GIDS Cass Review: Audit on Characteristics of 40 Detransitioned Patients

Reference: 24-25017

Date response sent: 07/05/2024

Details of enquiry

At para 15.55 on p.189 of the final report of the independent Cass Review which was published today, reference is made to information held by you:

“An audit was undertaken at The Tavistock and Portman GIC on the characteristics of individuals who had Detransitioned. Most papers on detransition are based on community samples, and questionnaire reports, but this was a case series of 49 patients who had all been examined by a psychiatrist.”

In conformity with s.1(1) of the Freedom of Information Act 2000 kindly:

Confirm whether or not you hold this information;
Communicate the information to me.

Response sent

Confirm whether or not you hold this information;

The Trust confirms that it holds this information.

Communicate the information to me.

The Trust is withholding this audit report in its entirety due to the nature and level of personal details contained within it and has engaged exemption 40(2) of FOIA – information which constitutes the personal data of others, where it would not be permitted under the Data Protection Act 2018.

This is due to the fact that the sample group of patients within scope of the audit is small, thus increasing the likelihood of some or all personal characteristics and circumstances of individuals being recognizable by the patients themselves and/or others. Redacting or masking of these characteristics and details would not ensure the patients right to confidentiality

This is evidenced as:

The 2010-15 cohort – reviewed a total of 21 patients which only averages around 3.5 patients who de-transitioned per year, and of which a small number, equal to or less than 5 were assigned female at birth over the whole period.
The 2017-20 cohort: reviewed total of 43 patients over a much shorter period, which only averages around 10.7 patients who de-transitioned per year, thus rendering their identification highly likely by others who would have heard/read about them. Such a disclosure is likely to cause significant distress and anguish to this small group of patients, should they recognize themselves during, what would have been, a stressful and vulnerable period in their lives.
Anecdotal evidence that cases of patients detransitioners, being relatively few in number, tend to attract attention and that these details are often spread by word of mouth and some media outlets.

2.1

The Public Interest Test

2.1.1 In Favour of disclosing the audit

We have conducted the public interest test to weigh up the prejudice (legal definition) of the harm that would be caused by releasing the report, against the public interest (legal definition meaning in the public interest and not what the public would find interesting)

a. The recent publication of the Cass Review has attracted worldwide attention, and a public release of an audit to which it refers, on para 15.55 on p.189 would increase the public’s awareness of gender de-transition issues experienced by our patients.

b. There is always some legitimate public interest in the disclosure of any information held by public authorities, and this helps to promote transparency and accountability…

c. The release of factual experiences of detransitioners’ reviewed by two experienced gender Specialists and Consultant Psychiatrists, would provide the public with new or additional information and a new dimension to the data already publicly available.

2.1.2 In favour of withholding the audit

The Trust considers all of the data disclosed in the audit to be personal data belonging to third parties, and therefore exempt from disclosure. The report has been written in such a way that, even if redacted, for low numbers, and/or personal experiences/circumstances the facts mentioned could lead to the identification of patients whose records had been referenced, particularly when combined with other gender information that is already in the public domain. . Redaction of these details would thereby render the remaining text as meaningless.

a. In recent years, a lot of information about GIDS and the adults GIC service has been released into the public domain, via a high number of FOI requests some of which has led to headlines and publication via the media. Given that the Cass Review has received intense world-wide publicity, the Trust therefore considers it reasonable to anticipate that if released, this audit would receive a similar level media coverage, but would be misunderstood by the public at large, as an authoritative and representative audit, something which it has failed to achieve. The risk of misleading the public by its release is therefore very high.

b. All Tavistock and Portman NHS Foundation Trust patients are assured that their records will be treated in the ‘strictest of confidence’ and have any reasonable expectations that their details would not be placed into the public domain, albeit anonymised and that they would be used, only with their permission, for very limited purposes.

c. Whilst the audit was conducted by Trust staff, it was neither commissioned nor approved for any purposes by the Trust, mainly due to the small cohort group sizes. Whilst this alone does not exempt the audit from release, it is highly likely that any release would be misleading and misinterpreted by the public at large as a Trust endorsed audit, whereas the reality is that it was not commissioned, nor approved nor endorsed by the Trust.

i. In addition, when reviewed against the mental illness/autism prevalence cited in the small sample group, there is a big risk that it maybe person identifiable, should this be released into the public domain. As stated above, this would, (most particularly in view of the world-wide reactions to the Cass Review), trigger unwanted publicity and cause distress and/or harm to this sample group of service users, and leading to the identification of those whose records had been referenced, and rendering them recognisable by friends, family, or other interested or well informed parties.

ii. The audit quotes low percentages of regret from small sample groups meaning that individuals who regretted their transition could be recognised by others from their quoted characteristics, experiences, and dates of audit.

d. a determined individual with other knowledge of gender transition matter may be able to use the specific details within the audit to attempt to triangulate data already in the public domain, or data already known to them to identify the individuals involved, via the given personal data.

e. Guidance provided by the Information Commissioner’s Offices notes that any consideration of data release needs to take into account that disclosure under FOIA involves disclosure to the world at large, ie into the public domain.

The Balance of Public Interest

Having weighed up the balance of public interest in releasing or withholding the requested audit report, we have concluded that, on balance, the public interest in withholding the audit outweighs the public interest of its release.

The Trust is therefore withholding the audit (cited on para 15.55 on p.189 of the Cass Review, Final Report), based on its engagement of exemption 40(2) of FOIA – information which constitutes the personal data of others, where it would not be permitted under the Data Protection Act 2018 and the outcome of the public interest test, as conducted above.

The Trust hopes that you are satisfied with this response. If you are dissatisfied, you can ask us to carry out an internal review of our handling of your request. You can request a review by emailing us at FOI@tavi-port.nhs.uk. Your review will be carried out by a senior officer within the Trust who has not been involved in this response. If you remain dissatisfied following completion of our internal review, you have a right to complain to the Information Commissioner’s Office (ICO) at https://ico.org.uk/make-a-complaint/official-information-concerns-report/official-information-concern/ or visit https://ico.org.uk/global/privacy-notice/how-you-can-contact-us/