Barnes mixes the stories of people working at GIDS with stories of children who have been through the clinic. There are some de-transitioners and some who had issues with the clinic. Hannah Barnesis an award-winning journalist at the BBC’s flagship current affairs programme Newsnight. She led its coverage of the care available to young people experiencing gender-related distress, which helped precipitate an extensive NHS review and unearthed evidence that was later used in several sets of legal proceedings. Newsnight’s reporting also led directly to an inspection by the healthcare regulator the Care Quality Commission, which branded the NHS’s only youth gender clinic in England ‘Inadequate.’ The management team of the clinic was disbanded as a result and the work was nominated for an array journalism awards, including the prestigious RTS Television Journalism Awards. Time to Think goes behind the headlines to reveal the truth about the NHS’s flagship gender service for children. As someone who knew about this years ago, as people were writing to me asking my former newspaper to investigate it, it would suit my agenda to say this was all down to trans activism. But it’s not that simple. We were seeing very haphazard referrals from Irish psychologists operating mainly in the private sector, where somebody was going along, saying, ‘I think I have gender dysphoria,’ and there wasn’t really an assessment being carried out,” O’Shea says. “We began to see more and more disasters,” Moran explains. There were suicides; other people barely left their homes in years.

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At times, the world Barnes describes feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for’ – Observer I think there was a complicating factor that, in some cases, safeguarding concerns… you know, there was a grey area between the safeguarding concern and the trans identification. And the service was very keen not to stigmatise these young people, not to pathologise. And so, there was a line to tread whereby a concern about a young person wasn't a questioning of their gender identity. But on balance, many clinicians felt that the bar was too high. Because of that… fear, if you like, in the service, the bar was too high for referring, for taking these concerns as seriously perhaps as they would in other services.FiLiA: You include lots of different perspectives and lots of different voices from people who were actually there, who were actually involved, and had direct experience. So it's not a sort of commentary from folks on the side lines. Dr Anna Hutchinson, in particular, plays quite a large role in the book. She kind of opens and closes the work with that question: ‘Are we harming children?’ You do seem to be quite careful about choosing a range of different stories with a range of different outcomes in terms of kids who've actually been through GIDS themselves and have different perspectives, and some of them seem quite positive. So do you think it's fair then to characterise what happened at GIDS as a “serious medical scandal”? And in that case, why? Time to Think” goes behind the headlines to reveal the truth about the NHS’s flagship gender service for children. What is most inexcusable in this story is the fact that the failures of the early days of the service have simply been repeated down the years. The GIDS not only failed to take account of its own data, learn from it and put in place structures to ensure a safe service for children, it doubled down, allowing pressure from activists to dictate. The service became increasingly ideological, not less.

Time to Think review: the book that tells the full story of

GIDS began seeing Irish children in 2012 under the Treatment Abroad Scheme. Three years later, as demand increased, staff started holding monthly clinics in Crumlin hospital. Between 2011 and 2021, 238 young people in Ireland were referred to GIDS. As in the UK, the Irish referrals were overwhelmingly female and had multiple other “difficulties”.A powerful investigation … The interviews with staff and children — some who have happily transitioned and some who have not — show how complex the issues are. Not a comfortable read but meticulous and thought-provoking’ – Camilla Cavendish, Financial Times, Best Summer Books of 2023

Time to Think by Hannah Barnes | Waterstones

Arguably, GIDS moved from being a disorganised, ill-thought out service to being the centre of a medical scandal when, in the 2010s, numbers grew exponentially. The demographics also changed –across the world – as there came reports of an unexplained rise of teenage girls presenting at clinics with gender-related distress. In the gender identity literature there had never been significant numbers of teenage girls; pre-pubescent boys had always been the largest proportion of the paediatric cohort. In addition, the cases of these teenage girls appeared to be complex, happening within the context of wider identity confusion. One Finnish study showed that “Thirteen per cent were in care or living independently, and well over half had been ‘significantly bullied at school. But close to three-quarters of those had been bullied before they came to think about their gender identity. Most startling was that the fact that 75 per cent of the young people ‘had been or were currently undergoing child and adolescent psychiatric treatment for reasons other than gender dysphoria when they sought referral’.” Actually, there isn't agreement amongst frontline clinicians working with this group of young people about how best to care for them, and how there may be different ways to care for different people. This is not an easy book to read - but it's important that it was written and published. Hannah Barnes strikes a balanced, journalistic tone throughout the sorry tale of a pioneering NHS unit becoming ensnared in a crisis not wholly of its own making, but then doubling-down on idealogical grounds and creating the potential for very great harm to children and young people in the process.

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It hadn't really crossed my mind before that, at a particular time at least, this was a really close-knit group of professionals, and they were encouraged to think of themselves as almost a family. And it becomes even harder then to raise concerns because you're somehow letting down the people that you cared about. And one clinician puts it this way: ‘What do you do? It's a major dilemma. Do you screw over your colleagues to help the service users, or inadvertently screw with service users to help your colleagues?’ This book is a testament to the moral courage of Hutchinson and colleagues who sought to expose the chaos and insanity they saw while practising by stealth the in-depth therapy they believed young people deserved … And Hannah Barnes has honoured them with her dogged, irreproachable yet gripping account’ – The Times Camilla Cavendish of the Financial Times described it as a "meticulously researched, sensitive and cautionary chronicle" and a "powerful and disturbing book" that reminded them of other NHS scandals. [6] Rachel Cooke, writing in The Observer called her work "scrupulous and fair-minded" and, with regard to GIDS, "far more disturbing than anything I’ve read before". Cooke says the account is of a "medical scandal" and "isn't a culture war story", concluding: "This is what journalism is for." [7]

Time to Think - the inside story of the collapse of the

This book contains so much more than is outlined here. It should be read carefully by everyone involved in the care and safeguarding of children, including schools and government ministers. What other institutions are in thrall to transgender activists, leaving the most thoughtful professionals afraid to speak out? Where else do we see the same failure of safeguarding demonstrated at the GIDS? Why are the same ideological groups that influenced the GIDS allowed to influence policy in schools? Medical harm may be the most extreme result, but what other harms are being caused to children in schools, social care and child agencies by the failure to put facts and evidence ahead of ideology? Many of them were same-sex attracted – the same was true for the boys attending GIDS – and many were autistic. Their lives were complicated too,” Barnes writes. In 2007, 50 kids a year had been referred to GIDS, but by 2020 there were around 5000. As a result, GIDS faced huge waiting lists, with junior shrinks having caseloads of 100, instead of 30 which would be the standard NHS practice. Many clinicians left.FiLiA: There was this kind of siege mentality, let's say, because there was pressure being put on the service from all sides. I suppose one of the questions I had also was about whether or not there was a kind of worry about feminists from that perspective, too, if that makes sense. So the sort of questions around ‘TERFs’ or ‘gender criticals’ or if there was any sort of sense of that sort of dialogue also affecting folks at GIDS, when it was happening? Some studies have asserted the mental health benefits of these drugs, but Barnes says these have been heavily critiqued and shown to have flaws. “The science is not settled, and this field of healthcare is overpopulated with small, poor-quality studies,” she concludes. “It’s often not possible to draw definitive conclusions on the benefits or harms of these treatments.” The pair started a new service, identifying people who were ready for transition by assessing them before they started hormones. This approach, involving an assessment by a psychiatrist, was criticised as pathologising by the trans community, but they say it has resulted in dramatically better outcomes. Making sure that we offer the books our customers want to read is the basis of good bookselling and good service means treating all our customers with respect and for them to feel welcome to choose the books they want.”