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Welcome to the first of what I hope will be a regular series of on-line postings about NHS England’s work to improve gender identity services.
I have heard directly from individuals and organisations across the trans and non-binary community regarding concerns they have about limited communication from NHS England in relation to this service area. I want to use this blog to start to change that, by talking about the work both underway, and planned, in relation to gender identity services. I hope you find it useful.
Firstly, I should say something about my role in relation to gender services. My job is Regional Director of Specialised Commissioning for London, one of four equivalent roles across the country. NHS England is the responsible commissioner for most, but not all, of the services set out in the interim protocol and the draft service specification. As the lead for London I have direct responsibility for services we commission from West London Gender Identity Clinic, the surgical service at Imperial, and the children and young people’s service at the Tavistock Clinic.
I am writing this blog in my role as chair of the national task and finish group on gender services. This was set up to support the commitment of the NHS England Board to improve gender identity services, specifically relating to:
- Inequitable and fragmented access arrangements
- Variation in services with inconsistent protocols and procedures
- A need for an individual centred approach to care
- Long waiting times for assessment and treatment, particularly for genital surgery
- Poor patient experience in primary and secondary care reported by the transgender communities
Many people wait far too long to access gender surgery. NHS England has confirmed that the 18 week referral to treatment time standard set out in the Constitution applies to gender identity services.
As a commissioner, NHS England is investing £4.4 million more in additional gender surgery procedures in 2015/16, and will invest more again in 2016/17. We are funding the surgical units at full capacity, which means that the key limiting factor for bringing down waiting times more quickly is the need to recruit and train additional surgeons.
The latest available waiting time figures confirm there is still some way to go: the waiting time at Nuffield in Brighton is between four and six months; and at Charing Cross the average is 36 weeks. I propose to use this blog for regular updates on these waiting times.
Long waits for surgery have been the first area of focus, but clearly many people are waiting even longer to be seen for the first time at a Gender Identity Clinic (GIC).
The task and finish group commissioned a report looking at demand and capacity within each clinic, and the current waiting list numbers and waiting times. This report, which is still in draft as it is being checked with the GICs, highlighted great variability between the different clinics.
We are now starting some work with the GICs reviewing their waiting times, and looking at ways in which we can reduce them. I will use this blog to keep you informed on progress with this.
In recognition that many of the concerns put to us are outside of NHS England’s influence, we invited a range of national organisations with responsibilities across regulation, standards, training and education and professional leadership, to a symposium.
This event in June brought together, for the first time, individuals and representatives from the trans and non-binary community with representatives of a wide range of national organisations, to discuss the problems experienced by trans and non-binary people, many of which are about their day to day experience of general health and care services.
The symposium heard some very powerful personal stories from individuals, and attendees identified steps that needed to be taken to improve people’s experience.
You can find a report of the event here and a web cast of the event here. The symposium will be followed up with a further event early in 2016, to review progress against the commitments made on the day.
Earlier this month, the Select Committee on Women and Equalities held a hearing looking at the commissioning of gender identity services. Dr John Dean, Chair of NHS England’s Gender Identity Clinical Reference Group (CRG), was among the witnesses giving evidence. NHS England has submitted to the inquiry a description of the problems and how we are addressing them.
Finally, a ‘hold the date’ for you: Our next Transgender Network workshop will be held on 3 December in London. Further details to follow.
I hope this blog has been helpful, and signals a commitment to improving the way we communicate with you about developments in gender identity services.
Please let us know what you think by responding to the blog or via Twitter #NHSgenderid.