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Tackling capacity constraints in the trans pathway – Matthew Mills

The Royal College of Speech and Language Therapists is doing some impressive work in coordinating national efforts to address capacity issues in the trans pathway. Here the college’s National Advisor in Transgender Voice tells us more: 

Speech and Language Therapists aim to support trans and non-binary people in specialist voice modification therapy, facilitating gender expression through vocal and communication style changes.

I am pleased to be asked by Will Huxter to detail the work that we, members and colleagues from the Royal College of Speech and Language Therapists (RCSLT), have been doing as a profession to try to address the difficulties in service provision of speech and language therapy for trans and non-binary people in England.

I am a National Advisor in Transgender Voice for the RCSLT, and work as the Lead Specialist Speech and Language Therapist at the Gender Identity Clinic (GIC), London, West London Mental Health NHS Trust.

NHS England’s second multi-agency symposium in March was invigorating because it provided Royal Colleges of Medicine, other colleges and organisations with an opportunity collectively to sign up to the development of action plans to improve services for trans and non-binary people and to develop the professional workforce.  Representing the RCSLT, I was gratified that symposium members considered developments in speech therapy to be ‘trail blazing’.

What problems are we addressing? The clinical pathway for trans and non-binary people can be diverse and complex, and it is known that speech and language therapy services are patchy geographically for trans clients. There are not enough competent or confident SLTs nationally who have access to supervision and a GIC multi-disciplinary team.

But we have a number of work-streams in place to create positive change.

Firstly, we are in the process of developing and consulting on a draft competency framework to support dynamic and innovative skill learning for speech and language therapists in order to develop our workforce. I was co-opted on to NHS England’s Clinical Reference Group for Gender Identity Services in 2015 to take forward this work begun by the RCSLT in 2014.

This is an evolving landscape but we are exploring how to define the competencies of a GIC-based specialist SLT, as compared to an experienced specialist SLT who is not based in a GIC. We clearly need to find ways of cascading and growing skills effectively while protecting and taking seriously the highly specialist knowledge and skills required to deliver first-class voice and communication therapy to trans and non-binary people.

Secondly, a number of SLTs and I recently formed a National Transgender Clinical Excellence Network (CEN). Its inaugural training meeting was held in February, attended by 50 SLTs UK-wide. We received presentations from SLTs and service users and held a workshop on the draft competency framework. We have an online forum – ‘Basecamp’ – which enables us to share clinical resources and provide mutual support.

Thirdly, the RCSLT is currently consulting SLTs from a range of clinical areas, the British Association of Gender Identity Specialists and other clinical professionals to consider service delivery models. The ‘hub and spoke’ is one such model, and also used for other specialist fields.

We are still examining the pros and cons of its application to voice and communication therapy service delivery. Following the report I delivered to the CRG on the nature of voice and communication change for our clients, it debated and voted to recommend a ‘hub and spoke’ model to NHS England.

I am very excited about NHS England’s increased investment for the GICs.  Following our recommendations, GICs are increasing their speech therapy capacity and recruiting to the team.

Indeed, in very recent discussions I have had with GIC managers and Lead Clinicians in Leeds and Exeter, and with the recent SLT appointment in Nottingham, I hope that by the end of 2016 with the current trajectory, all seven GICs in England will have at least one specialist SLT embedded within the team.

This delights me but it is not the end of the story.

We need to move to a model which supports both specialist GIC-based speech therapy and greater local provision of speech therapy to iron out geographic access problems. With supervision and training given by the GIC-based SLT, the local SLT provider can treat initial stages of voice therapy in on-to-one sessions, after which group therapy work, social communication and psychosocial integration of voice and communication can be delivered by the GIC-based SLT. If we are to have a hub and spokes, we need both. But this model needs to be accounted for in detail with a joined up commissioning plan and care pathway between GICs and their local providers.

Speech and language therapists are passionate! We take time to consider the details – but they are well worth considering. I am part of a growing network of committed SLT colleagues working and developing in this field nationally. As one of my trans women clients attending a recent voice group told me: “Without this therapy, I could never have found my true voice and really live my life to the full. It is so important.”

We owe it to our clients to keep delivering and keeping the momentum going. I am utterly committed to this, and I ask for commissioners to help us take our vision forward.

I also hope that other clinical specialties are prepared to follow our lead and develop similar plans to improve competencies and stimulate interest in improving services for trans and non-binary people.


matthew-millsMatthew Mills is Lead Specialist Speech and Language Therapist at the Gender Identity Clinic, London where he has worked since 2009.

He is a National Advisor in Transgender Voice for the Royal College of Speech and Language Therapists.

He originally trained as a professional actor and singer at Guildhall School of Music & Drama and worked in theatre, film and television for 15 years.

He is a lecturer in voice at Royal Central School of Speech & Drama and in speech and language therapy at the University of Greenwich. He is also a council member of the British Association of Gender Identity Specialists.

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4 comments

  1. Michael Thomas says:

    With GICs now taking patients across the country, it would be really helpful to have reciprocal ‘exchange’ arrangements between the GICs for access to speech therapy. E.g. if a patient lives close to Nottingham, but is a patient of Charing Cross GIC, at the moment their only option seems to be to travel to London for speech therapy appointments – the Nottingham speech therapist won’t take referrals for non-Nottingham patients, even though they are all ultimately funded by the NHS England specialist pathway.

  2. Jane Chaplin says:

    It is such a shame that local CCG’s in some areas refuse to support or fund access to speech therapy for trans people leaving them with no assistance other than that available at GIC’s which are all in excess of 100 miles away. A sad reflection of the attitudes of committee structures elsewhere in the NHS

  3. Kim Clarke says:

    Where as this sounds very positive, Southampton does not appear to be part of NHS England, as they have repeatedly stated “we do not provide this service”, although the GIC insist they do, they just dont know it yet, and the local GP have refered me several times with no success.

  4. Miss Petrina Drake says:

    That’s all very well but what if like me the London G.I.C recommends my local GP to arrange voice therapy but he doesn’t know who to contact? Plus its not just this area but also I’ve found that information about blood tests etc. done locally are not being forwarded to G.I.C. there is no real cohesion for example between my GP and the G.I.C and I’ve had to take copies of tests with me because GIC have not had them.