Needing Support around their Gender Identity The NHS England Approach to Treatment Mandated in two key documents published in August 2016 Service Specification 61 pp httpswwwenglandnhsukcommissioningwpcontentuploadssites12201609gidsservicespecificationpdf ID: 631749
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Children and Adolescents under 19Needing Support around their Gender IdentityThe NHS England Approach to Treatment
Mandated in two key documents, published in August 2016: Service Specification (61 pp) https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/09/gids-service-specification.pdf Commissioning Policy regarding gender affirming hormones (24 pp) https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/08/clinical-com-pol-16046p.pdf NHSE approach is based on an evidence review, completed in January 2016, that is deeply flawed https://www.engage.england.nhs.uk/consultation/clinical-commissioning-wave8/user_uploads/e03x16-evidence-rev.pdfNot due to be reconsidered until December 2019, unless internally generated data support an earlier date.
www.gires.org.ukSlide2
Documents evaluated in relation to the requirements thatMermaids families worked with GIRES to develop in October 2013Families seek the development of other independent providers. currently
Tavistock Clinic retains monopoly;Families seek application of the most up-to-date Endo Soc (2009), WPATH (2011) and DSM (2013) approaches, especially with regard to readiness for physiological intervention:NHSE now generally applies these approaches, including: - blockers: from Tanner stage 2; - gender affirming hormones: at about 16;But still ignores WPATH warning that “withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option”;Leading clinicians overseas now interpret “about 16” flexibly. e.g. from 13Endo Soc and WPATH are currently updating their publications, which are unlikely to set chronological age for access to hormones.
www.gires.org.ukSlide3
Families want the provider to recognise the urgency of adolescent cases, (N.B. problem now aggravated by 10 month wait) but NHSE:has introduced triage at referral, without fast-track for highly urgent cases;requires a minimum of 3 assessments at 3 monthly intervals before referral to endocrine service;
endocrine service then requires further 3 month wait for result, following initial blood test;requires all clients to be on blocker before feminizing or masculinizing hormones, regardless of Tanner stage;requires clients to be in education or work, which is not possible for some;
www.gires.org.ukSlide4
Families want treatment for young people who have been treated elsewhere (NB adult services can provide bridging prescriptions in such circumstances) but NHSE:
refuses to treat if hormone interventions have been obtained outside its protocolsstops treatment if gender related medications are taken without NHS prescription.
www.gires.org.ukSlide5
Families wish to ensure that GPs provide an acceptable service.But no programme to upskill GPs (no mention of e-learning resource published by the RCGP)Families seek seamless transfer to the adult services
(this should not be rigid or require needless repetition of assessments undertaken by the adolescent service)Currently only a generalised statement of intent; no specific protocolFamilies seek respect for all protected characteristics.Equality statement is generalised; does not list all the protected characteristics or consider intersectionality
www.gires.org.ukSlide6
Outstanding QuestionsWill the clinicians now apply these NHSE documents:Flexibly?Rigidly?Will NHSE:Correct its evidence review and apologise for the errors, as promised?Revise its specifications and policy to:
- reduce delays before endocrine treatments? - eliminate punishment of families forced to obtain treatment elsewhere? - provide specific support for GPs? - establish a proper process for transfer to adult services? - conform rapidly to further changes in international best practice?
www.gires.org.uk