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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.