Transgender Healthcare Services In The UK Are Broken URGENT Improvements Are Needed
Gender diverse patients, waiting up to four years for a first appointment, are suffering unnecessarily. Clarity is urgently needed on interim healthcare options.
The Women and Equalities Committee inquiry into the provision of LGBT healthcare has now closed (05.10.18) and our thoughts have never been more focused on the future provision of healthcare to gender diverse patients in the UK.
Now is the time for transgender voices to be heard and for their health to be given the same level of importance as every other person in Britain.
The 2016 Women and Equalities Report found that ‘the NHS is letting down trans people, with too much evidence of an approach that can be said to be discriminatory and in breach of the Equality Act.’ Yet, since then, little appears to have changed. Gender dysphoria, if dismissed and ignored, is life-threatening across all age groups, and yet patients can wait up to four years for a first appointment. By comparison, patients with diabetes wait 18 weeks to see a specialist.
To that end, the signatories of this letter are today calling for better transition healthcare for this marginalised group of people.
Despite the World Health Organisation thankfully declassifying their diagnostic category of Gender Incongruence as a mental illness in 2018, there is something about gender diversity which makes some people very afraid.
Mention children and the levels of hysteria rise further, as borne out by regular tabloid headlines denying and ridiculing those who are simply not comfortable with the gender they were assigned at birth.
Yet, research recently published in the the Journal of the American Academy of Child and Adolescent Psychiatry reveals that when children are allowed to transition, including the use of puberty blockers, it improves their mental health.
Furthermore, the American Academy of Pediatrics, which with 64,000 professional members is the most respected paediatric organisation in the world, recommends taking a “gender affirming” non judgemental approach so that: “children feel safe in a society that too often marginalizes and stigmatizes those seen as different.”
As you well know, our response to gender variant patients here in the UK is to put them on a waiting list for highly specialised NHS service provision. These specialised service clinics are massively overwhelmed. As a result, young people wait 18 months just for an initial appointment, and adults wait up to four years. It is only then, that the path to treatment begins and it is a path that can take anything up to 24 months.
Many trans patients are told that their care will be withdrawn if they seek interim private options while they wait for NHS services. No other branch of medicine would operate in this way.
Furthermore, while they wait, there is often little support, as many GPs and local hospitals hide behind a shocking lack of knowledge and skills. Instead huge numbers of patients are left to flounder. For some, this proves too much and they resort to accessing medication on the black market without a prescription, to bridge the gap while they wait for safe care. For others, it is worse and common outcomes are self harm and suicide.
The recently published NHS England Service Specifications supports an approach emulating best practice in parts of Canada and the US. Here, a primary care based model operating according to the informed consent principle, is closer to the ‘norm’.
However, while the developments are certainly heading in the right direction, patients are unlikely to see the benefits until 2021/22. Furthermore, the service specifications do not give any recommendations on bridging services for patients while they wait for treatment, nor do they advise GPs on how they might support their patients, while they wait to be seen. The guidance does refer to the fact that patients might be self-medicating, but offers no advice for the safe transfer to prescribed medication.
What these patients need is access to the right interim support and medication via a channel where they can be monitored and cared for. Healthcare professionals of all grades also need emergency education to enable them to offer help at all levels.
Patients are suffering and a workable solution must be found.
We are calling for:
NHS waiting times for gender diverse patients of all ages to be urgently reviewed.
Clear options on interim solutions to be made available to people while waiting for their NHS appointment.
Assessment and treatment pathways to be modernised.
Alternate healthcare solutions to be recognised.
Clear information on how best to support gender-diverse patients in a primary care setting to be cascaded to those working in primary and secondary care.
Clear guidelines so that GPs feel empowered to offer support, including bridging prescriptions and shared care agreements, where requested.
Private care to be made available without retribution or consequences to the patient (as laid out in the NHS constitution).
On behalf of the many transgender people currently being let down by NHS healthcare services, we request a response to the above issues outlining how they will be tackled, and by when.
We welcome the opportunity to discuss our ideas for education and service delivery in person, and to facilitate the opportunity for trans voices to be heard.
Dr Helen Webberley, GP and Gender Specialist Dr Mike Webberley, Consultant Physician and Gender Specialist Aimee Challenor, Equality Campaigner Ali Camps, Co-Chair of Pride in London Annette Pryce, NUT (Section) LGBT+ Executive Member Aydin Olson-Kennedy LCSW, Executive Director Los Angeles Gender Center Bernard Reed OBE, MA, MBA, Trustee, Gender Identity Research and Education Society (GIRES) Capt Catherine Burton FRAeS Chay Brown, Trans Actual UK Christine Burns MBE., MSc., C.Eng., MBCS, Author; Trans Britain Dominic Davies, CEO Pink Therapy Dr Adrian Harrop, ST3 Registrar in General Practice; LGBTQ+ campaigner Dr Ben Vincent, BA (Cantab) MPhil PhD, Chair, Gender Identity Research and Education Society (GIRES) Dr Heather Peto, LGBT Labour Transgender Officer Dr Meg-John Barker, Senior Lecturer in Psychology, The Open University Dr Ruth Pearce, Research Fellow, University of Leeds Dr Carol Steele B.Sc., Ph.D. Dr Norman Spack, Founder of 1st USA clinic to medically treat adolescents with gender dysphoria, at Boston Children’s Hospital and Harvard Medical School Edward Lord OBE, JP Chair Establishment Committee, City of London Corporation (personal capacity) Ellen Murray, Executive Director TransgenderNI Heather Paterson, LGBT+ Campaigner and Community Worker Iain McCallum, Advisor All About Trans India Willoughby, Broadcaster & Journalist Jane Fae, Writer Jay Stewart, Gendered Intelligence Jennie Kermode, Chair, Trans Media Watch Jenny-Anne Bishop OBE, All Wales Gender Identity Partnership Group Juno Roche, writer and campaigner Karen Pollock MBACP, Counsellor Northumberland Kate Adir, Trans advocate Kate Hutchinson, Director at Wipe Out Transphobia Katherine O’Donnell, Journalist, LGBTI rights campaigner & Equality Network Trustee Kellie Maloney, Former Boxing promoter. Broadcaster and diversity Speaker Marianne Oakes, Dip Couns Michelle Ross, Founder and Director cliniQ Munroe Bergdorf, Model and Social Activist Natacha Kennedy, Goldsmiths College and University College London Natalie Washington, Transgender advocate Neville Southall, ex goalkeeper for Everton FC Paul Farrelly, MP Prof. Stephen Whittle, OBE, PhD, DLaws hc, FAcSS, MA, LLB, BA, Professor of Equalities Law, The Manchester Law School, Vice President and Head of Legal Services Sally Jane Coles B.Sc, child health, RGN,NMP Sophie Cook, Writer and Broadcaster Sue Pascoe, LGBT+ Conservative Council Member Tara Hewitt, Leadership & Inclusion Consultant Co-founder Trans Equality Legal Initiative Terry Reed OBE, JP, BA (Hons), MCSP, SRP, Grad. Dip. Phys, Trustee, Gender Identity Research and Education Society (GIRES)