Great Ormond Street is an ordinary side-road in the Holborn area of central London, England, not far from the British Museum. This street has become synonymous with ‘The Hospital for Sick Children’, founded there with just ten patient beds in 1852. It was a time of high rates of infant mortality in the smoggy and damp industrial city, almost a century before the creation of the UK's National Health Service (NHS) would provide healthcare to children regardless of their parents’ means. The hospital earned the goodwill and gratitude of many, who fund-raised for the institution or donated to its work. In 1929, Scottish author J.M. Barrie gifted his copyright in the 'Peter Pan' stories to the hospital, a copyright which by special dispensation of the House of Lords was allowed to exist in perpetuity and provided the hospital with revenue for expansion.
To this day, Great Ormond Street Hospital or GOSH as it is known within the NHS, raises donations from the public via a dedicated charity in addition to income from private and international work, and the public funding it receives from British ‘national insurance’ payments and general taxation. As the UK's preeminent children's hospital, it specialises in serious illnesses and hard-to-treat conditions in the very young, including rare cancers. In 2022, the BBC reported that GOSH would begin operating a gender clinic for children by spring 2023, as one of the replacements for the discredited Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust. In fact, the GOSH paediatric gender clinic opened a year late in April 2024.
As I have written previously, GOSH was also the hospital given the task of drafting NHS training materials for the new paediatric gender clinics promised by Britain’s state healthcare executive after the failure of GIDS. Consensus could not be reached on the text for these materials; there were resignations, and the task was given to the Academy of Medical Royal Colleges instead.
In the 2023/24 reporting year GOSH had 5,462 full-time equivalent staff, with additional support from volunteers. The hospital saw 47,823 inpatient and day treatment cases, and 243,386 outpatient cases that year. Its International and Private Care directorate with offices in London and Dubai provides treatment pathways for patients who would not be eligible for NHS funding. Of the hospital’s £598m total income for 2023/24, £79m was from private patients, up from £55m in the previous year. There was an additional £1m income from private international patients who funded their own care in 2023/24, a significant increase from £119,000 the year before (Annual Report and Accounts 2023/24, page 186).
However, GOSH is not currently breaking even. Page 185 of the hospital’s annual report for 2023/24 records a £4m operating deficit prior to capital donations, gains on disposals, donated inventory, depreciation in respect of donated assets and impairments. This is an improvement compared to the previous year, when the deficit was close to £10m. Page 48 of the annual report mentions that research is bringing in much-needed funds. In 2023/24, the hospital ran 879 studies with 2,592 participants, including 14 ‘first-in-child’ clinical trials. It also moved the hospital’s Clinical Research Facility (CRF) to a purpose-built site. The National Institute for Health and Care Research and Biomedical Research Centre five-year funding awards to GOSH were £4.8m and £37m respectively.
It is the same National Institute for Health and Care Research which is funding the new puberty blocker trial on children in the UK, with no upper limit announced on the number of participants. In case you read or heard that the UK has banned puberty blockers following the Cass Review, that simply isn’t true. NHS prescriptions are explicitly exempt from the temporary restrictions on private prescribing to children in The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024.
A case of (alleged) malpractice
In September 2024, the Sunday Times newspaper published details from a leaked Royal College of Surgeons report on Yaser Jabbar, a consultant orthopaedic surgeon carrying out lower limb reconstruction at GOSH from 2017 to 2023. Of the 721 child patients known to have been treated by Jabbar while he worked there, the report said 22 children in the 39 cases reviewed so far had been harmed. Specialising in leg length correction for children, Jabbar’s work reportedly left one child with a limb eight inches (20cm) shorter than the other.
One parent of a child operated on by Jabbar reported that their daughter’s leg had to be amputated after several failed attempts to correct its length, stating "We think that she thought her leg was going to grow back, in her head, because she was told it was a healthy bone... He sold her a dream".
Other hospitals where Jabbar worked previously have been asked to review his cases. No records of concerns by hospital staff about his work have been found prior to 2022, when complaints by both parents and hospital staff began to be filed. Medical negligence lawyer Caroline Murgatroyd works for one of several legal firms pursuing compensation claims for the children allegedly harmed by Jabbar.
As reported by Sky News, Murgatroyd stated that the Royal College of Surgeons (RCS) review described “unacceptable assessments, examinations, clinical decision-making, and treatments of patients, poor communication with families with regards to seeking their consent for treatments and procedures...” There were allegedly “failures to make it clear what kind of complications children could face after undergoing surgery.”
Murgatroyd continued "There are also references to children being subjected to surgeries which the RCS review panel could see no justification for, with children undergoing procedures which brought them no clear benefit... inappropriate and unnecessary surgeries which will require further and prolonged treatment, and nerve injuries causing ongoing pain."
These accounts might sound familiar to anyone who has listened to American gender clinic whistle-blower Jamie Reed:
Or the testimony of Keira Bell regarding her experience of the GIDS service:
A medical professional was supposed to be helping people, but allegedly harmed them instead. The difference between the gender clinics around the world and the Great Ormond Street case is that no-one in the public sphere seems to be rushing to the defence of surgeon Yaser Jabbar.
Unfortunately, his was not the only case in the UK which has lead to questions regarding the ethics of surgeons. Breast surgery specialist Ian Paterson operated on 4,424 NHS patients and thousands more privately, including the use of a technique he devised himself known as the partial or "cleavage-sparing” mastectomy. Some women had breasts removed without medical justification, while other patients who were seriously ill were left with breast tissue that could have caused secondary cancers. Page 157 of the Kennedy Review into the case found that there had been formal concerns raised about Paterson in 2003 which were not addressed until they were raised again by a different surgeon in 2007. Paterson was not suspended by the UK’s General Medical Council until October 2012. Prosecuted in 2017, he was found guilty of 17 counts of wounding with intent. The NHS paid out £17.8m in damages and costs to 256 of Paterson’s patients.
Speaking to the BBC, cancer surgeon Professor Philip Drew, an expert witness for the prosecution at Paterson’s trial, said “Financial can't have been the only motive... What else are we left with?” Comparing Paterson to British serial killer Dr Harold Shipman, Drew said "I think both of them demonstrated some degree of psychopathic approach to the care for their patients, that it wasn't the patient that they were caring about, it was more their own goal, or their own importance that was driving their behaviour."
Emotion as cancer
While there might be at least one or two dangerously delusional people in any profession, the Royal College of Surgeons of England decided to carry out its own investigation. Published in 2015, a research article in Volume 97, No. 8 of the College’s journal asked “are surgeons psychopaths? And if so, is that such a bad thing?”. This study found that consultants at teaching hospitals scored higher in psychopathic personality tests than district general hospital consultants, who in turn scored higher than the general population. The article concluded that ‘stress immunity’ and ‘fearlessness’ in surgeons, not getting upset in life-or-death situations, may better facilitate patient care. However, among the specialisms of the consultants who were tested, psychiatrists and paediatricians also scored highly on the psychopathic trait of ‘carefree non-planfulness’, which might not be what we want to hear before a loved one goes under the knife.
A parent whose child has undergone successful surgery expresses gratitude of a type which is rarely matched. There are some tasks which few of us are trained or equipped to attempt, and paediatric surgery is clearly one of them. The sight of an anaesthetised child being wheeled into an operating theatre should rouse the emotions of even the most hard-hearted and indifferent parent. Those parents must trust the surgeon implicitly before, while and after their child is being operated on. It is the breach of this trust which makes medical malpractice so devastating, in combination with the effects on the young patient, up to and including death.
Among this heightened emotion, the surgeon must do their job without distraction. I recall one surgeon’s admission that in his job, emotion became a metaphorical cancer that he believed he had to remove every last cell of. This professional detachment may help steady the hand that wields the scalpel, but it can also make health professionals the least well-equipped to make ethical decisions regarding the patients in their care.
A problem identified in the body should have a clear justification and remedy before elective surgery is planned. The surgeon can then carry out a procedure, be it routine or experimental, safe in the assumption that not treating the problem will leave the patient worse off. As we have seen in reports by detransitioners including Ritchie Herron:
Problems of gender identity do not lend themselves so easily to actions and solutions. Perhaps it is difficult for the surgeon with a vocational imperative to help people in need to admit that some classes of problem are beyond their capacity to fix. Nevertheless, the skilled surgeon has many specialisms to choose from. Why would a surgeon specialise in the particular field of experimental gender reassignment surgery?
As Jennifer Bilek has documented in detail, there is money involved. In Andy Warhol’s memoir ‘Popism’ (1980), the silver-haired pop culture Svengali recounted how a New York doctor with an expensive gambling habit would supply just about anything to members of the hipster community in return for cash. That included amphetamines, illegal abortions, or feminising hormones for Warhol’s associates who were making the transition from part-time theatrical transvestite to full-time drag queen. However, almost any specialism should afford the honest medical professional a decent quality of life.
There is the thrill of the pioneer who carries out a surgery never attempted before, but there is no shortage of health conditions which require research into new surgical and medical treatments. A sincere desire to help a marginalised community is another potential motivation, but there are many of those communities, not least among them the millions of people around the world who suffer and die each year for the lack of basic care that many of us can take for granted. This leaves the possibility that surgeons who specialise in this type of procedure chose it because they enjoy it. As we saw in the Operation Spanner case, there are sadists who take pleasure in ‘consensual’ genital cutting. What kind of person takes a blade to a healthy clitoris?
Conclusion
A surgeon at the UK’s best-known children’s hospital operated on hundreds of young patients with questionable results before being challenged, and another consultant carried out hundreds of unnecessary or ill-advised mastectomies despite formal complaints being recorded. It is clear that just one person with sufficient authority in a healthcare setting can cause a great deal of damage to people. We might ask how much oversight there is for the private hospitals which carry out NHS-funded gender reassignment work in the UK. While the Cass Review focused on the country’s national gender clinic, GIDS, at the Tavistock and Portman NHS Foundation Trust, that clinic was not a surgical centre, and only catered for children. Perhaps the UK needs a complete and thorough review of adult gender services, including private surgery and endocrinology provision, which the cohort Dr Cass studied will soon be ageing into.
A constant need to innovate and attract new funding, including from private and international patients, makes Great Ormond Street Hospital less than objective regarding the wisdom of medical and surgical interventions on gender incongruent children and young people. It is hardly likely to be the only teaching hospital in the same position.
Surgeons who score highly on psychopathic traits cannot be expected to set ethical standards for society: they do the work we ask them to. This why organisations including Genspect, which don’t earn their keep from promoting invasive medical and surgical interventions, have a key role to play in enabling public discourse on gender and gender identity.
We are the true trans rights activists, because we want gender non-conforming people to have the same rights as everyone else. That includes the right to be protected from rogue surgeons and medical malpractice. There are new Peter Pans being made every day: boys and girls who might never grow up into complete, healthy and confident adults.
Genspect publishes a variety of authors with different perspectives. Any opinions expressed in this article are the author’s and do not necessarily reflect Genspect’s official position. For more on Genspect, visit our FAQs.
It all sounds much worse than I had inagined !
Very discouraging to hear that the NHS is still prescribing puberty blockers. How many generations will pass before people get off the trans train?