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What’s going to happen at the beginning of 2021?

We are not expecting to hear whether the Tavistock has permission to appeal until January 2021 and even if it does, the appeal won’t be heard until later in the year. Further, GIDS have confirmed that all clinical reviews – which will determine whether a ‘best interests’ order will need to be applied for – will only start at the end of January 2021.

Please see the GIDS statement published 22 December HERE.

We would encourage you to check the GIDS website for the latest updates over the Christmas period and we will be back updating our FAQs from 4th January 2021.

We hope you are able to have a rest over the Christmas season. As ever, please don’t hesitate to reach out to our Helpline should you need any support

YOUTH FAQs: Bell v Tavistock and Portman case 

These questions are created to help young people understand the recent court case and what it means for them. 

For ease, our answers also aim to include and reflect the NHS England’s recent ‘amendment’ to its services that were brought in because of this case.  

This is a live situation and we will do our best to keep this page up to date, but you may also wish to keep regularly checking the GIDS website.

1. What are people talking about when they say the ‘Keira Bell case’ or the ‘Tavistock case’?

They are referring to a case that was ‘heard’ in the High Court in October 2020, which was deciding whether under 18s can understand enough about puberty blockers and hormones to make their own decision about whether to take them or not. 

Keira Bell and ‘Mrs A’ were the ‘Claimants’ in the case and the Tavistock and Portman NHS Foundation Trust was the ‘Defendant’ in the case. 

The judges’ decision was published on 1 December 2020. 

2. What is the High Court? 

The High Court is the court that has made the decision in this case. As its name suggests, it’s one of the most important courts in England & Wales and its decisions are only overruled by the Court of Appeal and then the Supreme Court. 

You can find a diagram explaining the structure of this country’s court system HERE

3. What did the High Court decide?

Basically, the court has said that people under 16 are unlikely to be able to ‘consent’ to hormone blockers on their own.  

As a result of this decision, the NHS England has changed the process around accessing hormone blockers and now, a court has to decide whether it’s in someone’s ‘best interests’ to start puberty blockers before a doctor can prescribe them. 

For those over 16, a court may be asked to decide whether someone can start hormones, it will depend whether the person’s lead doctor is unsure if the person understands enough about the treatment. If the lead doctor is unsure, then a court will be asked to decide whether it’s in someone’s ‘best interests’ to start cross sex hormones before a doctor can prescribe them. 

4. What is the NHS England Amendment? 

This is the update that the NHS England has made to its services as a result of the Bell v Tavistock case. The Amendment was published on 1st December 2020 and shows what process changes the NHS England has made because of the High Court’s decision.  

5. Is the Bell v Tavistock result the law now? 

Yes, the High Court’s decision is the law (it is a piece of ‘case law’) until a higher court overrules what the High Court has decided, maybe after an appeal.

The NHS England Amendment is not the law itself, but has been introduced as a result of the new case law. 

6. What is case law? 

Case law is when a court decides what the law is and what it should be and how it should be applied.

7. I live in Scotland / Northern Ireland – am I affected?

Not technically, but it may still influence doctors and courts in Scotland and Northern Ireland. 

8. I’m under 16 and on the waiting list, will I be able to get hormone blockers? 

GIDS is not stopping their emotional support service so you should still receive an appointment letter at some point depending on where you are in the waiting list.  

If after the consultation process, it is decided that hormone blockers may be something that would benefit you, GIDS will apply for a ‘best interests’ order from a Court. 

As we understand it, no new referrals for prescriptions are being made at this time. 

More information on what a ‘best interests’ order is can be found below. 

9. I’ve just started the consultation at GIDS, will I be able to access hormone blockers? 

GIDS is not stopping their emotional support service and so this should continue as normal. 

If you are under 16, if after the consultation process a doctor thinks that hormone blockers may be something that would benefit you, GIDS will need to apply for and get a ‘best interests’ order from a Court. More information on what a ‘best interests’ order is can be found below. 

As we understand it, no new referrals for prescriptions are being made at this time. 

10. I’ve been referred for hormone blockers already, will I still be able to get them?

If you’re under the age of 16 and have been referred but not started on hormone blockers, as far as we understand, your referral will only keep going if your doctor in charge of your care reviews your file, thinks that hormone blockers are in your best interests, makes an application to the court and the court says it’s in your ‘best interests’. GIDS have said reviews will start at the end of January 2021.

GIDS are advising that all those with scheduled endocrinology appointments will be contacted in due course and individual plans will be made. You can find out more on the GIDS website.

11. I’m already on hormone blockers, will I be able to get another prescription?

If you’re under 16 and already on hormone blockers, your doctor will have to review your case and decide if they think the hormone blockers are in your ‘best interests’ and if they do, they will have to make an application for a ‘best interest order’ from the court. GIDS have said reviews will start at the end of January 2021.

GIDS are advising that all those with scheduled endocrinology appointments will be contacted in due course and individual plans will be made. You can find out more on the GIDS website.

If you are already being seen by an endocrinology team, you will receive a letter from GIDS with further information, which states that if you are under 16, and already receiving puberty blockers “your access to medication will not be automatically withdrawn”. You can find this letter on the GIDS website.

12. What if I am thinking about starting hormones?

GIDS have advised that since the Court ruled that if you are aged 16 or 17, you are more likely to be able to give informed consent, and therefore, a ‘best interests’ order is probably not necessary for you to receive, or continue to receive puberty blockers or cross sex hormones. 

GIDS have stated they will still carry out a clinical review of your case. If there is doubt about the patient’s ‘best interests’, the lead clinician will have to consider an application of best interest to the court, through their NHS provider. GIDS have said reviews will start at the end of January 2021.

You can find out more on the GIDS website.

13. What is a ‘best interest’ Order? 

The ‘best interest’ order is a decision from a court that you need so that you can get hormone blockers if you’re under 16, or potentially cross sex hormones is you are 16 and 17. 

This order will say, if granted, that taking the hormone blockers or cross sex hormones is in your best interests. 

Currently, we are unsure which type of court the application will be sent to and what the application will look like, but we have asked the NHS England to let us know as soon as possible.

14. How long will the court take?

Unfortunately, we don’t know at the moment, but we have asked the NHS England to let us know as soon as possible. 

15. Will this mean I have to wait longer to start hormone blockers?

Again, we’re not sure but we think it will make waiting lists longer.

16. Who will apply to the court for this order?

Your NHS provider will apply and you won’t need to. We don’t know whether you will be able to apply yourself yet, but we have asked the NHS England to let us know as soon as possible. 

17. Is the case being appealed and if so what does that mean?

Hopefully. It has been confirmed that an application has been made and we’ll know if the case will be heard by the Court of Appeal, probably in the New Year. 

18. What can I do if I need support? 

Mermaids will continue to support trans, non-binary and gender-diverse young people, and their wider families, as we have been doing for the past 25 years, to create a world where our young can be themselves, and thrive. 

Our helpline is open Monday through to Friday 9am-9pm on 0808 801 0400, we also have a WebChat service that operates on the same days and times. 

There are also other amazing organisations out there that can also offer you support as well as us, such as – Gendered IntelligenceBarnardosGIRESNSPCCStonewallAll Sorts Youth 

19. Are you in crisis? Do you need help?

If you need someone to talk to, please reach out for support – there are several options for you and by no means is this list exhaustive. 

  • You can text MERMAIDS to 85258 for free 24/7 crisis support all across the UK. All texts are answered by trained volunteers with support from experienced clinical supervisors. 

What does the Court Order say?

The Court Order is the formal paperwork that sets out the decision of the court and literally sets out what it orders certain parties to do.

What does it mean that the decision was ‘stayed’?

You will see at paragraph 3 that the outcome of the judgment is ‘stayed’. This means the High Court essentially paused the carrying out of the decision until (whichever would be the later date) 4pm on 22 December or the decision of the appeal, should permission be granted. i.e. nothing had to be done immediately to implement the decision. Seeing clause 3 of the Order raises serious questions around why NHS England published its Amendment so quickly when it was not required. We are seeing the first hand impact of such haste, which has resulted in many young people and family members terrified for their future.

Considering the detail of the Order, we have asked NHS England to provide clarification on why they acted with the speed they did and ask that they suspend the effect of the Amendment, in line with the Court’s Order.