Exclusive: NHS saw an opportunity for 'income generation' from first child gender clinic in Belfast
Northern Ireland’s health authorities believed there was a possibility for “income generation” when Belfast Trust set up a new child gender clinic offering medical interventions, documents seen by the News Letter reveal.
The Health and Social Care Board approved the Regional Gender Identity Service in 2013 – a service which allowed hormone treatments such as as puberty blockers to be used on children.
However, when signing off the service, officials stipulated that no “irreversible” treatments should be provided to children.
Belfast Trust says it did not in the end have the capacity for external referrals. It has also defended the prescription of puberty blockers – saying “irreversible treatments” were considered at the time to be “gender affirming surgeries”.
Puberty blockers – now banned in the UK amid safety concerns – stall normal development in boys and girls. Gender affirming care is a euphemism for surgeries to remove or replace body parts, to make people appear more like the sex they identify with, and are usually carried out in adulthood.
The latest revelations come amid ongoing controversy about the origins of the NI service – and who signed it off. Documents seen by the News Letter show that there were no specific details about the clinic in a commissioning plan signed off by former DUP health minister Edwin Poots in April 2013/14.
That report did, however, reference “emerging issues in relation to the small but growing numbers of young people under 18 years presenting with gender dysphoria and the need to develop a consistent service response”.In the background, Belfast Trust had been seeking approval for funding for a children’s gender service – submitting a plan to the Health and Social Care Board (HSCB) in February 2013.
That was eventually signed off by the now-defunct HSCB on June 25 2013 – with three key conditions attached. The third stated: “Although the capacity as outlined is for the population of Northern Ireland, given the specialist nature of this service it is acknowledged that the service provides the opportunity for income generation for the Trust. The Board will monitor the total activity for the service and will make adjustment to the level of investment according to demand and any income that is being generated”.
The approval followed a request by Belfast Trust for funding to allow “intervention to meet the specific gender identity needs” of u18s – describing it as a “regional assessment and specific intervention” service.
At the time, HSCB commissioned services – and acted as a middle-man between the Department of Health (DoH) and NI’s health trusts. A number of senior figures in the DUP, past and present, argue that this was a screen between their ministers and policy areas with which they may have been uncomfortable.
However, that is entirely rejected by others in the party – who point out that various services are currently commissioned on a regular basis by Trusts without ministerial oversight.
Former minister Edwin Poots has said that he had “no role whatsoever in the establishment" of the service, and “nor was he informed of its establishment”. Last week, the News Letter reported that he had answered questions relating to the staffing, funding and waiting lists for the Gender Identity Service in June 2013.
The latest documents seen by the News Letter show that was in advance of the children’s service being approved at the end of that month – after having been proposed to the HSCB in February. DoH is yet to respond to a query, submitted over a week ago, about whether children were treated by the gender clinic in 2013 – prior to the opening of the child service.
The News Letter asked Belfast Trust if it disputes the characterisation that it saw a possibility for “income generation” from the service – and whether it was successful in attracting children from outside Northern Ireland.
Belfast Trust said: “At this time, it was thought services outside of NI may have sought an extra contractual referral for consultations from the Gender Identity KOI service. If this had been the case a cost would have been incurred by any service outside NI to access this”.
The trust said it later became evident the service would “not have capacity to offer anything beyond the regional service” – and no further action was taken. It was asked if it was confident that prescribing puberty blockers to u18s was in line with the request for no irreversible treatments.
A spokesperson said: “When commissioned in 2013 irreversible treatments were considered gender affirming surgeries under the WPATH guidelines. KOI has never provided access to surgical interventions for under 18s. The Endocrine Pathway within KOI was closed in March 2020 to any new referrals to the KOI service. The Cass Review was published in April 2024. BHSCT continues to work with the Department of Health on the development of the Lifespan service model for NI and the recommendations of the CASS review”.