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The Chair of the NHS England Gender Task & Finish Group looks at how a finance boost into Gender Identity Services can help tackle delays:
Welcome to my seventh blog on gender identity services, and the work NHS England is doing with the trans community, providers and other stakeholders to improve the experience of people needing support from the NHS.
I have written and spoken before about the unacceptable length of time that people with gender dysphoria have to wait to be seen in a gender identity clinic, and then, should they wish to receive it, for surgery.
I have heard from many people about the negative impact on their health and wellbeing while they wait to be seen, and the sense that their lives are put on hold during this time. These are all reasons why NHS England has invested more in gender identity services, to increase capacity and reduce waits – and I am personally very committed to continuing our work to tackle this longstanding problem.
For the financial year that started on 1 April 2016, adult Gender Identity Clinics (GICs) across the country, and all the contracted surgical providers, are receiving substantially more money than last year – £2.5m more for the GICs, and £2m more for surgery.
The biggest percentage increase in referrals across all gender services in 2015/16 was for the children and young people service run by the Tavistock and Portman NHS Foundation Trust, which saw a doubling of new cases last year. As a result, their contract has increased by over £2m, from £2.6m to £4.8m per year.
The additional money is accompanied by increased transparency about the national reporting of waiting times, and explicit expectations from commissioners about bringing down waits.
Recruiting and training new specialist staff is time-consuming, as there can be a long lead-in time from having the money to increasing the capacity. But the new investment is recurrent, and there will be more to follow in 2017/18 as capacity and activity increase.
NHS England specialised commissioning teams are agreeing concrete plans with individual providers to make a real impact on waiting times, and we will take an overview of this at the national Task & Finish Group, seeking confirmation that good practice is being shared and implemented across all providers.
On waiting times, the national NHS England ‘frequently asked questions’ guidance on recording and reporting waiting times has been updated to remove any ambiguity about the application of the 18 week rule to gender identity services, and to ensure consistency across providers.
The document has been published on the NHS England website.
For people referred to GICs, the clock measuring how long someone is waiting starts when the GIC receives a referral, and stops when first definitive treatment starts. For people then referred for surgery, a new clock starts on the date that the referral from the GIC is received, and stops when surgery has taken place.
We are working with the Elective Care Intensive Support (ECIS) Team and each of the GICs to improve how waits are currently recorded and reported, and to ensure we have a common understanding of what constitutes first definitive treatment. This will include on-site visits by the ECIS Team.
I have explained to the providers that we need to ensure that reporting systems are fit for purpose as soon as we can, so that waiting times for gender identity services can be reported nationally and published, in the usual way as for other clinical specialties.
The continuing increase in the number of people with gender dysphoria seeking support from the NHS confirms the urgency of our developing the workforce to respond to current demand and to ensure sufficient numbers of suitably trained and experienced staff for the future. This was the focus of our most recent symposium with other organisations.
I am pleased to say that we are scoping a piece of work with Health Education England (HEE), looking in particular at the workforce in terms of the specialist skills required to support a gender identity pathway; curriculum issues related to preparing people to become gender identity specialists; and developing awareness and skills for all and any staff in the wider NHS who interact with members of the trans community. I’ll keep you posted on progress with this important initiative.
GICs are subject to scrutiny by the trans community, commissioners and regulators, including the Care Quality Commission (CQC). The CQC is undertaking a programme of visits to all the GICs, as part of a focused inspection.
The report on the visit to the Charing Cross GIC, undertaken in January this year, was recently published. The report highlights problems which the GIC is looking to address, in particular long waiting times, administrative systems, and lack of clarity for some people about how to raise complaints.
The CQC also identified areas of good practice, and noted that most of the feedback they received directly from people who used the service was positive about the quality of care and treatment which was delivered. I will refer in future blogs to CQC reports on the different GICS as they appear.
I hope that this blog contains useful information. Please let me have your comments and thoughts via Twitter at #NHSgenderid