I spoke with Dr Sam Hall, who started the trans health service at WellBN in 2020:
The trans health service at WellBN has built up over 5 years with NHS Sussex funding and caters for all ages since we have never agreed with the discriminatory stance taken by NHSE (namely that trans kids should be treated any differently to trans adults). We have the clinical expertise and experience to look after these young people and hope to continue to do so. We are careful not to give any irreversible treatment, we honour and respect the right to autonomy and choice when it comes to reproductive capacity and controlling hormones, and we centre harm reduction in our service. We believe that the wider NHS provision for trans youth is harmful and have witnessed first hand the impact of this. There is research comparing experiences of the GIC model post Cass with the affirming model of care which gives stark evidence of the harm being done by the state to trans youth, as well as multiple Prevention of Future Death reports from coroners urging NHSE and other NHS bodies to provide better care for this growing cohort of young people.
At WellBN when we talk about harm reduction, it is an umbrella term that alludes to better mental health and less suicidality, but also reducing the more subtle psychological harm that comes through having to jump through hoops to ‘prove’ your identity. We see fewer people needing surgeries and better outcomes from nuanced care that takes account of the primary ‘harm’ of being assigned a gender at birth in the first place.
We teach young people that society sees gender as fixed and rigid, but this isn’t the case…Gender is just an idea set down by society on how we should act and present ourselves. It takes root in their bodies and lives, and causes distress which we help them manage. We talk about specific things that may be distressing, such as breast growth or voice change, and plan to mitigate against anything that might cause the young person to withdraw, feel shame, depression or intrusive thoughts. The ban on puberty blockers last year has left trans youth and their families feeling desperate and gives a message ‘you cannot be trans’. But of course we are trans regardless. The first thing these young people need to see and hear is that it’s ok to be who they are.
Five years of scrutiny for Dr Sam and WellBN
Dr Sam tells us:
Sadly the direction of political travel in the UK has affected WellBN greatly. There have been multiple investigations and inspections by the CQC, NHSE and the General Medical Council over the past five years. These have all had positive outcomes for WellBN and we have continued to expand our service, reaching more and more people in need, thanks to the Locally Commissioned Service funded by NHS Sussex. They fund care for over 18s, but we choose to treat all ages because to deny care to trans youth would be to be complicit with discriminating against them. I believe NHS Sussex are themselves being pressured to carry out this investigation when they have been fully aware of our service, and the high quality of care we provide, for the past 5 years.
Medical ethics
NHSE and NHS Sussex are riding roughshod over medical ethics by suggesting that national clinical guidelines MUST be adhered to at all costs. All doctors use guidelines and protocols in a nuanced way because medical ethics centre the patient’s autonomy. After NHSE issued guidelines about hormone prescriptions for under 18s in the Spring of 2024, WellBN practice did not change. We continued making best interests and ethically sound decisions on a case by case basis. In addition, the mechanism by which NHSE suggested hormones might be prescribed, didn’t actually exist and still doesn’t. The old GIDS clinic was crushed, the new ones not yet up and running; although they now are, many of our patients are refugees from these new clinics which offer only psychological support with a desired outcome being ’not trans’. I struggle to think of another healthcare specialty or arena that has national clinical policy issued by NHSE restricting people’s autonomy in this way, or telling doctors what they can or cannot do to the point of discriminating against a marginalised community like this.
WellBN have saved our lives
Dozens of young people and their families have given testimonies about the care they receive at WellBN:
“WellBN saved our lives” says a mother who saw her child’s life transformed through his care at WellBN. “The GP at WellBN was the first person my son opened up to. My son is now confident and happy in himself. Before that meeting he was anxious and worried all the time.’’
“The care our daughter has received from WellBN has been outstanding – inclusive, affirming, evidence informed and life-changing. Her wellbeing has significantly improved since starting gender-affirming care. She is happier, more confident, and mentally well. As her parents, we have witnessed the difference it has made first-hand.”
“My daughter’s GP was not willing to take over her private prescription, despite having guidance to that effect by NHS England and the Department for Health. As a result of being left with no hope, my daughter began having thoughts associated with suicidal ideation and self harm again. Consequently, we searched the UK, looking for a GP who felt competent to take on my daughter’s care and able to meet her needs. We have been extremely lucky in that WellBN were willing to take over her care and have been amazingly supportive in the process. “
“For our daughter, care from WellBN has been quite literally life-saving. Her mental health has stabilised, her distress has dramatically reduced, and she is finally thriving after years of uncertainty and fear. To hear that this small but vital service is now under review feels like the lifeboat we are clinging to is being deliberately rocked; or worse, dismantled.”
“I had heard about WellBN. So I emailed and registered my son, finally a service that cared about trans youth, listened and made us feel listened to. This made a world of difference to our lives. I can’t even explain in words the difference. After years of living hell where my son started puberty I felt safe, I felt my son was now safe. I got a prescription before the ban was in place and we were safe. We could live again. WellBN gave us our lives back. My son became confident again, goes to school and this year he has 100% attendance. Goes out with friends and goes swimming. He is a happy boy. “
I asked Dr Sam why this kind of care makes such a difference:
“It isn’t just or even about access to medical treatment. Over half of the kids we see are not on any medical treatment at all. Others come off treatment as they develop their self-understanding, which you can’t do if you’re panicking about the irreversible changes of a puberty you don’t want, or can’t cope with yet, or ever. What really makes the difference is this service being led by trans people. It’s the shared understanding that we all need in a cis world. We ‘see’ these kids for who they really are. It’s a recognition that only other trans or non-binary people would understand. And it gives them hope. ‘Here is a grown up one of me, and he is a doctor! Maybe I will be ok’. These stories of kids getting better and doing well as a result of our service, make all the strife worthwhile”
NHS Sussex ICB was asked for a reaction via email on 14 November, but at the time of publication no reply has been received.
