Dr David Levy, who led the report, described services as “falling down” when he began his assessment last year, citing extensive delays, inconsistent evaluations, and a critical lack of data.<\/p>\n
His review, commissioned after the 2024 Cass report on child highlighting a “lack of joined-up care across the wider healthcare system”. <\/p>\n
Dr Levy acknowledged the “challenging landscape, where debate is often hostile and polarised” surrounding gender care, likening his review process to “a veritable minefield you have to walk through”.<\/p>\n
In an interview with the Press Association, he said: \u201cI\u2019ve walked through the minefield. I had to tread very carefully.<\/p>\n
\u201cBut the clinics were very good about coming along with us, because we talked about this as an improvement journey. This is about getting things better for the patients, getting things better for the staff.\u201d<\/p>\n
Baroness Hilary Cass previously said she had been approached by a number of current or former adult gender clinic staff who told of their concerns about care being provided.<\/p>\n
Their most common worry was the \u201cvery limited time for assessment and the expectation that patients would be put on hormones by their second visit\u201d, she said in a letter to NHS England chiefs a month after publishing her report.<\/p>\n
The Levy review visited nine clinics since it was formally launched in July last year to look at the effectiveness, safety and stability of each service, and whether the existing service model is safe for patients.<\/p>\n
![\"Dr](\"https:\/\/www.newsbeep.com\/uk\/wp-content\/uploads\/2025\/12\/18133048-25ffe521-6800-4b55-91f3-7b7847a2296c.jpg\")
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Dr David Levy carried out a review in NHS adult gender clinics in England (Shivansh Gupta\/PA)<\/p>\n
Published on Thursday, it noted: \u201cAt the time of the review, forecast wait times for newly referred patients had risen significantly.<\/p>\n
\u201cA majority of GDCs (gender dysphoria clinics) were projecting waits of 15 years or more if no improvements were made.\u201d<\/p>\n
Dr Levy, an NHS medical director and cancer specialist, said he found the waiting times \u201cshocking\u201d and it had spurred him on to undertake the review.<\/p>\n
He told PA: \u201cMy reaction, when I was first told, I said to the person who told me, \u2018Sorry, did you say months or years?\u2019.\u201d<\/p>\n
The review branded these waiting times \u201cunacceptable\u201d and noted that the \u201cdistress some patients experience\u201d is often \u201cexacerbated by unclear waiting times and a lack of communication\u201d.<\/p>\n
His review found that long waits were at times considered \u201ca \u2018normal\u2019 part of this service, with no solutions being offered\u201d.<\/p>\n
Dr Levy, who while not a gender care specialist has previous experience in leading complex health service reviews, said some clinics had been unable to discharge patients who were on hormone treatments amid a lack of confidence among some GPs in handling these cases.<\/p>\n
Among the recommendations in his report, he said clinics could manage hormone prescribing for patients for a minimum of a year until levels are stable, before patients are then discharged into primary care.<\/p>\n
The review also concluded\u00a0there needed to be improvements in the culture at some clinics.<\/p>\n
He said he heard experiences of \u201csenior staff being disrespectful\u201d towards colleagues and \u201cnot allowing people to undertake audit activity to understand \u2018what are we doing? What could we do better?\u2019.\u201d<\/p>\n
At the time of her report Baroness Cass branded it \u201chugely disappointing\u201d that most adult clinics had refused to take part in research into long-term outcomes for people who had moved from care as children in the now-shut Gender Identity Development Service (Gids).<\/p>\n
Dr Levy said that currently, aside from waiting times data \u201cthere\u2019s virtually no other data\u201d available from the adult clinics, including to show patient outcomes and \u201cminimal clinical audit\u201d.<\/p>\n
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open image in gallery<\/p>\n
Baroness Hilary Cass carried out an earlier review into children\u2019s gender services (Yui Mok\/PA)<\/p>\n
His review stated that this \u201cmakes it impossible to properly understand patient outcomes and the safety of these services.\u201d<\/p>\n
He added: \u201cThese gaps place these clinics outside standard NHS quality assurance expectations.\u201d<\/p>\n
Asked why he thought this situation had been allowed to continue for years, he said: \u201cWhen you get around to the smaller departments, the ones tucked around the back of the hospital, the ones that don\u2019t even have a sign to them, people aren\u2019t really paying much attention to them.\u201d<\/p>\n
A further recommendation in the report is for more oversight, with trust boards and NHS England working to \u201cdevelop an individual service-improvement action plan for each clinic\u201d.<\/p>\n
Health Secretary Wes Streeting has previously branded long waits \u201cunacceptable\u201d, adding that it is \u201cfundamentally wrong that so many LGBT+ people still face challenges when accessing healthcare\u201d.<\/p>\n
On his overall findings, Dr Levy said: \u201cWhen I visited these services, they were falling down.<\/p>\n
\u201cThere were long waits, inconsistent assessment processes and absence of outcomes data.<\/p>\n
\u201cInefficient ways of working with not sufficient oversight from their trust executives and NHS England\u2019s regional team.\u201d<\/p>\n
But he said he is confident that following his recommendations waiting times will come down and there will be a more consistent process to assess patients.<\/p>\n
He added: \u201cWe will have joined up the health service, because this is about a whole healthcare system response. We will enable patients to be seen in a shorter period of time, in a consistent assessment process. We will have outcomes data, which will then inform the oversight by trusts and others. And patients will be assured they will get a consistent offer wherever they go.\u201d<\/p>\n
Professor James Palmer, national medical director for specialised services, said: \u201cWe know adult gender services must improve for patients \u2013 too many people are waiting far too long to get care, experiences of care are variable, and we need to ensure care is equitable wherever patients live.<\/p>\n
\u201cWe have already begun to take action to improve adult gender services by increasing investment and opening more clinics to help bring down long waits but we will use the recommendations in this report to further improve services across the NHS.\u201d<\/p>\n
Dr Levy will, from January, chair a new national improvement programme for adult gender services.<\/p>\n","protected":false},"excerpt":{"rendered":"Your support helps us to tell the story From reproductive rights to climate change to Big Tech, The…\n","protected":false},"author":2,"featured_media":259171,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[102,2960,56,54,55],"class_list":["post-324751","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-health","tag-healthcare","tag-uk","tag-united-kingdom","tag-unitedkingdom"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/324751","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=324751"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/324751\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/259171"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=324751"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=324751"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=324751"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}