Ex-Nurse Fails Legal Bid to Block Private Gender Clinic Registration

A previous nurse has failed in a High Court case against the health regulator's choice to approve England's initial private facility providing gender-related care for minors.

Susan Evans and another parent referred to as XX filed a lawsuit against the Care Quality Commission (CQC) regarding its choice to approve the registration of the Gender Plus Hormone Clinic (GPHC) in Birmingham during January of the previous year.

The pair additionally contested the regulatory body's choice from last December to maintain the clinic's authorization and permit it to administer gender-affirming hormones to individuals aged 16 and 17 without restrictions.

The facility, which received an exceptional rating from the regulator last year, serves individuals who are 16 years old or older, offering treatments such as hormone therapy aimed at affirming one's gender—either masculine or feminine—but, following NHS guidelines, does not provide puberty-blocking medications.

Attorneys representing the women informed a court session in June that the CQC had behaved "unreasonably" and reached conclusions that were "not permissible for it to make," considering the NHS's position regarding hormonal therapy for individuals between the ages of 16 and 17 following the Cass Review.

The CQC and GPHC rejected the challenge, as lawyers informed the court in London that the legal action was "seriously defective" and the clinic was determined to "prioritize patient safety and well-being."

On Thursday, Mrs Justice Eady rejected the claim, stating there was "no irrationality" in the decisions made and that they fell within the "reasonable range" of possibilities for the regulator.

Previously, hormone therapy was offered through the NHS via the closed Gender Identity Development Service (GIDS), which was managed by the Tavistock and Portman NHS Foundation Trust, where Ms. Evans was employed.

However, a report released by Baroness Cass in April of last year stated that "extra care" must be taken when considering prescribing the therapy to individuals aged 16 and 17, emphasizing that there needs to be "a strong medical justification for administering hormones at this age instead of postponing treatment until someone turns 18."

The NHS has established three specialized pediatric gender clinics and intends to open an additional five across the seven NHS regions in England by the conclusion of 2026; however, it has stated that every recommendation for hormonal treatments must receive approval from a nationwide multidisciplinary team (MDT).

It is known that the MDT has not obtained any suggestions regarding hormonal therapy for individuals aged 16 and 17 years following the Cass Review.

The GPHC was established by Dr. Aidan Kelly and is currently managed by nurse consultant Paul Carruthers, both of whom have prior experience working at Gids. The organization mainly serves patients between the ages of 16 and 25 through its dedicated multidisciplinary team.

Tom Cross KC, representing Ms. Evans and XX, stated in written arguments that there were "several significant distinctions" between the protections offered by GPHC and those provided by the NHS, such as the fact that referrals to the former originated from Dr. Kelly's firm, Kelly Psychology, which operates without regulation.

He stated in court that the CQC had "failed to consider" certain aspects of the NHS treatment procedure, which "act as crucial protections" and were "clearly significant."

He stated that evaluating these factors would have resulted in stopping the treatment of individuals below 18 years old.

Jamie Burton KC, representing the CQC, stated there was "sufficient evidence" indicating that Kelly Psychology did not present an undue risk to patients, and that a "substantial number" of individuals evaluated by the firm were not directed toward care at GPHC.

The court heard that the CQC did not find any proof of "unauthorized choices or issues that could raise alarm," and that the CQC "took into account" NHS procedures.

Peter Mant KC, representing Gender Plus Healthcare Limited, stated that there is no legal obligation for a private organization to align its services with those of the NHS, and that the clinic's approach is "completely aligned" with the Cass Review and NHS guidelines.

In a 64-page decision, Judge Eady stated: "While acknowledging that GPHC was unable to access the NHS national MDT or exactly duplicate it, considering the intent behind the NHS framework, I do not believe the CQC's conclusion about adequate alignment fell beyond the acceptable scope of possible judgments."

She added, "The scope was determined based on the fundamental element that supported the NHS framework, rather than just the decisions regarding how those structures were shaped."

Using this method, as I believe the CQC did, the conclusions made remain within reasonable limits, and the CQC had the right to determine that no additional requirements were necessary.

Dr. Kelly expressed that he was "completely thrilled" about the decision, while Mr. Carruthers mentioned that the verdict "further highlights the thoroughness and honesty of our efforts."

Ms. Evans expressed her "extreme disappointment" with the verdict, feeling that the CQC's choice was "unreasonable and very dangerous," whereas XX stated: "To claim I'm disappointed is an exaggeration."