My most cowardly instincts warned me against interviewing Hannah Barnes. Those instincts had nothing to do with her, of course. Barnes is a fair, compassionate person and an exceptional documentary journalist for the BBC’s Newsnight.
It was the prospect of talking about her first book, Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, that brought on the cowardice. This investigation into the Gender Identity Development Service (Gids), a clinic at the Tavistock and Portman NHS Foundation Trust in north London, is as scrupulous as journalism can be. Barnes’s work was based on over a hundred hours of interviews with clinicians, thousands of documents, and close readings of official reports and legal judgments. But since Time to Think considers, unavoidably, issues of gender and identity, it is a controversial book – and was controversial even before publication.
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Barnes, whom I met recently in an office in London’s Somerset House, told me Time to Think was turned down by every major British publisher. Their responses weren’t negative: “Some said this is a really important story… You’ve got to tell it, just not with us.” Why not with them? “There was an acknowledgment from some that it would be too difficult among their team and their junior members of staff.” Barnes said her eventual publisher, Swift Press, struggled to find people who would copy-edit the book or design its cover.
The topic is fraught. What should be a debate grounded in evidence too often becomes furiously partisan, distracting from the young people struggling with gender dysphoria, who often face violence. (On 11 February a trans teenager, Brianna Ghey, was stabbed to death in Cheshire.) The only way left to approach it was the way Barnes did. Though pundits will use it as fuel for columns, Time to Think is no anti-trans polemic. It denies nobody’s identity, nor their right to a happy, harassment-free life with access to good healthcare. I tried to push Barnes into revealing whether this story was personal for her; whether she had an axe to grind, a child who had encountered Gids. The answer was “no”. Time to Think was personal in the sense that a story like this would be for any journalist.
Barnes, who lives in south-west London with her two children and husband, wasn’t sure she wanted to be a journalist. After studying PPE at St Edmund Hall, Oxford University, she briefly considered becoming a management consultant. But a natural nosiness led her towards radio, and then current affairs at BBC radio.
To tell the story of Gids over several decades, Barnes talked to trans people, their parents and clinicians – those at the core of this issue. “You might disagree with what these people are saying,” Barnes admitted, “but that was their experience.” The result is nuanced, ambiguous and, sadly, often disturbing. “It’s not my job to tell people what to think. I’m trying to present the evidence so people can make up their own minds.”
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Gids treated children and young people who express confusion about their gender identity. It was nationally commissioned by the NHS in 2009 and saw thousands of children. Treatment often involved helping them gain access to “puberty blockers”, usually the beginning of a medical pathway to physical transition. (The drugs are also prescribed to treat prostate cancer.)
There are extraordinary claims in Time to Think, made by the dozens of clinicians Barnes spoke to. Young people with autism, eating disorders and histories of family abuse – complex case histories – were referred to the service, then given puberty blockers. Staff involved in prescribing the drugs told Barnes they did not know how many children changed their minds about transitioning after being treated at Gids. When one former Gids clinician, Dr Anna Hutchison, met a young person who had changed their mind, they told her: “I can understand why children make these mistakes, but you? You are adults.” It’s a line that rings like a bell in your head long after you’ve finished Time to Think.
The clinic will shut later this year, to be replaced by a number of regional centres that will aim to offer more holistic treatment. An interim report published in February 2022 – as part of the Cass Review into gender identity services for children – found that the clinic’s “single specialist provider model is not a safe or viable long-term option” for young people experiencing gender incongruence or gender-related distress.
In the 2010s the service “buckled”, according to Bernadette Wren, who was part of Gids’ leadership team for a decade. An exponential increase in referrals put enormous pressure on the clinic: in 2019-20 Gids added 2,748 children to its case load; in 2009-10 the number was 97. There was also a shift in who was being referred, with the largest group now birth-registered females presenting for treatment in their teens. Barnes writes that, faced with these challenges, “Gids simply ploughed on, neither reflecting the fact that the existing poor evidence base [for puberty-blocker referrals] was designed for a different cohort of young people altogether, nor considering that perhaps an alternative to the medical pathway needed to be considered.”
The collapse of Gids is being described as the biggest medical disaster for decades. Clinicians interviewed by Barnes compared it to East German doping scandals in the 1970s and the failings at Mid Staffs hospital in the 2000s. While some Gids doctors spoke positively of their experience there, others described the clinic to Barnes as “mad”.
Barnes was more cautious. During our conversation she stressed that there are more unknowns than knowns. “Has Gids helped some people? As far as we know, yes, it has. I’ve spoken to those people,” she said. “Has it harmed people? Yes, it has. And I’ve spoken to some of those people.” There is not enough data available to know whether more young people were helped or harmed by Gids’s treatments. “What’s missing in this whole discussion,” Barnes said, “is that, actually, there’s loads that we don’t know.”
Barnes realised, after producing several films with the science correspondent Deborah Cohen for Newsnight about Gids, that she had to write the book. “I just knew too much,” she said. “I felt that if you’re the average layperson, depending on what media you consume, you might think that there’s no debate in the clinical community about how best to treat young people experiencing gender incongruence.” If this debate had taken place in public, it would have led to accusations of transphobia. “But that couldn’t be further from the truth. It’s so much more complicated than that.” The idea that the clinicians interviewed for Time to Think might be transphobic bewildered Barnes. “They’re liberal Guardian-reading lefties… It’s just not believable that these concerns come from transphobia.”
Hannah Barnes will likely be accused of it anyway. This is a difficult subject, maybe the most difficult in the public sphere today. For years it has been presented as a fundamental clash between those who believe, as the trans author Jan Morris put it, that being trans is a “passionate, lifelong, ineradicable conviction” and those who believe it is closer to a pathology that requires therapeutic intervention. You come away from reading Time to Think wondering what exactly that debate was supposed to be about. While Gids carried out its work, research was published that suggested 45 per cent of trans young people have attempted suicide at least once. That was the real story – a story about children’s health, and a struggling service – and that was where the truth, however uncomfortable, lay. “Sometimes,” Barnes said, “the truth is awful.” That doesn’t mean we should hide away from it.
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This article appears in the 15 Feb 2023 issue of the New Statesman, Why the right is losing everywhere