We are meeting concerns on gender services
NHS England’s new Senior Responsible Officer for Gender Identity Services introduces a 12-week consultation on proposed new service specifications:
I want to begin my first blog by thanking predecessor Will Huxter who held this job for the last two years and has been a powerful advocate for the rights of trans people.
Since 2015 there has been much progress in how the NHS commissions and delivers the various treatments and interventions on the NHS pathway of care in England:
In response to long standing concerns of trans people, we now have clarity on the application and interpretation of the national 18 week Referral to Treatment standard along the entire trans-pathway, and all NHS-commissioned gender identity services will begin regular, consistent national reporting in 2018 so that there is absolute transparency about waiting times.
We have significantly increased financial investment in specialised gender identity services. This has helped meet increased demand, though the increasing numbers in recent years has been so significant that we have some way to go in bringing waiting times down. This is a priority for us and is one of the key drivers for our intention to re-tender the award of contracts for providing specialist gender identity services in the future.
We adopted a new service specification and clinical commissioning policy for the Gender Identity Development Service for Children and Young People in 2016, informed by a process of public consultation and stakeholder engagement.
We have established a multi-agency symposium of organisations and groups – including those representing trans-people – who have an interest in helping NHS England address system-wide issues of concern. Our initial work has focused on the development of a competencies framework for health care professionals working in gender identity services, under the leadership of Health Education England
We have convened a reconstituted Clinical Reference Group (CRG) for Gender Identity Services, under the chairmanship of Dr John Dean, to provide expert advice to NHS England. Its membership includes trans people. The CRG’s immediate priority has been to provide advice in the process of developing new service specifications for specialist adult services
In June 2017 the National Institute for Health Research, having taken advice from the CRG for Gender Identity Services, published a call for applications for research in the field of gender identity services. An improved evidence base will greatly assist the NHS in making decisions about the commissioning and delivery of gender identity services in the future.
Despite the progress, we know that some concerns persist. In speaking with Will, CRG members and groups representing trans people over the past few years, I have learned about the discrimination and inequalities experienced by trans people, and I am committed to working with them to address issues of concern.
I have two immediate priorities:
On 7 July 2017 we published two proposed service specifications for a 12-week public consultation covering both surgical and non-surgical interventions. These were informed by the outcome of a stakeholder engagement workshop that we held in January.
The specifications make proposals for how specialised gender identity services for adults will be commissioned and delivered in the future. The final versions will be informed by a consideration of the views put forward during consultation and they will be used in a national process of procurement later in this financial year. The procurement will determine which organisations are best placed to provide gender identity services for adults in the future in accordance with the new specifications.
I encourage people to take part in the consultation and associated events that we are hosting or attending.
I am mindful of the findings and recommendations of the Women and Equality Select Committee’s inquiry on Transgender Equality in 2016, particularly addressing the lack of cultural awareness in the NHS that can often act as a barrier to access for trans people, and in some cases discrimination.
The problems range from ignorance among front line staff about general issues such as the correct use of pronouns to more serious problems that can cause extreme distress to trans people and that raise concerns about safety and quality, such as the risk of hospitals placing trans people on wrong sex wards.
I have put into place a piece of work that will explore and test potential approaches for addressing these concerns in the wider NHS. Our immediate focus will be on NHS services that are part of the trans-pathway for adults but that are often delivered in non-specialist hospitals, and if we are successful we will share the learning from this initial work for application in the wider NHS. This work will very much benefit from the participation of trans-people and LGBT groups and we will share details through our list of registered stakeholders very soon.
I look forward to working with you all and my focus will be on establishing a model of care and configuration of providers that delivers the best possible quality of service.
I welcome your comments on this blog and will do my best to respond as quickly as I can.
James Palmer
James Palmer has been Medical Director for Specialised Services since NHS England’s inception in 2013. He is a member of NHS England’s Specialised Commissioning National Team. He is a Consultant Neurosurgeon at Plymouth Hospitals NHS Trust.
11 comments
All well and good re the service specifications – but where are we with the clinical commissioning policy – has there been any progress since the Interim Protocol?
In view of the draft service specifications – is there any development on a new Clinical Commissioning policy for Gender Identity Services? Or is the interim protocol still in play? A reply would be appreciated.
I was diagnosed with GID in 1996. I did not have a successful hormonal reassignment and did not develop secondary sex characteristics, breast development was less than 34AA. The GI Clinic put me forward for breast augmentation in 2005 stating that if the surgery was funded I could move on in the clinic and could then be released from treatment, the West Berks PCT have continually refused referrals using every excuse in the book, in fact I could probably write a book about the excuses, some are beyond the ridiculous. After 21 years, I am legally female, physically male, but I cannot function as either, I am stuck in a gender limbo and my GP is still trying to get funding for me, perhaps James Palmer could explain such an injustice in modern Britain ?
Is it any surprise yet another attempt by Specialised Services is being made to convince the naïve, that indulging in poor practice achieves fair and meaningful documents of a high standard?
They may have, foolishly, convinced themselves, or allowed themselves to be deceived into believing, toxic and self-important behaviour achieves this.
It never does, it only excuses rising levels of discriminative practice, so abundant, yet so preventable by meaningfully listening to advice from those who actually know their communities, not those who think they do.
I’m sorry that you have concerns at the way in which NHS England has engaged with trans people and organisations that represent them in the process for developing the proposed service specifications. The proposals have been informed by a number of workshops and other events that we have held with trans people over the past few years, and we are now holding a public consultation so that everyone with an interest in these documents has an opportunity to have their say. No decisions will be made on the final version of the specifications until the outcome of consultation has been carefully considered.
Dear James,
My name is Chris Hart I am the MD of Cristianos Laser Clinic. We have been providing hair removal(laser Intense Pulsed Light and electrolysis for both F2m and M2f patients for 20 years over five national sites. I was privileged to have been asked by Dr Dean to give expert information to the Depilation Sub Committee and despite providing information in respect of a Clinical Paper looking specifically at light assisted facial hair removal in M2F patients this does not appear in the evidence review. in fact to states no trials have taken place looking at this patient group. I am concerned at both the number of treatments and the limited modalities on offer to patients in the new proposal. I believe this will greatly reduce patient choice and indeed may lead to Health and safety issues.
I also would like to request the North event is rescheduled as the consultation document was issued on the 7th and the event on the 8th.
Dear James, The Gender Identity Research and Education Society (GIRES) applauds the sustained effort by NHS England (NHSE) to improve gender identity services for children, adolescents and adults. It is heartening that Will Huxter’s work will be continued by a person of such high status within NHSE. We will be very pleased to be involved in the current consultations regarding adult services and were encouraged by the care that Dr John Dean, Steve Hamer and Sara Greater took to listen and respond to stakeholders’ views at the first consultation event in Manchester on 8 September. Regarding the service for adolescents, we are disappointed that the current service specification and policy have been based on a deeply flawed evidence review. We have informed NHSE of the errors in that document and suggest that the resulting specification and policy be urgently reconsidered. Kind regard, Bernard Reed, Trustee, GIRES
Dear Bernard. Thank you for your feedback, and for taking part in the event in workshop in Manchester. As you know, the service specifications that NHS England is currently consulting on are for adults aged 17 and above. There are no plans at the moment to re-open the consultation on the service specification and policy for services for children and adolescents.
There was a rail strike on July 8th so that anyone who doesn’t drive or live in the Manchester area could not get to the Sparkles consultation.
Can you rerun a northern consultation please
Dear Claire. Thank you for your feedback. There are a number of ways that you can get involved in the consultation, including a workshop in London on 6 September and two webinars, which are happening on 4 and 5 August. More details on https://www.engage.england.nhs.uk/survey/gender-identity-services-for-adults/.
If there is interest in an additional Manchester workshop then we will look into this.