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2017: a key year for gender identity services
It has been a busy year and I want to thank all those who have taken the time to work with us in our various initiatives to improve services for transgender and non-binary people.
They include members of the Transgender Network; members of the Clinical Reference Group and its various working groups; the organisations that have joined our symposiums; and the staff who work in the services.
2016 saw publication of the report and recommendations of the Women and Equalities Select Committee on Transgender Equality, and we have used those recommendations to inform our work in developing new service specifications for gender identity services.
I am very pleased about the quality of engagement with partner organisations at our symposiums during the year, which has resulted in a joint initiative with Health Education England to progress training and education, for specialist staff and for others more widely across the health service.
The applicability of the 18 week waiting standard is now established in the transgender pathway. The surgical providers are now required to publish their monthly waiting time data, measuring compliance with the 18 week waiting standard, and Gender Identity Clinics will begin reporting in 2017 – though the requirement to meet the 18 week standard applies to them now.
NHS England invested an additional £6.5m in gender identity services in this financial year, and we will continue to hold the providers to account in demonstrating how that money is being used to tackle long waiting lists.
Looking ahead to 2017, we will be going out to consultation on new service specifications for both the adult gender identity clinics and the gender surgical services by the Spring. I will publicise the consultation in a future blog.
The Clinical Reference Group has been given the challenge of delivering new specifications that will give us an innovation and new models for care, addressing the concerns identified by the Select Committee and Transgender Network.
We have convened a stakeholder testing group on 5 January for registered stakeholders to help shape the specifications for the purpose of consultation. Once the specifications have been agreed, NHS England will begin a process of national procurement to identity providers and agree new contracts for the delivery of services in line with the requirements set out in them.
I reported previously that West London Mental Health NHS Trust, which currently hosts the Charing Cross Gender Identity Clinic, had decided it no longer wished to provide gender identity services in future. Since that time, we have been working closely with the Trust, and with the staff of the GIC, to identify an appropriate organisation to host the service. Our commitment throughout has been to ensure there is no disruption or reduction to the service provided by the GIC.
I am very pleased to report that, following discussions with a number of different organisations, NHS England has agreed the Tavistock and Portman NHS Foundation Trust will host the Charing Cross Clinic from April 2017.
This will be on an interim basis, pending the outcome of the national procurement which NHS England will undertake in 2017. The focus for the Tavistock and Portman will be to assume the service with minimum disruption to patients and staff, combining their expertise with the knowledge, skill and experience of the current Charing Cross staff. The service will continue to be delivered from the same location as now, and there will be continuity in the clinical and non-clinical team. The change will not have any impact on appointments that have already been scheduled or treatment plans.
There are many advantages to the Tavistock and Portman as the new host for the service, given their experience in delivering the children and young people’s gender identity service, and its links with the adult services.
Making the transfer from children to adult services as smooth as possible will be one of the expectations in the specifications to be issued in the new year and, dependent on the outcome of the procurement process, the experience of having both services in a single provider should help us to understand how to do this better, to the benefit of all people seeking support.
I wish you a Merry Christmas and a Happy NewYear, and I look forward to working with you all in a busy 2017.
- Please let me have any observations or questions about this blog via Twitter at #nhsgenderid
May we please have progress not rhetoric. At age 73 having tried to overcome my dysphoria due to attitudes in the cycle trade and cycle sport for a long time, I cannot believe the present situation.
Was referred to Leeds last September, “screened 2 1/2 months ago but no idea if or when an appointment may happen. Also found referral to plural Clinics allowed!
4? Surgeons to cover England are inadequate.
Organised my own hormone treatment, now with Bridge scripts, my own facial electrolysis and enquiring about European surgery.
Changed my name, doctor, bank, driving license, sporting gender in mtb orienteering and as a British Cycling Commissaire etc. Continued to support disabled people in my voluntary work.
Do I really need to raise capital on my home to gain access to surgery – I have already progressed much of the pathway with little NHS support.
In my teaching or later business I despised personal failure. Doubt those “improving ” the system do.
Dear Will Huxter, it seems that despite your statements with regards to the extra funding provision for nhs GIC services there is still a postcode lottery of services provided between the 7 Gic’s and a statement by the Laurels clinic in Devon recently that the nhs no longer fund breast augmentation surgery. Why is it that extra funding has been provided yet crucial services have been cut?. It is disgusting the way trans patients are being treated due to stereotypical views of gender being used to gatekeep patients & the lack of social care besides monthly peer led groups. There ought to be an intensive fully supported treatment programme for both the medical & social aspects of transitioning, an endocrinology specialist available at the clinics & regular communication with patients Gp’s, most gp’s feel unable/unwilling to do anything without instruction from a GIC.
I have been reading around this subject for some time and also the comments on this particular section. My partner was recently discharged from GIC care after re-assignment surgery. Our main contention as many others seem to be is FFS! This is NOT cosmetic. She has endured three years plus of laser and electrolyis as well as private rhinoplasty all at our expense. This really has to be addressed within the trans care givers especially regarding hair removal and adams apple shaving, during consultation did no one listen to all the trans women whose life is made miserable and sometimes almost unlivable by having to go out or being forced to stay at home because of the mental anguish caused by this!!! I really think, as usual, the experts are not actually expert in this field as the only real experts are those that are living the whole ordeal or trying to be the person you are on the inside. Can you tell any of them that this will actually be looked at SERIOUSLY in the near future?
My partner has been waiting for an appointment in exeter since March 2016 however every time we phone to check on waiting times we are never given a satisfactory answer they tell us they are in the process of making a lot of changes and everything has been put on hold this is Now making my partner very distressed and life at home is becoming very difficult because of this it would be much more satisfactory if they would update their website and perhaps let people know how long it will be before the clinic is up and running in a normal fashion as this is so distressing for us both can anyone enlighten us as to what is happening with the changes that are ongoing
hi Will, today I have had word that Northampton (Daventre) is now 23-24months for first appointment from receipt of a referral confirmation letter. this is a jump of 10months in a short space of time from when it was 14months. also why is the GIC only active for 4hrs one day a week on a Tuesday, with this wait time? Natasha.
You state for facial feminisation surgery,There is a separate process going through Clinical Reference Group.
How does one apply for this ?, my local gp refuses to listen to my needs to the point of that I’ve not had a job for 12 years and never left the house alone due to the impact on my mental health which is directly related to this problem.
I wish to challenge them for surgery so I can live my life before I’m too odd.
12 years indoors is unfair preventing me from living my life and pushing me closer to suicide.
Please contact me through email or respond here.
I am the Clinical and Service Director for mental health in Brighton and Hove, and also Associate Medical Director for Sussex Partnership NHS.
We have the capability, the interest and willing to provide GI services locally.
There is much demand for a local service with our population and could service the South Coast.
I have been trying unsuccessfully to have my voice heard in the right place to discuss the viability of this
Please, please contact me –
Despite this encouraging news I have found out that the waiting time that is listed on the Northamptonshire GIC, at which I have been referred to,are stating waiting time of 40 weeks last updated Sept 2016, yet when I asked for this information by way of telephone conversation I was informed that the waiting time is now 14 months (so 60 weeks in my calculations is more than half as much again)! This is completely unacceptable and I am not convinced that the news here is anything more than some kind of carrot dangling on a string that is attached to a very very big stick!
Thanks for your post. I am sorry that you have been told of such a long wait to be seen.
I agree that long waiting times are unacceptable, and NHS England is committed to achieving the 18 week standard. That is why organisations who wish to provide these services in the future will have to demonstrate how they will deliver a model that ensures compliance with the waiting time standard.
I will be follow up with the Regional Director of Specialised Commissioning for the Midlands and East about the particular points that you raise about this clinic.
I too have been on the waiting list at the Northamptonshire GIC, since July 2016. To my disgust, I was asked to check with them again on July 2017 to see where I am on the list. They just don’t care, despite the encouraging news. This will only benefit newly referred patients and that’s no good at all. I like many other girls I resorted to self medicating as there is nothing else in place, it’s the only thing that has stopped me committing suicide. Like I say, they just don’t care
Will there be provision for facial feminisation surgery for those who need it, mainly older people who could not start the transition in their early years?
Thanks for your question.
As I have set out in a previous response below, facial feminisation surgery is not a treatment that is currently routinely commissioned by the NHS, and so will not be included in the proposed service specifications. There is a separate process for the Clinical Reference Group for Gender Identity Services to submit a proposal for routine commissioning. Any proposal , will need to be supported by a credible evidence base and which would need to be prioritised against other investment proposals for specialised services.
Many reading here will have heard about Mx (or Mix), a non-binary transgender title which can be very useful for some people.
I’ve been using Mx since 2002 and in 2015 I wrote a major article about it which includes info about how to incorporate Mx in application forms etc.
Thanks for bringing this to my attention.
I certainly do hope that there will be improved waiting times as a result of extra funding having been made available, I look forward to seeing if my wait for an appointment to my nearest GIC comes around sooner rather than later
Thanks for your post.
As the NHS is finding it difficult to cope with the numbers of applications soaring for GRS surgery from the GICs, with the current team on the Provider’s list, it is clear the surgeon numbers available is far too low, therefore, could Mr Christopher Inglefield GRS Plastic Surgeon in London LBPS be considered to be put on the Provider’s list please? as this would alleviate and reduce the pressures and suffering for those waiting for their GRS surgery.
I understand that Mr Inglefield is in the application phase at present, but it would help greatly for the people waiting for their surgery for another surgeon as qualified as Mr Inglefield to be on the Provider’s list, as soon as possible to avoid further unnecessary delays.
I responded to this question in the responses to my blog of 19 October 2016.
Thank you for your response, which I have noted your earlier comments to Mr Inglefield in October 2016.
However, when will the new applications for more surgeons on the Provider’s list be available?
Good news, and some would say long overdue.
Consistent good quality and national standards of delivery is what we need and deserve, right now it seems to be us talking with each other, comparing notes, experiences etc.
This is the complete opposite to my cancer care, which is at a small Surrey Hospital, though I understand it’s equally good elsewhere, so perhaps that is one model that could be looked at, no doubt there are others too.
Good luck and thank you
Many thanks for your comments.
Carrying on from my previous post about FFS:
Providing FFS would ameliorate some of the bottle neck in the chain for the waiting times for surgery and would perhaps allow the NHS to start meeting its target waiting times in a more timely manner.
Also, as FFS is not so radical a surgery as GCS, and would greatly enhance the individuals perception of themselves, this would lessen the degree of dysphoria that each individual suffers from.
As many people remarked in the survey which I did, “When I am walking down the street, nobody can see what is in my knickers, but everybody can see my face”.
Thanks for your both of your posts.
Facial feminisation surgery is not a treatment that is currently routinely commissioned by the NHS, and so will not be included in the proposed service specifications. There is a separate process for the Clinical Reference Group for Gender Identity Services to submit a proposal for routine commissioning, which will need to be supported by a credible evidence base and which would need to be prioritised against other investment proposals for specialised services.
I welcome the move of the Charing Cross GIC to the auspices of the Tavistock – provided that the Tavistock do not then see that as a vehicle to promote the Charing Cross GIC above the other adult GIC’s.
Although the extra £6.5 milion in funding is to be welcomed, I see this as a drop in the ocean to the amount that is realistically needed to bring waiting times down and provide a better service to trans people.
For instance, in a survey which I conducted 18 months ago, it was clear that many transgender women (around 50%) would prefer to have Facial Feminisation Surgery over Gender Confirmation Surgery – and yet there will be no provision for this being carried out through the NHS.
I realise that this is a contentious issue and the right wing press would seize upon this with glee – but it is people’s lives that we are dealing with here first and foremost.
Changes to meet demand for NHS England – Gender Services are long over due. Looking forward to providing positive input to help design a ‘new service model’ next year !
GICRG – Member & Stoke – NHS CCG – Patient Congress Member.
Thank you for your comment. We look forward to working with you too!
its good to know the GIC at Charing Cross is in safe hands moving to the tavistock and Portman NHS foundation Trust – two things: Facial Feminisation Surgery included in this service? and Monitoring long standing patients and not forget them?
Just to be clear, it is only the gender identity clinic service that is moving across to the TAVI, not surgery.
I will certainly make sure that we work with the TAVI to look at arrangements for monitoring long-standing patients, and can perhaps update people on that aspect of the service in one of my future blogs.