Not Not Safe: The Power of the Double Negative
The HSE and gender transition - an issue of accountability
27 August 2022
The Tavistock Gender Identity Development
Service (GIDS) clinic.
In July the NHS in Britain decided to close the Tavistock Gender Identity Clinic - a centre dedicated to sex transition for adolescents - following a critical report by consultant paediatrician Hilary Cass.
However, when the details of this decision had been absorbed in Britain, a further controversy arose in Ireland, when the Health Service Executive (HSE) announced that it would continue to use the service up to the point it formally closes and would seek alternative arrangements in Britain where a similar service might be offered.
National Clinical Director for Integrated Care within the HSE, Dr Siobhán Ni Bhriain said:
"The service has not been deemed not safe…So, we will continue to refer while Tavistock is still open, we will monitor extremely closely…"Ni Bhriain is able to make this claim because of the extremely cautious language of the Cass report. In reality what was said was that there was no evidence base for the treatment of children with gender dysphoria, especially in the prescription of puberty blocking hormones. This is a devastating charge - medicine without evidence is simply another word for witchcraft. In addition, the clinic, in association with trans activist groups, has had a policy of affirmation - a statement by a child that they believed they were in the "wrong" body often led to the prescription of puberty blockers and then later to hormones and surgery.
The decision was heavily criticised by Dr Paul Moran, psychiatrist with the National Gender Service (NGS) and by Irish feminist groups. In fact, the pattern in Ireland mirrors the pattern in Britain. Concerns and criticisms were brushed aside and reports were binned. There was an unhealthy connection between services and trans activists with no medical training, until we have a situation where the HSE can press on under the banner of the double negative; "not not safe".
The HSE is the centre of endless scandal: women's health, corruption, outsourcing and impunity. This is the case with most government agencies and with the government itself. What is essential to focus on is the absence of coherent opposition.
The explanation is partnership. Issues are resolved in back rooms with the involvement of union leaders, political parties, civic society and the NGOs. Nowhere is this more the case than in the rise of trans activism and gender identity. Activists became established in the NGOs, won support in government, and then began to lobby departments, winning enormous influence in Health and Education, rewriting the rulebook to essentially write out the concept of women as a sex or of the right to safe spaces. The refusal to back down, even in the face of the Tavistock scandal and the evidence of HSE complicity, shows the levels of entitlement and impunity at play.
Feminists and socialists have made a start in rolling back reaction and public scrutiny has helped greatly, but much more needs to be done. The whole arena of class collaboration, that is now manifesting in every area of working-class life, will have to be challenged.