In June, Newsnight revealed that serious safeguarding concerns have been raised by some staff of Jed's during an official review in 2019.

We've now learned that some of the worries voice during that review were not new.

They go back 15 years.

There had been another review of the service in 2000 and five by the trust's then medical director, Dr David Taylor.

It was triggered by a nurse working at the units to Evans.

She was troubled about what she was seeing.

My experience of working with most of the young people was that once you assess them and found out more about them, they had complex backgrounds.

It wasn't just the gender dysphoria they, some of them had bean sexually abused.

Some of them had been traumatized in their only life.

Early separations, some had autism.

There were other clinicians who seemed confident that they could see someone for about four to successions and then refer them on for hormone treatments.

And I just couldn't understand that a satisfactory assessment or any attempt at therapeutic work had been carried out.

Newsnight has obtained a copy of that 2000 and five review.

Dr.

Taylor stresses that staff were doing all they could to help the patients, who were often very distressed.

But his report went on to detail several areas he believed needed addressing.

He noted that many Children referred to the service had suffered trauma or have mental health problems.

Staff face pressure to comply with demands from patients and their parents to be referred for puberty blocking medication.

There wasn't a robust evidence base underpinning this treatment on staff disagreed about the best way to treat these young people.

The implications for this other young people might not have had other issues addressed before making a potentially life changing decision to go into puberty blocking drugs.

Thes concerns are strikingly similar to those raised by staff in recent years.

The service was much smaller in 2000 and five, receiving tens of referrals rather than thousands, and did not contribute significantly to the Tavistock trusts finances.

Young people had to be 16 before referral for puberty blockers.

Now they could be as young as nine, and yet there are still questions about the evidence base.

The findings of the 2000 and five review have never been made public, and getting sight of them hasn't been easy.

In May 2019 Newsnight requested a copy of Dr Taylor's review using the Freedom of Information Act.

The Tavis stock declined, arguing its disclosure could adversely impact on the trust's ability to provide effective and safe services to its patients.

We appealed in July 2019 and, when refused again, went to the information commissioner's office in October.

In August 2020 the CEO ruled that it was in the public interest to disclose the document, saying patients, prospective patients and their families should be able to see this information.

We received the report a few weeks later.

The recommendations made by Dr Taylor were, in his words, not rocket science, he says.

They reflect core principles of clinical practice on could be applied toe any part of medicine.

You call for the service to follow up all its patients for more research in this area of health care and for staff to be supported if they came under pressure to refer for a treatment they thought was inappropriate.

Dr Taylor said that puberty blockers might be an appropriate course of action for some, But all young people needed exploratory therapy first looking at the report today that was written 15 years ago in those years, the missed opportunity for me is that Dr Taylor recommended there should be clinical audit, better understanding developed of gender dysphoria in young people.

Research should be woven into the work of the clinic, and I really don't think listening to the more recent reports about the cleaning I I really can't here that that has gone on sufficiently.

Last year, Evans initiated Judicial Review proceedings against kids arguing under Eighteens cannot give informed consent to puberty blockers, where not enough is known about what they do.

The trust is contesting the case.

It will be heard next week.

The perception that Jude's could have done things differently has angered some staff.

Dr.

Kirsty Entwistle, left Kids leads in 2018.

She's not spoken publicly before but is a witness against the service in the upcoming judicial review.

I left the service kind of wondering why me like, why did I have, like, such a strong reaction and then and then you know, it takes away this time, and I find out that there's a these clinicians in London who had the same concerns as me, and and then you find out what actually, you know, people have been having these concerns about the service for years.

You know, just seems like it's more convenient just to plow on, because I think the concerns that people are raising, you know, require a fundamental reorganization or a fundamental rethink off what's going on here.

Dr.

Taylor, a psychiatrist who worked at the tavern Stock for 30 years, wrote in his review that some of what he'd suggested would likely be resisted by some patients and patient organizations.

He recognized that this could lead to a fall in referrals.

If you try to set out to please or comply with someone, whether your apparent or a clinician, then you won't be helping.

Hm.

It's very important that you keep an independent perspective, but I do think that maybe the service, as it developed to some extent, lost its compass in those respects, so I would.

His reviews recommendations implemented.

There isn't one easy answer.

The demand for these services was greater than the capacity off the unit to cope to cope by maintaining its standards off thoughtful mental health care, which considers all the factors biological on social.

Andi, he say's the setting in which the service was working society.

Shifting attitudes towards gender identity on the lack of alternative provisions are also important.

Many patients would have been better served, referred to other services.

But underfunding of child and adolescent mental health services made that impossible.

Over the last 14 months, Newsnight has looked at the uncertainties about treatments given to young people questioning their gender identity.

We've also revealed allegations that safety concerns weren't taken seriously enough.

Last week, the NHS announced an independent review into gender identity services for young people.

I think that's Ah, a very, very good development and entirely the right way forward Andi, because those those reviews are arenas that are more public, in which the kind off discussions and debate that we're talking about can go on.

15 years after Dr Taylor's report, key issues at the heart of service provision for young people questioning their gender identity are still being debated.

The question now is, will this review bring some resolution zone?

Newsnight put the issues raised in their report to the Taba stock, who responded by saying, This report from 2000 and six is not relevant to the circumstances and issues faced by Jin's.

That's the Gender Identity Development Service today, they continued.

While the demand for the aged service has increased markedly since 2000 and six, each young person does receive ah, highly personalized service from Jim's Clinicians that we're sorry that this is now delivered after a longer wait than we'd like.

It has recently been announced that Dr CASS will lead a wider review of the care provided to gender questioning young people.

We welcome this and hope this will lead to better and quicker access to support for these young people.

Some of the young people we see in the service experience difficulties which may or may not be related to gender dysphoria.

Kids is a specialist service and relies on integrated care model, in which it works closely with local cams to support ongoing difficulties.