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James Palmer

Medical Director for NHS Specialised Services

NHS England, PO Box 16738, Redditch, B97 9PT

By email to: james******1@nhs.net, england.contactus@nhs.net

22 December 2020


Dear Dr Palmer,

We write to you as you are the Medical Director for NHS Specialised Services. You will no doubt have seen the panic and distress caused by the recent determination against The Tavistock and Portman NHS Trust.

The Gender Identity Development Service (GIDS) was unable to reassure the courts that young patients going through their service would be able to give consent to treatment with puberty blockers.

You will know that this is an extremely well-evaluated treatment for transgender youth that is firmly set in standards of care in the large International Centres of Excellence across the world. We are very surprised that the GIDS policies and protocols, along with the evidence provided to substantiate them, were unable to provide sufficient reassurance as to the clear clinical governance procedures in place.

As a result of the judicial review, patients have been advised that medical treatment will be paused or not started and to take this issue up with NHS England Commissioners of GIDS. You will not be surprised to hear that this has caused extreme distress to many young people who are eligible for this treatment and who require it.

Puberty Blockers are indicated in patients who fit the criteria for Gender Incongruence in Childhood and Adolescence from Tanner Stage 2 of puberty. To deny them access to this essential treatment means that they will undergo serious, significant, life changing physical developments that could have been avoided. The mental health implications of this cannot be underestimated, and the risk of self-harm and suicide must be acknowledged.

As medical director, you are an ‘advocate for the patient at the organisation’s highest level and are crucial to improving the quality and value of care.’ You share responsibility for decisions about the service provision for Gender Identity Development Service for Children and Adolescents.


Urgent action is required and your leadership and direction provided to the GIDS are crucial. We urgently request the following:

  1. A statement from you on the current status of service provision to trans youth.
  2. Clear expectations of specialists who are commissioned to provide this care.
  3. Clear guidance to General Practitioners and other healthcare professionals who are currently supporting the psychological and medical care of transgender children and adolescents.
  4. An investigation into why the clinical protocols and evidence of qualitative care were not able to reassure the court that patients could safely consent to a treatment that is standard practice in centres for the care of trans youth across the world.
  5. Interim solutions to prevent harm.


Yours sincerely,