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  • The Tribune

The unreported crisis in Sheffield’s transgender healthcare

35 years. Almost half a lifetime. And the wait transgender people in Sheffield could face to access healthcare at a city clinic.

According to data from a Freedom of Information Act request, Sheffield’s only Gender Identity Clinic (GIC) is seeing patients at a slower rate than any other in the country. Just 33 patients were seen for an initial appointment in 2022, despite 1,865 people being on their waiting list.

The Porterbrook Clinic in Nether Edge, which is one of seven adult GICs commissioned by NHS England, saw just 0.2 new patients a day last year — approximately one new patient a week. And with waiting times of 56 months (4.75 years) for a first assessment, transgender people from Sheffield and elsewhere say they’re being left in a “desperate situation.”

Further FOI requests sent by The Tribune revealed those also waiting to access one of the other six adult GICs across the country face similar, and in some cases even longer, waiting times. This isn’t about inconvenience. Research shows longer waiting times to access trans specific healthcare contribute to feelings of low mood and suicidal ideation, as well as, as you might expect, decreasing a person’s overall quality of life.

Amber is one of the 1,865 people on the waiting list to receive an appointment from Sheffield’s GIC. She was referred to the Porterbrook Clinic in November 2021 and is still waiting for her first appointment from the clinic who have so far made no contact with her. Six months after her referral, in April 2022, Amber began checking Porterbrook’s website, which is updated with the current expected waiting times every two months. At that point, it said they were only just starting to see people who had been referred to them in 2018.

Speaking to The Tribune, Amber said the wait times on the Porterbrook Clinic’s website were misleading. While the website says there is currently a four-year waiting time, she has calculated that at their current rate of seeing people — one a week — it would take them more than 35 years to clear the backlog. And she added that the long waiting times were having a catastrophic effect on the wellbeing of transgender people like herself.

“My mental health is through the floor,” Amber told us. “I’m over 40 now so I don’t want to have to wait any longer for treatment. I’m considering going back to my GP to see if anything can be done. I would struggle with the cost of going private but it’s a desperate situation.”

Amber is one of the many patients who face the difficult decision between an agonising wait, or financial difficulty as they seek private treatment. Another source told us it was “extremely common” for people to use private clinics in order to start hormone treatment while waiting for NHS gender clinics to take over.

“Basically, everyone who can afford to go private, does,” they said. “Sadly, that means those who can’t afford it are the ones who have to struggle on for many years without treatment.” The source added that many people also resort to self-medicating, but that is extremely dangerous. “I know so many people who have just given up with the NHS and sold stuff or remortgaged their house or whatever just to pay privately,” they told us. “It’s so dispiriting.”

The issue of transgender people waiting months and years for healthcare isn’t exclusive to Sheffield. The Tribune sent FOI requests to the other six adult GICs across the country. Of those that responded, the waiting times are similar and in some cases, even longer.

But with just 33 new patients seen for initial appointments last year, it appears that Sheffield is seeing patients at a much slower rate compared to any other GIC in the country. London has a much larger waiting list of 11,407 patients, yet their maximum wait time is 214 weeks (compared to 220 in Sheffield), with an average of 2.25 new patients seen per day. To be clear: this is a higher rate of people seen per day than Sheffield sees in a week.

London isn’t an anomaly here. Leeds is a similar sized city to Sheffield, but Leeds’ GIC had the shortest wait times, with an expected wait of seven months, they saw 458 new patients in 2022 — nearly 14 times more than the Porterbrook Clinic. And Northampton, which has a population less than half that of Sheffield, and a shorter waiting list, carried out 158 initial appointments last year at their GIC — nearly five times more than Porterbrook did.

Another client we spoke to, Rachel (not her real name), referred herself to Sheffield’s GIC because the wait times were supposed to be the shortest in the country, according to figures published on the website at the time (patients can choose to refer themselves to any GIC they choose).

She waited for two years with no contact from the clinic before attending a pre-assessment workshop with a large number of other clients. “We were all so excited because something was finally happening,” she said. “Only for them to break the news to us that the waiting times would be even longer.”

Rachel waited over three years for her first appointment and believes that the long wait times and small number of patients seen per week is down to staffing issues. “I’ve now been waiting seven months for my next appointment but I have no idea when it will be,” she told us. “There’s absolutely no sign of hearing from them or talking about surgery.

Communication is just non-existent; you email them and you get no reply, it’s awful.”

And a third client, Ben (also not his real name), explained the extent of the mental health impacts waiting to transition can have. He’s been waiting for six years for an initial appointment, during which time he’s been exposed to being misgendered because he hasn’t been able to start treatment yet.

“The waiting times pick you apart piece by piece,” he told us. “My dysphoria is like some ravenous monster that eats away at me, makes me suicidal and frustrated. I get awful nightmares surrounding my body that I don't belong in.”

Ben has also heard the issues don’t stop once you make it through the doors. He said he’s been told “horror stories” about “uncaring staff” being transphobic, misgendering and deadnaming (using a person’s old name, before they transitioned) patients. He has personally received letters that openly misgender and deadname him, despite the fact he was referred to the clinic several years ago under a chosen name and not his birth name.

When he confronted the clinic about the issue, he was told it was a “data error”. However, they said if he wanted letters to be sent to him under his chosen name, he would have to send them his deed poll. “There’s a lot of problems at Porterbrook,” he said. “From their coldness toward our issues, to not taking trans people seriously and the wait times being absolute agony.”

While it’s clear that the issue of long wait times isn’t unique to Sheffield, Porterbrook still isn’t seeing patients at the same rate as other cities. A 2019 report by Healthwatch Sheffield recommended that wait time for transgender patients needed to be “proactively managed” — yet the waiting times for the clinic continue to grow, increasing from 55 months to 56 months between October and December 2022.

The report also revealed that transgender people in Sheffield felt there was a lack of awareness of trans and non-binary identities among health and care workers. Participants felt that the communication from care providers, such as Porterbrook, could be improved and there were also reports of healthcare providers in the city refusing, or choosing not to, use transgender patients' preferred pronouns.

The report also highlighted the negative mental health impact of long waiting times for transgender people in Sheffield who felt the lack of support during the waiting period left them with a “sensation of abandonment”. This resulted in participants making suicide attempts, self-harming or using hormones bought online and without medical supervision.

Heather Paterson from SAYiT, an organisation which offers mental health support for LGBT young people in Sheffield, says the situation is “horrific”.

“We see people’s mental health deteriorate as they are staring into a black hole they don’t see the end of,” she told us. “People get into financial difficulty trying to source healthcare from abroad or buy hormones online. It’s not safe but people are desperate.”

Heather said that SAYiT can offer support to people up until the age of 25 — but that after that there is very little help available at all. One trans woman she knows who has been waiting four years has given up on ever being able to access care on the NHS. This feeds in, she added, into a sense of them being abandoned and of being at the “bottom of the pile”.

“There is a lot of anti-trans sentiment around at the moment and this is just playing into the sense that they don't matter and that they live in a society that doesn't care about them,” she added. She told me that the people her organisation works with are upset, angry and anxious. “We talk about people's mental health but in many ways it’s quite a rational reaction to the situation they are in.”

While Heather accepts that the entire NHS is struggling at the moment, she says what trans people are experiencing in Sheffield is way beyond anything that could be explained away by Covid or cut backs. “I’m on a waiting list for physiotherapy at the moment — but I will get seen,” she told us. “When people are waiting four and a half years to be seen by a gender identity clinic, the NHS simply isn't offering a service to trans people anymore.”

A spokesperson for the Porterbrook Clinic said: “We are here to help people who can be going through a traumatic time in their life — as an organisation we understand our waiting times are too long for someone to wait.

“We are doing everything to ensure people get a timely response — no one will be waiting for 35 years for an appointment. If someone is on the waiting list we offer help and guidance through our own Peer Support workers. They have lived experience of using our services.

“In addition we work closely with our partners at Gendered Intelligence. They offer free and confidential advice to anyone waiting to access our service.

“As an organisation we have recruited and trained more staff to make best use of our workforce and have increased the number of initial assessments since November 2022. We expect to further increase this incrementally by April.”

The spokesperson added that they “continually” update their website with the current wait times. “Our Porterbrook clinic is one of eight nationally in England and the issues we face are similar to those experienced elsewhere,” they said. “We are working hard locally to address the challenges, making sure we reduce our waiting lists and improve our service user experience.

“We are a learning organisation that takes allegations of any discrimination or improper conduct extremely seriously. Transphobia and ‘deadnaming’ [calling a transgender person by their birth name when they have changed their name as part of their gender transition] are unacceptable and have no place in wider society and especially not in Sheffield Health and Social Care NHS Foundation Trust.”

However, according to the people we have spoken to, the long waiting times transgender people are experiencing in Sheffield and up and down the country are evidence that the current healthcare system is failing them, resulting in catastrophic consequences for their mental health.

They say more needs to be done to speed up the treatment process, as those currently on the waiting list face breaking point. “We are suffering,” says Ben. “It’s so hard to face how badly it affects me but this is just something I, and others, go through daily.”

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