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 Some of the stories touched on the problems that are well known to us, including long waiting times, out of date or incorrect information provided by the NHS, and bullying and discrimination.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.
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