Leia Sampson-Grimbly

Parliamentary Under-Secretary of State for   
Patient Safety, Women’s Health and Mental Health 

39 Victoria Street  
London  
SW1H 0EU  

19th September 2025 

HM Coroner Andrew Walker 
Barnet Coroner’s Court,  
29 Wood Street,  
Barnet, 
EN5 4BE 

Dear Mr Walker, 

Thank you for the Regulation 28 report of  25 July 2025 sent to the Department of Health 
and Social Care about the death of Leia Dorothy Pandora Sampson-Grimbly. I am replying 
as the Minister with responsibility for Gender Services. 

Firstly, I would like to say how saddened I was to read of the circumstances of Leia’s death, 
and I offer my sincere condolences to her family and loved ones. The circumstances your 
report describes are deeply concerning and I am grateful to you for bringing these matters 
to my attention.  

The report raises concerns over the length of waiting lists to access a first appointment at a 
Gender Service. 

In  preparing  this  response,  my  officials  have  liaised  with  NHS  England  to  ensure  we 
adequately address your concerns. 

NHS  England  is  the  direct  commissioner  of  specialised  services  for  children  and  young 
people  with  a  diagnosis  of  gender  dysphoria.  All  specialised  services  that  NHS  England 
commissions are defined by national service specifications. A proposed service specification 
for  the  service  is  currently  subject  to  a  process  of  public  consultation.  In  the  interim,  the 
commissioned providers work to an interim service specification that is published. 

I understand that Leia was on the waiting list for NHS Children and Young People’s Gender 
Services until the age of 17 years. This response to HM Coroner’s report, therefore, focuses 
on  NHS  England’s  efforts  to  build  clinical  capacity  and  reduce  waiting  times  to  the  NHS 
Children  and  Young  People’s  Gender  Services,  but  it  also  provides  information  on 
commissioning initiatives for NHS adult gender services. 

NHS Children and Young People’s Gender Services 

   
 
 
 
 
 
  
 
 
 
  
  
  
  
  
 
 
 From 2023 the national waiting list for Children and Young People’s Gender Services has 
been  held  and  managed  by  NHS  England  on  an  exceptional  basis,  through  a  National 
Referral Support Service managed by NHS Arden & GEM Commissioning Support Unit. 

The Government and NHS England have acknowledged that waiting times, and waiting lists, 
for children’s gender services are unacceptably high. I acknowledge that this must be difficult 
for  children,  young  people  and  their  families  in  this  situation  and  we  are  determined  to 
change that.  

NHS England accepts that the service is consultant-led for the purpose of the Referral to 
Treatment standard (NHS Constitution) and that consequently the consultant-led treatment 
of patients referred to the service should start within 18 weeks of referral. However, NHS 
children’s gender services have been unable to comply with this standard. In recent years 
there  has  been  a  considerable  imbalance  between  an  increasing  demand  for  gender 
services and the ability of the NHS to increase the specialist clinical workforce because of 
historic recruitment and retention challenges in this field.  

The  increase  in  demand  for  children’s  gender  services  has  been  exponential:  from  51 
referrals in 2009 to 2,600 referrals in 2020. In June 2025 there were 5,699 individuals on 
the waiting list, with a mean average waiting time of 113 weeks.  

Although  NHS  England  is  the  responsible  commissioner  of  specialised  services  for  the 
population of England only, around 7% of the waiting list held by NHS England is accounted 
for  by  children  who  reside  outside  of  England.  This  is  because  their  responsible  health 
administration  does  not  commission  its  own  children’s  gender  service  (mainly  Wales, 
Republic of Ireland and British Crown Dependencies).  

Until 31 March 2024 there was only one commissioned provider of NHS gender services for 
children  and  young  people  –  the  Gender  Identity  Development  Service  (GIDS)  at  the 
Tavistock  and  Portman  NHS  Foundation  Trust.  In  2021  the  service  was  rated  as 
“inadequate’  following  a  focused  inspection  by  the  Care  Quality  Commission,  who 
highlighted concerns about the absence of clinical risk assessment of the waiting list. By this 
time,  NHS  England  had  commissioned  an  independent  review  of  how  the  NHS  should 
respond  to  children  and  young  people  who  present  with  issues  of  gender  incongruence 
(chaired by 
) citing the increasing demand and long waiting times 
as key drivers for the review. 

The GIDS was decommissioned by NHS England in March 2024, in line with the emerging 
findings and recommendations of the Cass Review.  

The final report of the Cass Review was published in April 2024. The Review made a number 
of  recommendations  for  the  reconfiguration  of  children’s  gender  services,  which  NHS 
England and the Government have accepted.  

In  August  2024  NHS  England  published  a  plan  for  implementation  of  the  Cass  Review 
recommendations, delivered through an ambitious transformation programme, with clinical 
oversight  by  NHS  England’s  National  Medical  Director  for  Specialised  Services.  NHS 
England’s focus is on building clinical capacity (and reducing the waiting list) through the 

 
 
 
 
  
 
  
  
  
  
  
 
 establishment  of  up  to  8  new regional gender services  for children  and  young  people  by 
2026, managed by NHS children’s hospitals, and working to a fundamentally different clinical 
model to that followed by the former GIDS. This is funded in full by NHS England through 
an increase in direct investment in children’s gender services from £8m in 2023/24 to £36m 
in  2025/26.  Financial  investment  will  increase  further  from  2026/27  as  new  centres  are 
established. 

It may assist HM Coroner to know that new clinical capacity cannot be built quickly given 
the specialist skills that are needed to staff the multi-disciplinary team comprised variously 
of psychologists, psychiatrists, psychotherapists, paediatricians, social workers, nurses and 
endocrinologists (not exhaustive). Clinicians require training and experience to build their 
expertise and competencies. That is why, to support a rapid build of a new clinical workforce, 
NHS England has commissioned the Academy of Medical Royal Colleges and University 
College London to design and deliver a professional competency framework and training 
curriculum by 2026. 

Since  April  2024  NHS  England  has  established  three  new  NHS  centres  for  children  with 
gender incongruence in the North-West (managed by Alder Hey Children’s Foundation NHS 
Trust); South-West (managed by University Hospitals Bristol and Weston NHS Foundation 
Trust);  and  London  (managed  by  Great  Ormond  Street  Hospital  for  Children  NHS 
Foundation  Trust). A  fourth new service  will  be  operational by  January 2026  (Cambridge 
University Hospitals NHS Foundation Trust). By 2026 it is planned that additional centres 
will be operational in North East and Yorkshire, and the Midlands.  

NHS  England  is  supporting  the  new  providers  to  establish  and  lead  regional  integrated 
networks that comprise the various statutory services that are likely to be involved in the 
care and support of children who present with gender incongruence, so that there is a more 
coordinated and joint approach to the care for these children and young people, and their 
families, including wellbeing support while on the waiting list. This model will also enable 
and  facilitate  support  to  the  various  health  and  other  statutory  professionals  across  the 
network  who  may  have  infrequent  experience  of  children  and  young  people  with  gender 
incongruence.   

To support the new providers in focusing their available clinical capacity on new patients 
from  the  waiting  list,  NHS  England  has  also  commissioned  a  separate  service  at 
Nottinghamshire Healthcare NHS Foundation Trust from April 2024 to provide psychological 
and  psychosocial  support  to  young  people  who  were  receiving  endocrine  intervention 
through a shared care arrangement between the former GIDS and one of two commissioned 
endocrine providers (Leeds Teaching Hospitals NHS Trust and University College London 
Hospitals NHS Foundation Trust) at the point of closure of GIDS. 

Given the scale and pace of change that was necessary from July 2022 when NHS England 
announced that the GIDS would be brought to a managed closure, no new patients were 
taken  from  the  national  waiting  list  between  April  2023  and  October  2024.  There  was 
agreement  amongst  senior  clinical  leaders  that  it  would  not  be  clinically  appropriate  to 
commence the new assessment of children while the GIDS was being decommissioned and 
before  the  new  commissioned  services  were  operationally  ready  to  begin  the  process  of 
clinical assessment of new patients (the priority of the new services between April 2024 and 

 
 
 
 
 
  
  
  
  
  
 September  2024  was  the  ongoing  care  of  children  transferred  to  them  from  the  former 
GIDS). This arrangement therefore inflated the national waiting list and waiting times during 
this period. However, as of August 2025, all three of the new services are taking patients 
from the waiting list, and the number of patients being transferred into the services from the 
waiting list each month is now higher than the number of new referrals each month (a net 
reduction).  The  fourth  new  service  is  planned  to  begin  accepting  new  referrals  from  the 
waiting list in early 2026. 

NHS England has taken a number of measures to identify and address clinical risk, including 
risk of deterioration in mental health and global functioning of those on the national waiting 
list.  This is important, in  view  of  the  evidence  that  children and  young people  referred  to 
gender  services  (and  adolescents  in  particular)  have  more  complex  presentations,  with 
greater mental health and psychosocial needs, as well as additional diagnoses of autism 
and/or attention deficit  hyperactivity  disorder.  The  Cass  Review described  an  increase  in 
children and young people presenting with issues around gender identity alongside mental 
health difficulties. 

NHS  England  established  a  funded  mental  health  support  offer  for  children  and  young 
people  who  were  on  the  waiting  list  between  April  and  August  2024  (and  who  were  not 
already under the care of NHS mental health services). The process for obtaining consent 
to the referral to mental health services, and the transfer of patient records to the correct 
local  mental  health  team,  was  overseen  by  the  National  Referral  Support  Service.  The 
support offer involved a face-to-face assessment by the patient’s local NHS  Children and 
Young  People’s  Mental  Health  Team  to  assess  mental  health  needs  and  risks;  review 
neurodevelopmental needs, if present; review safeguarding needs; and to allocate or refer 
to  the  appropriate  service  and  pathway  for  further  assessment  or  support.  Triage  and 
prioritisation was dependent on clinical needs and risks of the individuals, which recognised 
the vulnerabilities of this group of children and young people. 

More than 2000 children and young people consented to the mental health support offer and 
were  assessed  by  their  local  NHS  mental  health  team.  This  was  achieved  against  the 
backdrop  of  NHS  mental  health  services  for  children  and  young  people  managing 
unprecedented demand, with around 100,000 new referrals each month, nearly 8,000 more 
than  in  the  same  period  last  year  and  circa  37,000  more  per  month  than  pre-pandemic 
levels.  

Additionally, from September 2024, NHS England ended the ability of GPs to directly refer 
to children’s gender services. All children and young people who are considered for referral 
to the national waiting list for children’s gender services must now first be assessed by a 
local NHS mental health team or NHS paediatrics team. This arrangement ensures that an 
individual care plan is in place for the child or young person, as clinically indicated, before 
they are added to the waiting list. Clinical oversight remains with the local NHS team while 
the child or young person waits to be seen by the gender service. These arrangements are 
formalised in an ancillary service specification that is published. 

I acknowledge that the offer of support to those on the waiting list did not come in time for 
Leia.  According  to  the  information  available  to  NHS  England,  Leia  had  left  the  national 
waiting list for children’s gender services by April 2024, when the mental health support offer 

 
 
 
 
 
 
  
  
  
  
 was initiated. This is because, at the time, young people were necessarily removed from the 
children’s waiting list from the age of 17 because of the service’s age cut-off of 18 years. 
Young people removed from the children’s waiting list are advised to discuss with their GP 
whether a referral to an adult gender clinic is appropriate, and if such a referral is made by 
the GP, the receiving adult gender clinic will honour the original waiting time from the date 
of referral to the children’s waiting list as a measure to reduce time on the adult waiting list.  

National Review of Adult Gender Services 

This  response  has  focused  on  waiting  times  to  Children  and  Young  People’s  Gender 
Services  and  NHS  England’s efforts to  increase  clinical  capacity  in  this field.  However, it 
may assist HM Coroner to learn that in April 2024 NHS England took the decision to conduct 
a review of the operation and delivery of adult Gender Dysphoria Clinics (GDC), in line with 
the  recommendations  of  the  Cass  Review  and  in  recognition  that  waiting  times  for  adult 
gender services are also unacceptably high.  

The  review’s  terms  of reference  and  key  lines  of  enquiry  have  been  published,  and  they 
describe  that  the  review  will  examine  the  operating  procedures  in  each  service;  the 
appropriateness of the service model for the presenting population; areas of concern, and 
any action being taken to improve quality. It will identify areas for improvement in relation to 
service quality, good practice that could be shared with other clinics, and any support that 
should be made available to services to assist improvement.  

The  review  is  led  by 
,  Medical  Director  of  Lancashire  and  South  Cumbria 
Integrated  Care  Board,  and  previously  NHS  England’s  North  West  Regional  Medical 
Director. Following on-site visits to every GDC in England, the report detailing the review’s 
findings and recommendations will be published in the autumn of 2025. The report will inform 
NHS England’s work to build a new service specification for the GDCs over 2025/26, which 
will  involve  a  process of  public  consultation. In  the  context  of  reducing  waiting  times  and 
waiting  lists,  NHS  England  will  particularly  want  to  learn  the  review’s  findings  and 
recommendations around productivity and efficiency within each of the GDCs.  

Thank you for bringing these concerns to my attention. I would like to, once again, express 
my condolences to Leia’s family. 

I hope this response is helpful.  

Yours sincerely,

19th September 

Mr Andrew Walker 
Senior Coroner for North London 

Dear Sir,  

Inquest into the death of Leia Dorothy Pandora Sampson-Grimbly  
Regulation 28 Response  

I am writing on behalf of The Tavistock and Portman NHS Foundation Trust in response 
to your Report to Prevent Future Deaths made on 25th July 2025, following the conclusion 
of the inquest touching on the death of Leia Dorothy Pandora Sampson-Grimbly.  

At the outset, I would like to reiterate how sorry the Trust was to learn of Leia’s death.  

The Trust is grateful to you for raising the matters of concern in your Report which you 
have outlined relating to the services available to patients who are being treated by or are 
on the waiting list to be treated by the Gender Identity Clinic (‘GIC’) at the Trust.  

The role of the GIC is detailed in the service specifications published by NHS England for 
Gender Identity Services for Adults (Non-Surgical Interventions). The treatment pathway 
commissioned under the service specification is as follows: 

1.  Referral  to  a  specialist  Gender  Dysphoria  Clinic  (self-referral;  or  by  primary, 

secondary or tertiary care). 

2.  Assessment for gender dysphoria, and diagnosis. 
3.  Individuals  who  meet  the  criteria  for  diagnosis  of  gender  dysphoria  related  to 
gender  incongruence  are  accepted  on  to  the  NHS  care  pathway  and  an 
individualised treatment plan is agreed. 

4.  Therapeutic  interventions  delivered  by  the  specialist  Gender  Identity  Clinic; 

and/or referral for interventions with other providers. 

5.  Ongoing review and monitoring during and after interventions. 
6.  Conclusion of contact: discharge to primary care. 

The  service  specification  states  that  Gender  Dysphoria  Clinics  assess  and  diagnose 
individuals;  directly  provide  some  interventions  and  arrange  for  referrals  to  other 
services,  including  for  medical  and  surgical  treatments.”  We  are  working  with  NHS 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 England and other providers to develop innovative ways of reducing the waiting list and 
providing support to patients while on the waiting list. 

The Trust undertook a Mortality Review Report, dated 19.11.24 which was then updated 
following additional information received from the GP 17.1.25. Leia had been referred to 
the Tavistock GIDS service in January 2022, in line with referrals at the time this referral 
was immediately forwarded to the NRSS (the Children’s Gender waiting list) held by 
Arden & Gem CSU. As such Leia was never a patient in the GIDS. Leia received a letter in 
February 2024 asking them to attend their GP and request a referral to adult gender 
services. The GP confirmed this was the last time they had met with Leia. The GP said 
that they made a referral to the Adult Gender Clinic. There is no record on the Trust 
electronic patient record of this referral being received by this Trust. A GIC nurse 
investigated this discrepancy by contacting the GP surgery. From this investigation it 
was ascertained that the referral for adult gender services was written by the GP but had 
not been sent over to the Trust’s Service via the electronic referral system. There is 
evidence on HIE that a referral was made to the Haringey Recovery and Enabling adult 
mental health team by Leia’s GP in March 2024. The referral was not accepted due to 
her age at the time, (17yrs) following MDT discussion, advice was given to either refer to 
Tavistock or to re-referred in August 2024 when Leia would with be 17.5yrs old. There is 
no further documentation in our system suggesting that she was referred to CAMHS at 
this Trust.  

The Trust has identified there was a gap in care in that the young person was taken off 
the Arden & GEM child waiting list in February when they were 17 and 1 month. They 
were then referred to the adult gender clinic when they were 17 and 2 months, however 
the referral was not received by this Trust as it had not been correctly sent by the GP 
surgery. The gap in care had not been identified at the time of death and therefore as 
such it does not seem that it would have an impact on the predictability and 
preventability of death.  

The waiting times for such GIC assessments is currently around 2.5 years, which is 
broadly in keeping with the national picture, though there is some variation in waiting 
times. NHS England (NHSE) is the direct commissioner of specialised services for 
individuals with a diagnosis of gender dysphoria. Prior to 2019/20, seven specialist 
centres were commissioned in England, based in or near Newcastle, Leeds, Sheffield, 
Northampton, Nottingham, London and Exeter. Each of the Gender Dysphoria Clinics 
(GDCs) is operated by a Mental Health NHS Trust and is staffed by a multidisciplinary 
team to include the wide range of clinical professionals needed to deliver highly 
individualised care and meet the presenting needs of the whole person (typically and 
variously: clinical psychologists; specialist physicians; consultant psychiatrists; 
consultant endocrinologists; clinical nurse specialists; voice and communication 
therapists; counselling therapists).  

 
 
 
 
 The consultant-led services provided by the GDCs when adult patients are referred to 
them are amongst those intended to commence within 18 weeks of referral. 
Unfortunately, NHSE has been unable to commission sufficient capacity to meet that 
expectation because of the lack of specialist clinical staff (recruitment and retention) – 
against a backdrop of significant increasing demand, reflecting an international trend. 
Unfortunately, waiting times for a first appointment at a GDC remain very high. The Trust 
will continue to engage with its commissioners, NHS England, to develop provisions to 
reduce waiting times where possible. 

The Trust is grateful for your careful consideration of this matter, and hope this letter 
assists in reassuring you, and Leia’s family and friends, that the Trust and the GIC are 
continually exploring avenues to provide the best possible service to their patients. This 
includes measures to reduce the length of the waiting list for the GIC, as the priority has 
always been, and remains, to ensure that patients have prompt access to the service. 

Yours sincerely 

Legal Services Manager  
The Tavistock and Portman NHS Foundation Trust