Home › Research › Tavistock

Tavistock GIDS closed: from staff concerns to the Cass Review

The Tavistock children's gender clinic (GIDS) closed at the end of March 2024 (source). It was preceded by the Bell v. Tavistock lawsuit, the interim report of the Cass Review and concerns raised by staff.

What GIDS was

From 1989, the Gender Identity Development Service (GIDS) was the NHS clinic for children with gender dysphoria, housed within the Tavistock and Portman NHS Trust. When it was founded, the service saw fewer than ten children a year. In 2011 the UK began the 'early intervention study' with puberty blockers, based on the Dutch Protocol. According to the Cass Review, from 2014 blockers were also given outside that study, to a broader group of patients than the original study would have admitted (source).

The growth and the concerns

Until 2009 GIDS saw fewer than fifty children a year; from 2014 referrals rose exponentially, to by report about 5,000 in 2021/22, a figure that according to the Cass Review may contain double counting (source). The group shifted from mainly boys before puberty to mainly girls in or after puberty (source). David Bell, for 25 years a consultant psychiatrist at the Tavistock trust, submitted an internal report on GIDS to the trust's leadership in 2018 as a staff governor, in response to concerns shared with him by GIDS staff (source). Marcus Evans, a long-standing member of the trust's board, resigned in response to that report; his wife Sue Evans, formerly employed at GIDS, was involved in the legal action that became Bell v. Tavistock (source).

Bell v. Tavistock (2020-2021)

Keira Bell, a detransitioner, began puberty blockers at 16, started testosterone at 17 and had a double mastectomy at 20; in 2019, aged 22, she stopped taking testosterone and she describes regret (source). On 1 December 2020 the High Court ruled that it is unlikely that a child under 16 can consent to treatment with puberty blockers (source). The Court of Appeal overturned that ruling on 17 September 2021: it is for clinicians, not the court, to decide on competence (source).

Cass Interim (2022) and Final (2024)

The interim report of the Cass Review (2022) pointed to major gaps in the research base underpinning clinical care and wrote that little is known about medium- and long-term outcomes (source). In July 2022 NHS England decided to close GIDS and replace it with regional centres (source). The final report writes that a single national service with too few links to local services was not a safe or viable long-term option and recommends a regional model; it did not examine GIDS's earlier practice but looked at future care (source). After the final report NHS England wrote that puberty blockers are no longer routinely available in NHS gender care for children and young people (source).

What this says about the Netherlands

On 30 June 2026 the Dutch Health Council wrote that Dutch care is carefully organised and sees no reason to organise it differently, although the effects on cognition, fertility and the long term are still insufficiently studied; the council also writes that the English literature on which the Cass Review rests does not automatically apply to the Netherlands (source). Elsewhere too, review bodies reached more cautious conclusions: Sweden (SBU 2022, source) and Norway (Ukom 2023, source); on the Finnish guideline see COHERE Finland.