A Charity Commission inquiry has identified governance failures at the transgender youth charity Mermaids but found no evidence of misconduct relating to safeguarding, medical advice or referrals.

The regulator opened a regulatory compliance case into the charity in September 2022 after concerns were raised by members of the public and highlighted in the media about its chest-binding services – which were terminated the following month.

People had also raised concerns about alleged ties between the charity’s former chief executive, Susie Green, and the Tavistock and Portman NHS Foundation Trust – which the inquiry found no evidence of.

The regulator’s investigation was escalated to a statutory inquiry in November 2022, after an equity, diversity and inclusion review commissioned by the charity highlighted concerns relating to the charity’s culture, operational management and processes. 

The commission said Mermaids had addressed these concerns with an action plan, alongside additional steps that were recommended in a separate and wider external review of its governance. 

The regulator said that failure to ensure the charity’s governance, culture and practices kept pace with its growing size, demand for services and public profile was a major factor that contributed to wider governance failures. 

Kathryn Downs, chair of Mermaids, said the trustees had accepted this.

“These historic governance issues were addressed through the implementation of the recommendations of two independent reviews, proactively commissioned by our trustees, into EDI and governance,” she said. 

The inquiry found that trustees had failed to address internal issues around culture and inclusivity at the charity.

It also found trustees had failed to carry out sufficient due diligence checks when recruiting trustees, resulting in the appointment of someone the charity said “should never have been appointed”. 

Downs said the charity’s board had since strengthened its due diligence processes for trustee recruitment.

The report adds that trustees failed to properly adhere to their own internal HR policies when it came to the supervision of the charity’s former chief executive or make it clear to the former chief executive and staff that the role did not fall into the charity’s normal HR management policy.

But several concerns raised about the charity were deemed to be unfounded. The inquiry found no evidence that the charity had provided medical advice or that it had made medical referrals for young people without the approval of a parent or carer.

It also found no evidence of inappropriate ties to Tavistock and Portman NHS Foundation Trust or to private medical practices, or of any failures relating to safeguarding policies.

Downs said: “We are relieved that the Charity Commission inquiry which began nearly two years ago is finally over. The report states, as we anticipated, that there is no finding of misconduct at Mermaids.

“The commission has also confirmed, as we have repeatedly asserted, that we have not provided medical advice or acted improperly in our work with children, young people and their families.”

Following the inquiry, the regulator said it would require Mermaids to reflect the Cass Review – an independent review of children and young people’s gender identity services – in some of its work relating to puberty blockers and chest binding. 

The inquiry said the purpose of the information about puberty blockers published on the charity’s website was “unclear”. The inquiry provided statutory advice to the charity on this matter, which Mermaids’ trustees have acted on.

The regulator also looked at the concerns raised by the public about the charity’s chest binder service, which was terminated in October 2022. 

The regulator has issued statutory advice to the charity requiring that if it resumes this service, its future policy and controls should reflect the Cass Review or any future NHS guidelines on parental involvement. 

The Cass Review was met with some concern from LGBT+ organisations, including Mermaids. The charity originally said it was “deeply frustrated with the lack of clarity throughout the report”, which it said had “enabled wilful misinterpretation and the spread of harmful misinformation”.

When asked about the regulator’s enforcement of the Cass Review’s findings, Downs said: “The Cass Review final report is the highest-profile review of youth healthcare in the world and has influenced NHS England’s policies. However, it is not legislation or guidance. The Charity Commission notes that Mermaids’ website has been updated to reflect recent NHS statements.”

She said the charity’s advocacy and policy work would continue to be driven by and give a platform to the voices of young trans people, adding: “This includes healthcare, where we continue to campaign for access to timely, holistic and supportive healthcare for trans youth, including access to puberty blockers and hormones for those who need them.”

Downs added: “Considering the changes already made at Mermaids independently of this inquiry, the time taken to publish this report has been frustrating, significantly affecting Mermaids’ fundraising and ability to deliver on our charitable objectives. 

“We call on the Charity Commission to ensure that organisations serving groups facing rising hostility are supported and protected, while being held to account where this is necessary.”

Orlando Fraser, chair of the Charity Commission, said: “We have carefully scrutinised Mermaids’ activities through a statutory inquiry and have found mismanagement in a number of areas. Mermaids co-operated with our investigation and has been actively addressing the various concerns raised.”