing out inside your clinic and inside your team? Because what you've just said to me is

black and white. It's almost you're with us or against us. I'm not saying you're with us or against us. What I'm saying is that within a service, if there are completely incompatible views and a view that, you know, does not support the way the service is commissioned, then, you know, I can see that's problematic. It does sound a bit with us or against us. But if the service specification is to refer people for puberty blockers, and the service starts from an affirmative standpoint, how can it accommodate staff who don't take the same approach? This is the reality of a service operating in such a contested field.

The next bit of the CQC is direct. The service was not consistently well led. I put that to Polly in a Zoom call. Well, I genuinely feel that how all of this happened is much bigger than any individual. And I suppose what I think is destructive is the increased personalisation and attack on individuals. If you're asking me if there's anything I'd done differently, I'm sure there are things I'd have done differently. Whether actually they'd have made a difference is another question. It's worth pointing out that it wasn't all negative and in some quite important ways. The CQC inspectors found that young people were treated with compassion and kindness and their privacy and dignity was respected. Feedback from families was overwhelmingly positive.

And critically, when it came to puberty blockers, it said staff referred young people for medical treatments in line with good practice. But that's not what has been remembered. Should I have been more outspoken? Should I have been more assertive at different points? But, yeah, I maybe could have been more outspoken? Should I have been more assertive at different points? But, yeah, maybe could have been. Maybe things would have been different.

Maybe they wouldn't. At the end of 2021, something else happens that hasn't lodged in the narrative about the Tavistock. It was successful in overturning the judge's decision in the Keira Bell case. The Tavistock wins the case in the Court of Appeal. Once again, its clinicians and not the courts will judge whether a young person is competent enough to decide their own treatment. But it's too late for the Court of Public Opinion.

The overturning gets a fraction of the coverage that the original verdict received. It feels like the clinic's fate is set and more scrutiny is on its way. NHS England is the government organisation that is ultimately responsible for commissioning services such as JIDS. It writes the spec and works out how much demand there is for a service and has to find the resources to make it work. But it tends not to take the heat.

So it appoints Dr Hilary Cass. First of all, there's going to be a lot of listening, listening to everybody who has experience, either as a young person, a family member or a professional in the field. A former president of the Royal College of Paediatrics and Child Health to chair an independent review into the work of JIDS. As best we can, gaps in that evidence with our own research. She publishes her findings in February 2022.

Her conclusions are clear. Cass describes how staff were at odds about when to refer children for hormonal treatment. Some were more strongly affirmative, some more cautious and concerned. The report talks of overshadowing, meaning that in some cases, a young person's wider mental health problems are ignored by the focus on gender. But the main criticism, like the CQC report, was of a long waiting list, which are leaving children in severe distress.

It amounts to a considerable risk. Hilary Cass calls for more services spread out across the country. In a letter to young people and their families, she assures them that services won't be reduced or stopped. She writes, I want to assure you that this is absolutely not the case. The reverse is true. I think that more services are needed for you closer to where you live. The gender critical factions sees on her report as evidence that the service is as wrong as they say it is and that it

should be wound down. The trans healthcare supporters say it's a license for more treatment, not less. It's like the black gold dress again. It means all things to all people. There's another important point. Hilary Cass is adamant that we need evidence in order to design a new treatment model. What happened to all the children who've been through the Tavistock? Are there other detransitioners like Kira Bell? So a study is commissioned to track 9,000 ex-JIDS patients. There's a promise or an ambition that the future model of care for young trans people might be based on some actual evidence

rather than the culture and beliefs that have buffeted the service to date. But in June, I talked to some of my senior NHS sources. They're telling me the commissioners can't wait any longer. The Tavistock is becoming too unstable. The risks to the children on the waiting lists too high. The clinic is going to be closed, fast-tracked ahead of time. Then, in July...

Really strange moment. I'm sat by a swimming pool in Greece and you can hear the cicadas in the background. I've literally just finished reading the last of the transcripts of our interviews with Polly Carmichael as I received a breaking news alert saying that the Tavistock is being shut down. This is what we expected, what we knew from all our conversations behind the scenes, our sources were telling us would happen. But I'm thinking now, how does it affect our story? What's the urgency in the story about the Tallerstock?

Is the story over now that it's been closed? It turns out there's a whole other story I need to tell you about the fast-tracking of the closure of JIDS. It's about the safety concerns for kids on the waiting lists. It's about the real harm that's being done. And it's about what happens when culture outpaces the science and then the politics kick in. Next time in episode six. The NHS services in this area are too narrow.

They are overly affirmative and in fact they're bordering on ideological do you recognize the number 15 do you know what i really wouldn't be happy saying recognize or not i don't know how i got through it i don't know how i'm here today not to get meta and all kind of emotional and soppy but I don't know how I survived that. If she does transition medically physically how do you think that will affect your relationship? I don't know it will be very hard very hard if she goes on testosteronerible. I can't bear to think about her sounding like a man and, you know, the voice breaking. It is just too ghastly to think about, really. I have been told by two credible sources that there have been political pressures from the top.

Where is the line between politics and how we treat children. Thanks for listening. The final episode is available to listen to now. This series is written and reported by me, Polly Curtis. The producer is Katie Gunning. The executive producer is Jasper Corbett. The Tavistock is a Tortoise production. Another thing.