NHS exec calls for ‘fundamental debate’ on trans services as backlogs spiral out of control

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The Chief Exec of an NHS Trust has called for a “fundamental debate” on the future capacity on gender identity services for trans people – as an influx of people seeking treatments leaves to backlogs of several years.

Despite an NHS England target that all patients should be seen within 18 weeks, gender services across the country have been under increasing strain – with a leading NHS gender surgeon warning last year that gender identity backlogs are ‘spiralling out of control as the number of referrals outstrips the number of possible appointments.

Statistics released earlier this year showed the issue has grown worse since – and in some parts of the country, trans people could be facing waits of as long as five years to access gender identity services

Steve Shrubb, Chief Executive of West London Mental Health NHS Trust warned there was a “whole system problem” on the issue, citing the rising number of referrals to gender services.

He said: “The NHS is great of finding the wrong solution to the wrong problem. [We get] about 120 referrals per month, 1500 referrals a year.

“People are waiting currently between 12 and 18 months. To see the solution as pumping people through the system quicker is just not the way to go.

“Just pushing people through our clinic… without primary care and other bits of secondary care doing their bit is just going to move the bottleneck.

“We need a fundamental debate about this. Where else would it be acceptable for someone to wait 18 months for treatment? If you’re going to treat this the same, then you have to have a whole-system approach.

“The real issue is that because of all the fragmentation of the system, the harsh reality is it’s a lottery how you move through the system. Referrals [are going up] by 20 percent a year.”

Dr John Dean, Chair of the Clinical Reference Group for Specialised Gender Identity Services for NHS England, called for existing doctors and GPs to be trained on trans issues, warning: “The number of people seeking help is increasing dramatically, and it is no longer appropriate for any doctor to say ‘this is a terribly rare condition, it’s very specialised, I don’t have to know about it’.

“Trans people are people, who want to be treated like people, and want to access healthcare just as other people. That’s possible and appropriate.”


Steve Shrubb added that that current system does not constitute equality for trans people, saying: “As [trans people] travel through our system, which is sometimes a complex system, I don’t believe there is equality.

“Service users tell me it can feel like that they are not being treated equally.”

Asked whether he is directly saying trans people do not have equality within the NHS, he confirmed: “Overall, that is my view. I think we can debate what percentage is due to lack of information. I’m just giving you my sense of what I pick up from [patients and staff]. It doesn’t feel to me like they are treated equally.”

Former equalities minister Maria Miller, who chaired the committee, hailed the trans community’s large-scale response to a call for evidence.

She said: “We’ve had more than 230 submissions to this enquiry, which is just extraordinary.”