Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children

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This is not an easy book to read - but it's important that it was written and published. Hannah Barnes strikes a balanced, journalistic tone throughout the sorry tale of a pioneering NHS unit becoming ensnared in a crisis not wholly of its own making, but then doubling-down on idealogical grounds and creating the potential for very great harm to children and young people in the process.

Time to Think - the inside story of the collapse of the

FiLiA: I think one of the difficulties, is that it’s at every level. At the individual, when there's the two clinicians in the room, looking at the patient. Then beyond that, it's in that team meeting where you're allowed to speak but nothing seems to then happen. And then it's going to the more senior people, and having these secret meetings with, for example, Dr Bell or someone and creating this report. Then making those reports and then nothing happens from the reports. And then you have this top safeguarding lead [Sonia], who you're then not allowed to speak to because that's apparently going to be perceived as a hostile act. And so, I think is one of the questions that, I was thinking was: ‘Well, what is it about child safeguarding that provokes this idea that it’s being transphobic? Or vice versa?’ Some who had come into the profession to do talking therapy did almost none, as patients were referred for drugs sometimes after two sessions. Meanwhile, some of the gay staff were wondering if this all just conversion therapy for gay kids. Some staff felt under surveillance; they had doubts but they were reticent as expressing them could lead to accusations of transphobia. To say that sex itself is immutable was clearly heretical. The book has a narrow focus on GIDS and does not comment about the way in which the number of children with gender dysphoria increased so dramatically. This is to the book’s credit. The narrow focus on the exposition of events at GIDS in such a careful way is very impressive. Will Lloyd of the New Statesman called it "as scrupulous as journalism can be" and noted "[t]hough pundits will use it as fuel for columns, Time to Think is no anti-trans polemic ". [11]And I wondered a little bit about, do you think that there's something about, like you were saying, we're not really sure if it's a disease, we're not really sure if it's a condition or if it's just a state of identity, but is there something that is almost inherently troublesome with the condition or the question of gender dysphoria and paediatrics itself? That is causing perhaps, less of a focus on child safeguarding? As in, is this a problem with the idea itself? Or is this an issue of different practices locally that seem to be going beyond the scope of what is considered to be reasonable medical practice? Given that these sorts of issues are cropping up in lots of different places? Hannah Barnes’s well-researched book delves into how this situation arose. She speaks to over 60 clinicians: psychologists, psychotherapists, nurses, social workers. It is this forensic approach that makes her findings so devastating. Barnes is not coming at this from an ideological viewpoint. Some of her interviewees are happily transitioned. Others are not. They feel that the risks of the medical pathway they were put on were never explained to them or that they were too young to understand the full implications. One girl asked if when given testosterone she would be able to produce sperm. Dr Anna Hutchinson is a clinical psychologist who has specialised in adolescent mental health and embodied distress over many years. She was a senior psychologist in the GIDS service between 2013 and 2017 and her concerns relating to the clinical practice she witnessed there formed a key part of the narrative in “Time to Think”. LOCATION If a child has some of the minor gender non-conforming attributes that gay children can sometimes (but not always) possess, they would be happier to transition them than to accept their child's sexual orientation and let the child know that they are loved in all their gayness - a phenomenon that we know occurs in nature across all mammals. Instead, what Time to Think offers is almost like a time capsule of what happened inside GIDS. It is a forensic piece of work that captures what clinicians, patients and staff were thinking. Barnes writes with restraint. She avoids direct commentary, highlighting instead the reflections of those she spoke with:

Hannah Barnes and Time to Think — FiLiA Hannah Barnes and Time to Think — FiLiA

What is most inexcusable in this story is the fact that the failures of the early days of the service have simply been repeated down the years. The GIDS not only failed to take account of its own data, learn from it and put in place structures to ensure a safe service for children, it doubled down, allowing pressure from activists to dictate. The service became increasingly ideological, not less. In 2007, 50 kids a year had been referred to GIDS, but by 2020 there were around 5000. As a result, GIDS faced huge waiting lists, with junior shrinks having caseloads of 100, instead of 30 which would be the standard NHS practice. Many clinicians left. FiLiA: It sounds like these clinicians were put in almost an impossible position and in certain cases, definitely the empathy that you have for the participants in your book shines through. Even though sometimes it's infuriating. Because you kind of wish that you can have a more clear-cut story, of heroes and villains, and so on and so forth. So in that sense, it can sometimes be a slightly frustrating read. But I wondered if you would mind talking to us a little bit about what your discoveries were about the child safeguarding aspects in particular. Because I think one of the other things that this book has that's really important is discussion with Sonia Appleby after she had won her case. At times, the world Barnes describes feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for’ – Observer So I'm not a health specialist journalist. I'm a generalist and I tend to do long form journalism, in depth journalism. I'm not sure which other stories I'd compare it to to make a direct comparison. You know, I'm not sure how to answer that.Camilla Cavendish of the Financial Times described it as a "meticulously researched, sensitive and cautionary chronicle" and a "powerful and disturbing book" that reminded them of other NHS scandals. [6] Rachel Cooke, writing in The Observer called her work "scrupulous and fair-minded" and, with regard to GIDS, "far more disturbing than anything I’ve read before". Cooke says the account is of a "medical scandal" and "isn't a culture war story", concluding: "This is what journalism is for." [7]

Hannah Barnes review - The Guardian Time to Think by Hannah Barnes review - The Guardian

In the late 2000s and 2010s there was a dramatic rise in the number of children who had gender dysphoria. In 2009-10 GIDS saw 97 children, by 2015-16 this had increased to 1419 children. The rise in female at birth patients went from 32 to in 2009/10 to 1981 in 2019/20. This book contains so much more than is outlined here. It should be read carefully by everyone involved in the care and safeguarding of children, including schools and government ministers. What other institutions are in thrall to transgender activists, leaving the most thoughtful professionals afraid to speak out? Where else do we see the same failure of safeguarding demonstrated at the GIDS? Why are the same ideological groups that influenced the GIDS allowed to influence policy in schools? Medical harm may be the most extreme result, but what other harms are being caused to children in schools, social care and child agencies by the failure to put facts and evidence ahead of ideology?As Barnes makes perfectly clear, this isn’t a culture war story. This is a medical scandal, the full consequences of which may only be understood in many years’ time. Among her interviewees is Dr Paul Moran, a consultant psychiatrist who now works in Ireland. A long career in gender medicine has taught Moran that, for some adults, transition can be a “fantastic thing”. Yet in 2019, he called for Gids’ assessments of Irish children (the country does not have its own clinic for young people) to be immediately terminated, so convinced was he that its processes were “unsafe”. The be-kind brigade might also like to consider the role money played in the rise of Gids. By 2020-21, the clinic accounted for a quarter of the trust’s income. Hannah Barnes lays bare the whole appalling business in a clinical and forensic fashion. She is fair-minded - she speaks to young people who avow that they were helped by the service, as well as those who were irretrievably damaged. She uncovers a truly appalling management culture, and lays the blame very much with the leadership, although she does not impugn motive (there's some speculation here but no conclusion).