A nurse-led clinic providing specialised healthcare to transgender adults and youths has won a legal battle to remain open.
The results of a judicial review against a Care Quality Commission (CQC) decision to register, and later give an ‘outstanding’ rating to a private endocrinology healthcare provider, were published this week.
“The outcome of this judicial review further demonstrates the diligence and integrity of our work”
Paul Carruthers
Judge Mrs Justice Eady, who presided over the case, dismissed all grounds brought against the Gender Plus Hormone Clinic in Birmingham, which trades under the name Gender Plus Healthcare Limited.
The case centred around the CQC’s approval of the clinic providing hormone replacement therapy (HRT) to people aged 16 and 17 with gender dysphoria.
The clinic, day-to-day running of which is led by specialist paediatric endocrinology nurse consultant Paul Carruthers, also provides treatment to adults.
However, the legal challenge was focused on the treatment of people under the age of 18.
Transgender individuals treated by Gender Plus are referred to the clinic following assessment by a psychotherapist, or other appropriate medical professional, and the approval of a multidisciplinary team (MDT) which judges the case.
The two claimants were a mental health nurse and psychotherapist, who formerly worked at the now-closed Tavistock and Portman NHS Foundation Trust’s gender clinic, and the mother of a child treated at Gender Plus, whose decision to seek hormone treatment was the subject of family court proceedings.
They claimed that the CQC failed in its regulatory duties by registering the setting in January 2024 without conditions and, in December 2024, rating it as ‘outstanding’, with a rating of ‘good’ for safety.
Judicial review against Gender Plus Healthcare Limited: case summary
The claimants’ grounds were summarised by the judge in five key points, and each dismissed based on the evidence presented to the court.
First was the referral of 16-17 year olds to the clinic for hormone treatments by Kelly Psychology, an organisation run by Gender Plus director and consultant clinical psychologist Dr Aiden Kelly.
The claimants said that because this clinic was not directly regulated by the CQC, this was in breach of regulations for administering HRT.
Secondly, the claimants said that Kelly Psychology not being an NHS organisation meant it should not, under the regulations, be able to refer to Gender Plus.
In its submissions to the court, the CQC said it did not find any evidence of the clinic breaching regulations and that the legislation did not “drive the conclusion that [private providers] must replicate NHS processes”.
Mrs Justice Eady dismissed the first two claims, stating that they were not “made out in the facts”.
The claimants’ third claim was that there was a conflict of interest in the referral of patients from Kelly Psychology to the clinic, which are both private organisations owned by Dr Kelly.
The claimants said the organisations would have been motivated by profit, because of the fee paid to the clinic for the administering of HRT.
In its evidence to the court, Gender Plus said that the clinic ran at a loss and that it would have remained viable even if the income resulting from fees associated with treating 16 and 17-year-olds was lost.
The judge found that the CQC had properly assessed evidence surrounding this concern, and dismissed the third claim.
Fourthly, the claimants said that there were key differences between the NHS MDT, which approves hormone treatment for children on the NHS, and the one at Gender Plus.
This, they said, was not taken into account by the CQC when it registered, and later rated, the service.
Mrs Justice Eady rejected this objection and noted that there were only structural differences inherent between the NHS and a small private provider.
She added: “The evidence does not support the criticisms made under this point of challenge.”
The final grounds were that Dr Kelly, and other employees of Gender Plus, had made public statements “relevant to the question of registration”.
The claimants claimed that the CQC did not take into account these statements which, at times, “demonstrate that they advocate for the hormone treatment”.
In Dr Kelly’s case, the claimants pointed to times he had been quoted in the media following the publication of the final report of the Cass Review into gender identity services in England.
This review led to the banning of puberty blockers, which are distinct from the feminising or masculinising hormones given out by Gender Plus, for routine use in the NHS.
Dr Kelly, in April 2024, was quoted as having disputed the findings of the Cass Review and in July 2024 wrote an opinion piece for The Guardian criticising the move to ban puberty blockers in the NHS, calling the health service’s new approach to gender identity services as akin to “conversion therapy”.
The claimants then pointed to a 27 October 2024 statement by ReportOUT, a human rights organisation, made following news that Mr Carruthers had joined as a patron where it noted his work in “activism in transgender healthcare”.
Dr Kelly, in response, said the catalogue of peer reviewed articles he has authored on transgender healthcare was evidence that he was an expert on the topic.
The CQC added that it deemed it fair for employees of a gender clinic to hold and express views as long as they complied with the law and regulations.
The CQC also said it was “not necessarily wrong” for Kelly and other employees of Gender Plus to advocate for a service which they provide.
Dismissing the grounds, the judge noted that the “advocacy” evidence presented by the claimants was not “so obviously material to the CQC’s decision that its failure to find and take this into account reveals an irrationality and its process or reasoning”.
The response from Gender Plus
Following the publication of the disposal, Mr Carruthers said: “The outcome of this judicial review further demonstrates the diligence and integrity of our work.
“We operate according to the highest standards, always putting patient safety and well-being at the heart of every decision – we couldn’t have hoped for a better outcome.”
He said that the fact the clinic’s standards held up to scrutiny “time and time again” was “testament to the expertise” the organisation holds.
“I am incredibly proud of the entire team,” Mr Carruthers said. “Achieving an ‘outstanding’ rating from the CQC is a powerful reflection of the care, professionalism, and compassion that runs through everything we do.”
Dr Kelly added: “Transgender healthcare is subject to the highest levels of scrutiny and as a committed provider of safe, effective, essential healthcare to this patient population we have always held ourselves to the most rigorous standards.
“Indeed, the outcome of the judicial review supports this claim, stating that: The detailed findings made by the CQC in these respects have not been challenged; these attest to the high standards of care provided to patients throughout the integrated service operated by [the clinic].
“We are absolutely delighted at this outcome and we will continue to work hard to deliver our essential services to our patient cohort.”
