London's transition services need radical improvement, trans health expert Jess Bradley writes
West London Mental Health Trust (WLMHT) announced yesterday that it has served notice on the contract it has with NHS England to provide care to trans patients at the Charing Cross Gender Identity Clinic.
In the recent government Trans Inquiry, I had the opportunity to give evidence in the health panel on behalf of Action for Trans Health, a patient advocacy service I work for. At the inquiry I raised the excruciatingly and often illegally long waiting lists for treatment at gender identity clinics, a constant source of criticism for the WLMHT’s management of Charing Cross.
The challenge of reducing the waiting times at Charing Cross is a significant one, especially when considering that the number of adult trans people presenting at Gender Identity Clinics is rising up to 50% per year. In the announcement, WLMHT talked about this challenge which, reading between the lines, seemed to form a significant driver for this move. In a later addendum to the announcement, the lead clinician at Charing Cross, Dr. James Barrett, stated that the decision was mutual, and driven from the GIC’s side by a feeling that gender identity care should no longer sit under the auspices of a mental health trust.
This is seemingly a welcome move as trans activists have long argued that being trans is not, in itself, a mental health condition. The gatekeeping, gaslighting, and inappropriate questions that many trans people still receive from clinicians within the current system, discussed both at the Trans Inquiry and widely on the # transdocfail hashtag, is considered by many to be a feature of trans healthcare’s organization under a mental health banner. The move of gender identity care away from mental health towards a different sector of the NHS may provide a significant opportunity to move to less pathologising models of treatment.
However, it is unlikely that patients will see an immediate change in the way gender identity care is conducted once Charing Cross has moved to a different provider, unless NHS England significantly change the spirit of the contract that is being put to tender. It is expected that the staff will stay the same, and will remain stuck in their usual ways of doing things. Over time, though, trans healthcare will inevitably be influenced by the culture and practices of wherever it finds its new home.
The move itself presents its own challenges. If not mental health, then where? Trans healthcare provision is currently a mixture of psychiatric evaluation, hormones, and surgeries; it doesn’t fit neatly under either mental health, endocrinology or surgery.
Perhaps the fact that gender identity care straddles different sectors explains the reason why it seems that Charing Cross are struggling to find a new home. After all, it seems strange that WLMHT would publicly announce that they have given notice on their tender without first finding another provider to replace it.
More likely, though, is that trusts are put off by the long waiting lists and the ever increasing numbers of patients presenting for treatment. Without a significant increase in funding and staffing levels, or a change in the way that trans healthcare is conducted, the new provider will be taking on not just a gender clinic, but a massive headache too. Perhaps the adoption of the informed consent model of trans healthcare, which promises to be more streamlined and less pathologizing process, would help.
It is unsure how long the handover to a new provider will last. From the announcement we know it will take at least six months, but it could be many more than that. What we do know, however, is that WLMHT is unlikely to be implementing the significant changes to provision that trans activists are asking for, as gender identity care will shortly become someone else’s problem.
Change within the mental health sector typically takes place at a glacial pace, and is often even slower to implement in other areas of the NHS. This switch in service provider offers a crucial opportunity for trans activists to influence provision, if we move quickly. The key demands we must be taking forward to NHS England are an increase in funding and staffing levels, as well as a switch to a less pathologizing model of treatment such as the informed consent model. Only after a new supplier is chosen and these demands secured will NHS England be able to provide the reassurance and stability that trans patients are desperately need.
Jess Bradley works with Action For Trans Health, a charity fighting to improve trans people’s access to healthcare.