Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children

"The Tavistock Clinic was—it’s in the process of being shut down or reconstituted—a pioneering institution for the study and treatment of gender dysphoria. When it was set up, it was if not unique, one of very few places where these treatments were offered for children. Hannah Barnes is a journalist with BBC’s Newsnight . In this book she tracks the story of how an institution that was set up with very good intentions to do necessary work lost the run of it, you might say. Things went awry to the point where it was overwhelmed by demand. That may have been a significant factor in why they then started to attract criticism about treatments not being appropriate, in terms of who was getting them, and how when certain things were red flagged—that maybe certain treatments weren’t appropriate or had gone wrong—that there wasn’t the mechanism within the system to acknowledge and address that. There was a culture of covering up because the clinic was operating in a societal context where the whole issue around gender and transitioning had become very charged, with deeply and fervently held views in the debate. This is not an easy subject to write about, in the UK or anywhere else, but particularly in Britain at the moment. There have been a number of books that have sought to address the trans issue, coming at it from different perspectives. Some are pro and some are more critical and, very quickly, the authors and the books attract quite savage criticism. Barnes manages to give a very calm, well-researched account. She’s not taking sides about any policies, but she is talking about institutional failure. It’s about how you can start in a good place and how things can go wrong. The management breaks down and then there are bad consequences for everyone, both for the patients and for the clinic which has effectively been shut down. The services will still be available, but it’s been reconstituted and it will be organized differently. Beyond the trans issue, the book tells you something about the inner workings of the NHS, one of the biggest institutions in the world that employs well over one million people. It’s an extraordinary beast and running it must be a nightmare. Recently, there have been a number of scandals in Britain. There’ve been terrible stories about neglect or even killing of children. Everyone goes, ‘How could this happen?’ With this book, you can see how within this complex organisation, the management of certain things gets lost. It’s too unwieldly, almost. On a micro level, Barnes illuminates how money and resources and attention get divvied up. It’s a complicated piece of journalism to get right. The book is quite a brave endeavour, in that it could attract quite a lot of criticism. She manages it by not being polemical. She shows her workings. There’s lots of data, people on the record, and documents that she puts out there."