On 18 December 2025 NHS England published Dr David Levy’s operational and delivery review of the nine commissioned NHS adult gender dysphoria clinics in England. Same day, it published its initial response.
This is about adult clinics. It is an operational review — waiting times, data, staffing, how the clinics are run.
Levy’s key findings, in ordinary language:
The clinics mostly have exceptionally long waits. By the end of March 2025 more than 40,000 people were waiting for a first adult assessment. Patients being seen in late 2024 had waited an average of five years and seven months. Separate waiting lists mean nobody can even see the true size, because people can be on more than one list.
There is no systematic record of whether patients got better. Limited quality data and almost no clinical audit make it impossible to know outcomes or safety. Levy says that puts these clinics outside normal NHS quality-assurance expectations. The people turning up are also younger, with more extra health problems, and the clinics have not always changed how they work.
NHS England’s letter accepts the review. It says waits have been unacceptably long. Next steps it named include a National Portfolio Board, a single national waiting list (planned for April 2026), ending self-referrals, raising the referral age to 18 so it matches discharge from the children’s service, and asking clinics to get people out of the specialist service earlier.
Long waits and missing outcome data are not a reason to pretend adult medical transition is settled science. They are a reason to read the NHS pages.
- united kingdom
- nhs