How the NHS is failing the trans community of Britain

SarahEL · 2023-11-22 06:56:42

Historically, transgender individuals have faced challenges in accessing gender-affirming care and facing discrimination within healthcare systems worldwide. This includes issues such as long waiting times for gender identity clinics, lack of knowledgeable healthcare providers, and difficulties in obtaining necessary treatments like hormone therapy or gender-confirming surgeries.

With a conservative estimate of 11,000 people seeking help for transgender issues in the UK who are on the waiting list but have so far not seen a medical professional, it is no wonder that this wait list is now over 5 years in length. Recently more clinics have come online, but the main factor here is trans-care is being funnelled into specialist care centres when a lot of it could easily be completed with local doctors, counsellors and endocrine specialists with minimum training. Delays in accessing care can have negative effects on the mental health and well-being of transgender individuals. Long waiting times for appointments at gender identity clinics can be life threatening.

It is worrying that trans and gender-diverse people currently face these long waiting lists for gender-affirmative healthcare, but they also face barriers accessing general healthcare services, like booking a blood test. Difficulty in accessing gender-affirming treatments, including hormone therapy and surgeries, may contribute to dissatisfaction and distress. Research by TransActual in March 2022 found that 14 per cent of respondents reported being refused GP care because they were transgender, while 70 per cent had experienced transphobia from their primary care provider. The impact of this is that 57 per cent of transgender people are then put off or don’t feel safe seeing their GP when they are ill. Healthcare providers' lack of understanding or training in transgender healthcare can result in inadequate and insensitive care. Transgender individuals report feeling uncomfortable or misunderstood during their interactions with NHS professionals.
Due to some unique medical issues I have, as a male, 15 years ago, I was prescribed estrogen by my local endocrinologist. As soon as I informed them of my name change, they stopped supplying me with estrogen.. In fact, the head of the Endocrine dept at the local hospital, initially was refusing to treat me at all! I have a serious brain tumour which stops ALL hormone production, he was essentially giving me a death sentence.. Which was the ONLY reason they continued to treat me for my other hormone issues when this was pointed out and the reality of me waiting at least 3 years to see a specialist (it was 3 when I transitioned, now 5 years)!, however, they still refused to prescribe me estrogen. They said they were not sufficiently trained to do this?.. despite actually giving me the hormone days before I changed my gender marker from M to F.. I had to go private to get the estrogen prescription and have felt my hospital endocrine doctor is 'protecting' me from his boss, the head who, it seems is content to stand behind the NHS policy to not treat transgender individuals anywhere but in a gender clinic. Calling for training for the endocrine doctors is not, I think, a bad thing. It could even cost less than trying to push 11 thousand people through a handful of clinics. It could certainly help relieve the backlog and if coupled with the ability for an individual to get their own private gender counselling (which is not that expensive) instead of needing NHS and clinical diagnosis of GD, would only be a step forward.

Ensuring that NHS policies are inclusive and non-discriminatory is essential. Transgender individuals should be treated with dignity and respect, free from discrimination based on gender identity. There is provision to 'lock' your medical records and have it so only a doctor can access anything prior to your date of transition. Except this then creates a very suspect blank page.. a hole in your timeline that always is questioned. a few weeks after this had been done to my records, I visited my GP for a flu-jab.. faced with a total blank medical record, the nurse asked if I had just joined the practice and if I had the flu injection before and what was 'wrong with me' to mean I needed the injection.. To clear things up, I explained I had just transitioned to female. Visibly shocked she said, 'oh yes, that would explain it' and I then went on to discuss my medical needs for the injection. The nurse was trying her best. She had obviously never met a transperson before and had received no training.. so as she gave me the injection into my arm she asked 'SO... How is it going being a woman then?"... after a pregnant pause. I laughed.. and said 'Okay I guess, how about you?'... which made us then both laugh.. but still.. Some people choose not to have this lock put in place.. and their records flow, this then allows anyone, even the receptionist to know your history. FOr a lot of people, including me, that was not going to be acceptable. The promise of them moving and 'de-gendering' my past medical information never happened. To top it all off, my endocrine then sent my GP a letter, with the first line of his diagnosis reading 'Sarah, a transgender woman, met me today for an appointment at the hospital..." This letter, is now on my permanent record with my GP and makes the whole thing pointless.. ugh. (I have asked to have it removed)

The collection and monitoring of data on transgender healthcare experiences can provide insights into areas that need improvement and help policymakers address specific concerns. One of the main criticisms coming from doctors that run the gender clinics is that despite having lots of 'really great ideas' they cannot get funding to research them because there is not a collective database or anyone even collecting data that could be used to give an indication if the funding would be worth it. Dr Alison May Berner, specialist registrar at the Tavistock’s Gender Identity Clinic stated, “Time and time again I come up with a great idea and then am told, ‘No one is ever going to fund it, because you do not have any pilot data, nobody knows what your denominator number is and you do not know where people are’… I cannot tell them what the demand for that service would be because I cannot put a number on it because it is not monitored.”

I am not raising anything new here.. reports have been done for regions of the UK and the UK as a whole.. Government has looked at these, pondered their dire findings and basically shrugged it's shoulders at us. I also appreciate the fact that the NHS is struggling to even maintain basic services. Brexit has diminished the labour pool and low pay for the skilled workers is making just getting people into make the hospitals and clinics function hard. There are reports for people not receiving cancer treatments on time or huge waiting lists for new hips and knees.. The NHS is in crisis, has been in crisis for decades and will not get out of it until something radical shakes it up.. however, 5 year wait lists to see your first consultant is beyond the ridiculous, especially when many of these patients are suicidal, as I was. The lack of general training and knowledge is unbelievable and a simple fix. Also the information systems, data collection and control of transgender sensitive personal medical records is unacceptable.

I am trying to not make this essay out to be a whine or a whinge, I certainly do not want to diminish the work individuals put into the NHS,. I have met some amazing and dedicated people. But the NHS is not free, it is just state run.. We all pay into it if we work or earn money. As a nation we are chided into believing it is a free institution that we should be forgiving about, they are doing their best, like you would a charity.. when in reality this is a lie, it is not working for a lot of people and the government needs to make changes. While acknowledging the broader challenges faced by the NHS, including underfunding and workforce shortages, the specific issues within transgender healthcare demand urgent attention. The current state of the NHS necessitates a radical re-evaluation and restructuring to address the critical deficiencies in transgender healthcare and beyond. The well-being and lives of transgender individuals depend on the commitment to inclusivity, non-discrimination, and comprehensive, timely healthcare services.

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How the NHS is failing the trans community of Britain

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