Welcome to my latest blog on gender identity services.  As always, I aim to cover issues that are current, and are important to the planning and delivery of gender identity services, and what we need to do to ensure that the services that we commission are responsive and high quality.

In this blog I’m going to share with you an outline description of the process that NHS England will use to decide which organisations will host the adult gender identity clinics and the specialist surgical elements of the gender identity pathway in the future.

NHS England will do this by running a national procurement of adult gender identity services, as described in our recent commissioning intentions for specialised services for 2017-19.

I wrote to all of the current providers of gender identity services this week to state our intention to formally serve notice of termination on all of the NHS and independent sector organisations with whom we currently hold contracts for the delivery of specialised gender identity services (surgical and non-surgical), for the purpose of re-tendering the award of contracts via a process of national procurement in 2017. The current providers of gender identity services will be able to bid for the award of a new contract.

Organisations which are bidding for the award of a new contract will have to demonstrate that they are able to deliver the requirements of the new service specifications for adult services. We plan to consult on at least two new service specifications (for surgical and non-surgical services) in the New Year, following a further process of stakeholder engagement.

Why are we doing this?

Firstly, we need to follow a procurement process to identify a new host for the gender identity clinic currently delivered by West London Mental Health NHS Trust, which is England’s largest gender identity clinic (I wrote about this in my previous blog). This provides us with an opportunity to transform the way in which gender identity services are commissioned and delivered across the country. As many people have stated, change is essential if we are to be successful in reducing the historically long (and unacceptable) waiting times, and improve the patient experience in other important ways.

In recent years NHS England has worked with all of the providers of gender identity services in England to begin to address long waiting times, including the provision of significant additional funding in these services. But given the forecast continued growth in demand, and the national shortage of appropriately trained professionals, we know that additional investment in itself is unlikely to solve the waiting time problem, nor will it improve other aspects of the patient experience that we know are important to people who use these services.

We also need to be conscious of the report of Parliament’s Women and Equalities Select Committee’s inquiry, published in January 2016, criticising the delivery and commissioning of gender identity services, including: inconsistent clinical protocols; inequitable access arrangements; out-dated approaches to service delivery; and the absence of a consistent application of clear and appropriate standards.

Therefore, NHS England has asked the Clinical Reference Group for Gender Identity Services to make recommendations on new service specifications for gender identity services. What we need are proposals that will stimulate innovation and transformation in the gender identity services along the entire patient pathway, in order to achieve even better outcomes for people who use the services. This will include, in the longer term, recommendations on outcome measures against which to assess the safety and quality of services along the pathway. We will use the procurement process to provide assurance that the organisations with whom we hold contracts in the future have demonstrated an ability and willingness to deliver services in accordance with the new specifications.

I appreciate that any process of change may cause some anxiety for the dedicated staff who work in these services and for the people who use them, but please be assured that we are very clear that we do not expect that at any point there will be a reduction in the level of service provision as an outcome of this process. Our intention is to address the capacity and demand problems and to address the equity issues that we commonly hear from people who use the services.

I will write again with further details, including timescales for engagement and consultation, in a future blog.

The process that I have described will not include the Gender Identity Development Service for children and young people. We will continue to explore innovative ways to increase capacity in this service and address access issues, and we will review the need for any formal procurement process once we have implemented the new service specifications for adult services.