UK Hopes For Trans Health Care Drain Away

Trapped between the vicious attacks of Conservatives and the yawning nothingness of Labour.

Marching for the International Lesbian, Gay, Bisexual, Transgender and Queer Youth & Student organization, because empathy knows no border. Picture by Nicky Rowbottom. Used under CCA 2.0.

Over the past two weeks, more and more information has been coming out with respect to the NHS’s implementation of the Cass Review, an official study of gender-related health care services for children and youth in the UK, very little of it good. Since April, NHS England has been intending to release an implementation plan for the Cass Report’s recommendations, including a similar review of the NHS services provided to adult trans people. On August 7, new details were publicly announced. While not all of the Cass Report’s recommendations were bad, all indications are pointing toward NHS England slowly strangling trans health care in the UK.

The leader of the adult review will be Dr. David Levy, a physician with no prior interest in or experience with gender-related health care. This parallels the appointment of Cass, who worked as a pediatrician, but specialized in developmental neurodisability, including abnormal fetal development of the spine but not anything related to trans medicine.

Once again specialists with experience in trans health care are being deliberately excluded from any major role in the review. Combined with recent Labour government statements favoring a medicalized model of legal gender change and the Cass Report’s own vague recommendations that doctors control social transition for children and youth, there are clear reasons to worry about the extent to which the UK government wishes to colonize trans lives. The fears are real and significant. For instance, the medicalized model of legal gender change would effectively require an NHS waitlist for ID changes. The new model would effectively allow the NHS to deny ID changes, something consistent with the Cass Report’s recommendation that “social transition” should be gated.

Already this has led to emotional discussion about whether trans people should opt out of the Levy Review entirely. On the one hand, no one wants to have their own stories stolen, distorted, then used as a weapon against them. Denying access to data, if sufficiently widespread, could even conceivably undermine the legitimacy of the Levy Review and any recommendations it makes. On the other hand, if all the people who found medical care appropriate and useful opt out, a dishonest review can then report that no data showed people being helped. Given the biased framework, double standards, and ridiculous imaginary facts contained within the Cass Review, there’s little reason to hope that any parallel review of adult services will be honest.

In fact, one key tragedy (also highlighted by the Cass Review) is undisputed and has been so for years: The NHS constitution specifies a patients’ “bill of rights” in which all persons receiving NHS services have a right to expect access to a specialist within 18 weeks of referral while access to trans health care has been subject to wait lists of a year or longer at least since the late 2000s. Trans health care isn’t the only area with excessive wait lists (and the general trend for years has been a slow increase in all wait times), but it is one of the worst. This problem, a problem for both youth and adults, can only be solved with spending more money, something that the Tory government consistently refused to do, and the new Labour government has signaled it would not do.

Dr. Levy’s appointment was publicly revealed on August 7 in the same letter giving more detail on the NHS-England plan to implement the recommendations of the Cass Review. Those recommendations include opening a total of seven service centers for children seeking access to gender-related care, but again that requires money, and the money does not currently appear to be forthcoming.

The lack of funds appear to be causing at least some of the problems that conservatives of every UK party are using to justify reviews of trans care in the first place. Dr. Cass seems particularly outraged that some adult patients and even fellow clinicians placed pressure on clinicians to begin hormone therapy as early as a second visit to an adult gender medicine clinic. Her outrage at this was an important part of her articulated reasons for a review of adult care in the first place:

The most common concern was the very limited time for assessment and the expectation that patients would be put on hormones by their second visit.

Of course, these patients have been delayed in accessing care for many, many months. Depending on the region, wait lists are always in excess of one year and can prevent access for more than five years, enough that trans people have been known to move to regions of the country with shorter lists just to get treatment. Surely the time for assessment would expand and beginning medication would seem less urgent if access to care was prompt.

Given that England has already made private-pay care of children and youth illegal, the state of trans related medicine in the UK is rapidly resembling that of the state of Missouri, likely the worst state in the US for trans people seeking care. Unfortunately while families in Missouri have the right to move to Massachusetts or Oregon, yet one more tragedy of Brexit is that now trans people and families have no escape from their medical nightmare.

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