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Working together we can improve gender identity services – Will Huxter

In his latest blog the chair of the NHS England Gender Task & Finish Group looks at the work being done to help improve people’s experience of NHS gender identity services: 

We know we can’t do this on our own, and it is a really key part of our approach that we want to work in partnership with the community, with providers of gender identity services, and with colleagues in other parts of the NHS, including Health Education England and the General Medical Council.

Through working together, we can achieve real improvement more quickly.

Firstly, I wanted to draw attention to some great work on transgender issues that has been done in Brighton.   A new online guide for supporting trans patients in GP surgeries has been launched by NHS Brighton and Hove Clinical Commissioning Group (CCG).  According to estimates, at least 2,760 trans people live in the city, with many more going there to study and work.

The guide’s introduction follows a recent Women and Equalities Select Committee report into Transgender Equality in the UK.  The CCG’s guide has been developed with input from local transgender people and aims to help GPs and other clinical staff in General Practice support patients accessing NHS Specialist Gender Identity Services.

Last week we had the latest meeting of NHS England’s Gender Task & Finish Group and  I’m pleased to say we now have CCG representation on the group from Brighton & Hove.  We focussed in particular on our analysis of waiting lists for the seven Gender Identity Clinics (GICs); what we are doing to increase capacity in the GICs so that they can see people more quickly after referral; the rules in relation to recording and reporting how long people have been waiting to be seen; and preparation for the symposium meeting on 3 March.

In response to concerns we have heard about the inconsistent approach across the providers in the interpretation and application of the 18 week Referral to Treatment standard, we have been working to update the waiting time guidance. I will return to this in a future blog.

Our analysis of the waiting time data from all the clinics shows that as of December 2015 there were 4,075 patients waiting for a first appointment with a clinic, with 15% of those people already having waited more than a year for an initial appointment.

Age profiling of the clinic waiting lists shows a similar profile across all clinics, with almost half of all people waiting being between 18 and 24 years old.  75% of patients have been referred by GPs, with almost all of the remainder having been referred by another clinical speciality within secondary (hospital-based) care. I have asked the GICs to validate the data by 1 March and I will report on the outcome in a future blog.

This is the first time NHS England has looked consistently at the waiting list data for all seven clinics.  The analysis will inform what data we require clinics to supply to commissioners on a regular basis in future.

I have written and spoken before about what we are doing to invest more in the GICs to reduce waiting times by increasing capacity; we also need to look increasingly at the ways in which we can make the best use of current capacity, and offer people a consistent high quality assessment, diagnosis and treatment service whichever GIC they attend.

I chaired a meeting with all of the GICs at the end of January, when we met together with local commissioning leads and colleagues from the national specialised commissioning team.  At that meeting, the GICs shared information on examples of innovation that they have developed, and we discussed how the benefits from these can be achieved across the country, so that individuals receive support that is appropriate for them as quickly as possible.  These included a new four-week assessment process at Exeter, a preparation group for people on the waiting list in Sheffield, a triage system in London, and one day courses for patients and families in Nottingham.

Local commissioners from NHS England are now working with each of the GICs to agree the additional investment for the clinics from April 2016.  This will vary depending on the size of the clinic’s caseload, and the robustness of the plans to reduce waiting times.  I will share details of what is agreed once it has been finalised.

I am also meeting with representatives of the surgical providers in March to agree the future application and reporting of the 18 week Referral to Treatment Standard, and the additional investment that is needed to stabilise and then reduce waiting times for surgery.

One of the enduring challenges for all the clinics is recruitment of suitably trained and experienced staff, including in particular medical staff.  Ahead of this week’s symposium, we have been in discussion with Health Education England (HEE), the General Medical Council (GMC) and the Royal College of Physicians about what can be done in both the short and the longer term to develop gender identity as a specialism supported by appropriate curricula and recognition.  We will be discussing this further at the symposium, and I will provide feedback in my next blog.

The Minister for Public Health has provided a formal Department of Health response to the recommendations for the NHS set out in the Women and Equalities Select Committee report. Within NHS England, the Task & Finish Group will monitor progress against the recommendations, including the work being done to develop the service specification for adult services.  The draft service specification for the children and young people’s service is currently out for stakeholder engagement, and wider public consultation is planned.

Finally, I was proud that NHS England was recently nominated as a Public Sector Partner of the Year in the recent LGBT Foundation Heroes Awards. Congratulations to Police with Pride North West for winning this category and for all the good work that they are doing.

I hope that this information is useful, and I look forward to receiving any questions or comments via this blog.

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10 comments

  1. Mark Brennan says:

    While the 7 identity clinics offer a good service, they represent an administrative and geographical bottleneck on access, this in principle against 21st century healthcare policy. Much of this problem is simply historic, but I would ask that the Task and Finish group addresses the question as to why there are so few clinics in the UK. These are not high cost tertiary surgical units, and are not expensively resource heavy, nor are they consistent in their core staff – why not think outside of the box and commission a larger network with all the benefits of access, local support and data sharing???

    • Will Huxter says:

      Dear Mark

      Thank you for your suggestion.

      There is always a balance to be met with the configuration of any specialised service. On the one hand, we want services to be accessible with the shortest possible journey time between the patient’s home and the clinic; and on the other hand we also need to ensure that the service is delivered by specialist multi-disciplinary teams who have the necessary skills, expertise and experience in the interests of safety and quality outcomes.

      Our priority at the moment is to stabilise – and then reduce – waiting times at all of the gender identity clinics, hence our deployment of an additional £6m in gender identity services in 2016/17.

      In the longer term we certainly do intend to think “outside of the box” in order to achieve service and pathway re-design in the interests of a better patient experience and even better clinical outcomes. I definitely agree that a local, network focus – with appropriate national support where there is needed – is where we should start in this regard.

      Kind regards

      Will

  2. Trish Gamble says:

    Hi – could you let me have more details of the one day courses for patients and families in Nottingham referred to above.

    thanks

  3. Kim Bellis says:

    As chair of the NHS England Gender Task & Finish Group will this group be looking at how records are managed for patients who are going through the transgender process, and how information can be shared across services to improve the experience of these patients when they present at our organisations. Guidance on this would be extremely helpful.
    Thank you
    Kim Bellis, Records Services, PAS & Data Quality Manager and Chairman of the Institute of Health Records and Information Management.

    • Will Huxter says:

      Dear Kim

      Thanks for raising this issue.

      This isn’t something that the Task & Finish Group has looked at directly, but it could be something that we pick up in the wider discussions that we are beginning to have with other relevant organisations at the symposium meetings. If you could drop me a line with some further detail that would be great. Please write to me at NHS England (London Region), Southside, 105 Victoria Street, London SW1E 6QT.

      Kind regards

      Will

  4. Michael says:

    Given that half the people waiting are under 24, can you have a look at the current situation with referrals for those in the 16.5 -17 year old age bracket? If people in this age bracket are referred to the youth service, they may well turn 18 before assessments are completed and a treatment programme commenced.

    However, the situation with 16-17 year olds on adult clinic waiting lists seems to be inconsistent: Nottingham accepts onto its waiting list anyone who will be 17 by the first appointment (so based on current waiting times, anyone aged 16+ can join their waiting list); the Laurels states it will only take referrals from people who are already 17; the Porterbrook’s website suggests referrals can only be made for those who are already 18. London says it won’t see under 17s, but it is not clear from its website whether 16 year olds can join the waiting list. The position for the other clinics is not stated on their websites.

    A consistent policy in this regard would offer more clarity, and address the current situation where young people who are (say) 16 years and 9 months feel Nottingham is the only option available, despite the fact that most adult gender clinics will be unable to offer them an appointment until they are nearly 18 anyway (and in some cases, well over 18).

    • Will Huxter says:

      Dear Michael

      Thanks for raising this important issue.

      I absolutely agree that we need a consistent approach, and that young people seeing support can easily get information about what is available for them. This is something that we will achieve by the ongoing work around developing a new service specification for the children and young people’s service, and in developing protocols and a specification for the adult service.

      Kind regards

      Will

  5. Samuel Hall says:

    Great to see a mention of Brighton & Hove CCG. Please note this weekend 5th March we are holding a GP training event covering all aspects of Trans treatment – organized by the CCG with Brightons Trans Alliance and the Nuffield hospital in woodingdean. As far as we are concerned this is a first. Also a question – do you have any doctors who are Trans identified on the task and finish group? It would be remiss not to use those who have direct personal experience as well as insight into the clinical issues and inner workings of the NHS.

    • Will Huxter says:

      Dear Samuel

      Thanks for your post.

      No, we don’t currently have a trans-identified doctor on the group, though we do have a general practitioner and a gender identity specialist physician. We’ve also asked trans-people to join us to advise us on specific issues, and we hold ourselves accountable to the Transgender Network at its twice-yearly workshops.

      Kind regards

      Will