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Championing the needs of the transgender community – Will Huxter

The Chair of the NHS England Gender Task & Finish Group looks at what NHS England is doing to improve health services for transgender and non-binary people:

I was pleased to welcome to last month’s Task and Finish Group representatives from four local Healthwatch teams, together with their national counterparts.

These included members from Devon, Hampshire, Hertfordshire, and Telford and Wrekin Healthwatch teams who are the “consumer champions” for people who use health and social care services in England.

The Group heard all about the impressive engagement between Healthwatch teams and local trans-people including:

  • A report published in March by Healthwatch Devon called Speaking Out on Gender Identity Services. The idea for the report followed a multi-agency symposium convened by NHS England last year. They gathered views from around 150 people, via a survey. The report highlights, among other things, there can be a lack of understanding about the rights and status of trans people at all levels of service delivery, and across general and specialist services.
  • Chrysalis, a charity supporting trans-people, has worked with Healthwatch Hampshire to produce a film aimed at raising awareness of the transgender pathway amongst general practitioners.
  • Personal stories conveyed on behalf of trans-people. Some of the stories touched on the problems that are well known to us, including long waiting times, out of date or incorrect information provided by the NHS, and bullying and discrimination. Others cited specific examples of very practical problems faced by trans-people across the country, such as inconsistent approaches in reimbursing travel expenses for people who qualify under the NHS Healthcare Travel Costs Scheme . We also heard some encouraging examples of good practice, such as how GPs can really make the difference in supporting their patients through the process.

We discussed how important the patient voice is to improving services, and committed to  sharing information that helps us to understand the problems from a user-perspective and enables us to find more creative solutions, including accessing the skills and expertise of the voluntary sector.

I want to thank all of the Healthwatch representatives who gave up their time to attend the meeting, and I look forward to exploring how else we can collaborate in the future.

Also, last month, the Care Quality Commission published its inspection report of the Tavistock and Portman NHS Foundation Trust, which had a particular focus on the specialist Gender Identity Development Service for gender-variant children, adolescents and young people.

I’m very pleased the CQC found many positive things about the service, including:

  • a strong focus on developing research within the field and working with partners internationally to ensure that best practice was developed in an area where there was not a strong evidence-base currently;
  • the establishment of user/peer support groups to provide additional support to young people and their families, and a stakeholder reference group that includes young people; the regular “family days” are well regarded;
  • Strong relationships with local child and adolescent mental health teams.

Recently, I was pleased to be asked to present the work of NHS England at the Westminster Social Policy Forum on Policy Priorities for Transgender Equality, where I recapped on the work we have already done to improve services, and acknowledged that there is more to do.

I talked about the additional investment NHS England has made in gender services over the last two years, to address capacity and reduce waiting times.  I welcomed the Women and Equalities Select Committee report and its focus on the equalities agenda, and described it as both chastening and important.

In panel discussion, I was asked about the role of GPs, about the service specifications and about whether we are taking the wrong approach by investing in over-stretched specialised services which do not meet everyone’s needs.  I confirmed the basis on which NHS England commissions services is national specification and policy.  We have a legal duty to commission services in line with those specifications.

I cited regular comments that are made to me regarding the challenge of how we ensure we provide a nationally consistent offer to people.  We aren’t always doing it as well as we should while we’re commissioning services at the moment, but I questioned, given people’s reported experience sometimes in primary care, whether going to a model where people rely on primary care as the lead provider of some of these services is the answer.

The World Professional Association for Transgender Health (WPATH) held its international symposium in Amsterdam last week. WPATH convened a Standards of Care Revision Committee to begin the process of updating the current standards of care. I am pleased that Dr John Dean from the Laurels Gender Identity Clinic in Exeter, a member of the Task & Finish Group, has been appointed to the committee.

Finally, on 30 June I have convened for the first time, a joint meeting of all the gender identity clinics and gender identity surgical providers together. I have asked the providers to report on how the additional investment given by NHS England this year has been used in each service to reduce waiting times and reduce capacity pressures. I will report on the discussions in my next blog.

  • Please let me have any observations or questions about this blog via Twitter at #nhsgenderid

Thumbnail image of Will HuxterWill Huxter is Regional Director of Specialised Commissioning (London) at NHS England and currently chair of the NHS England Gender Task & Finish Group.

Prior to joining NHS England in June 2014, Will worked in a range of commissioning roles within the NHS, and for five years at an NHS Trust.

He has also spent eight years working in the voluntary sector.

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4 comments

  1. Alex O'Rourke says:

    Hello,

    NHS England funds England’s Gender Identity services, so I thought I would share my experience of the West London Gender Identity Clinic.

    I underwent an initial assessment at the West London Gender Identity Clinic on 20th January 2016.

    I had a wretched experience at the clinic.

    First, I was patronised by the consultant psychiatrist who conducted the assessment.

    Second, I was interrogated.

    Third, I was made to feel as though I had to justify myself.

    Needless to say, I won’t be going back for the second assessment.

    I hanged myself several months before the assessment. At the time of the assessment, the NHS was fully aware of my suicide attempt and the circumstances surrounding it.

    Now, the NHS and West London Mental Health Trust may feel, think, believe that the way I was treated at the West London Gender Identity Clinic is acceptable, but I don’t. I am – and always will be – disgusted by the way I was treated at the West London Gender Identity Clinic.

    Furthermore, since I am now left with no alternative other than to self-medicate, please explain in what way the NHS is fulfilling its duty of care to me?

    Yours faithfully Alex O’Rourke

    • Will Huxter says:

      Dear Alex

      Thanks for getting in touch, and I am very sorry to learn of your poor experience.

      Please be assured that NHS England takes complaints very seriously. It wouldn’t be appropriate for me to respond in any detail to an individual complaint via this blog, but instead I suggest you write to me with full details of your concerns: NHS England, Southside, Mezzanine Floor, 105 Victoria Street, London SW1E 6QT.

      Kind regards

      Will

  2. Deborah Jeremiah on behalf of Mermaids says:

    This posting is very perplexing and surprising when we know that children and young people are now waiting 9 months for even a baseline assessment at the Tavistock and Portman Gender Identity Clinic with no support in the interim. This waiting time has grown from 5 months to now 9 months but all breaching the 18 week target seemingly without punity. The CQC report looked at the wider services at the same trust and the inspection of the GIDs service did not include the adjoined endocrinology service which is a major omission. The CQC also raised areas of concern about the Gender Identity Services at the Tavistock and Portman and therefore this posting is unbalanced and presents rather a more positive picture than we know to be the case in reality. If NHSE are minded to use blogs to share information then at least let’s have a dialogue that is based in reality and not something self serving. The challenges to the trans community of all ages to access care and support are very real, life impacting and sadly at times life threatening. Let’s have substance and real improvements rather than display please.

    • Will Huxter says:

      Dear Deborah

      Thank you for your comments.

      The purpose of the blog is to share information in a concise and accessible way, signposting people to other websites and other sources of information. I have provided the direct link to the CQC report so that people can consider the report in detail for themselves.

      I don’t agree that my summary of the CQC findings is misleading. The CQC has rated the Young People’s Gender Identity Development Service as “good” in response to each of the five questions: “Is the service: Safe / Effective / Caring / Responsive / Well led”, as well as an “overall” rating of “good”.

      By comparison, when I referred people to the CQC’s report of the GI Service at West London Mental Health NHS Trust in May my summary focused on the areas that the CQC rated as “needing improvement”.

      The CQC report for the young people’s service notes that waiting times are currently too long, reflecting NHS England’s own public acknowledgement that waiting times at all of the adult clinics and the young person’s service need to be reduced. This is why we have again increased funding for gender identity services – by £6.5m this year – of which £2m is for the young people’s service.

      Kind regards

      Will