Trans care for under 18’s to be centralised!

Via the TNUK list yesterday I heard the below bit of news, published in the magazine of the National Children’s Bureau and the National Youth Agency.

Cutting away the fluff, in essence a move is set to be made on April 1st (yeah, the irony always seems to escape government) to transfer “commissioning” of transgender-related care for under-18’s from a local level, i.e. “PCTs”, to an unspecified “national level” body(ies). Whether this applies to only England, or the whole UK isn’t covered. Nor, if it is UK-wide “national level” means there would be equality of care across the UK or if the devolved regions would have autonomous control (and thus the ability to fuck up) …or if “national” with regard to England, means *national*, or if it means those regional Strategic Health Authorities. …Also, no mention of what here is being regarded as trans-related care? Does it included making science-informed sensible decisions on hormone regimes? Does it include facial hair removal, counselling, etc, etc?

Me thinks a letter/email to the DoH requesting clarification is required.

“Commissioning” is NHS-speak for ‘deciding what treatments to offer to a patient, and stumping up the money to fund it’. It doesn’t cover ensuring there is a facility or staff, which meet their contracting out criteria (some places, like Wales won’t contract to non-NHS providers), to provide such treatment. This is a problem in and of itself, due to, as far as I understand, there being no coordination of treatment provision. Therefore, it’s just left up to individual Trusts and other bodies to set up treatment provision units if they have enough internal demand or feel they can make a profit out of care contracts from other trusts, hence, in part, the progressive loss of Gender Clinics in recent years.

Putting aside the few missed out critical details, I presume this will mean a substantial improvement in care for the under-18s, if only for there being a uniformity of commissioning across at least England …or each English SHA. While of course such commissioning could be really shit in one body or another, the reduction in magnitude of involved bodies (from a few hundred, less than 10) makes the task for the trans populus of sorting them out when they ‘go bad’ significantly easier.

Separately I think this is a massive and notable event due to what the move signifies. That the Westminster government has conceeded, if not in words, in actions, that local NHS bodies can’t be trusted to treat (at least a subgroup, of) trans people!

As I’ve a million times before the flaw in “localism” (the principle that all decisions should be made on a local level) is the prevaling abscene of compassion for minority groups or expertise at local levels.

Surely the next step is to look at similar moves for trans care for the over 18s.

Health – Reform of gender identity support

Children & Young People Now, UK
12 March 2009

Moves are afoot to speed up access to support services for young
people with gender identity issues. Neil Puffett explains.

Children experiencing gender identity issues are set to get better
access to vital help next month when support services go national.

At present, children and adolescents can, in theory, access the Gender
Identity Development Service (GIDS), established in 1989 and based at
the Tavistock and Portman NHS Foundation Trust.

It is the only service in the UK for young people up to the age of 18
who believe they may have been born the wrong sex, but many experience
problems securing a referral.

Faster access to services

Treatment available includes expert psychological observation,
assessment and support, possible suspension of puberty to allow
children more time to decide what they want, and hormonal medication.

The service also liaises with schools in an attempt to ensure teachers
are aware of specific circumstances in order to reduce the likelihood
of bullying.

Existing arrangements are funded through individual primary care
trusts (PCTs), which means the speed of referrals varies from area to
area depending on local budgets and expertise.

But from 1 April these services will be commissioned at a national
level, which experts say will help children get faster access to the
help they need.

However, some argue more progress is required, both socially and
medically, to ensure children affected by gender identity issues get
the right support.

Last year, 64 children and adolescents were referred to the service.
An estimated three-quarters of these are expected to become
comfortable with their gender by puberty.

Despite hopes that the changes will lead to big improvements in access
to services, controversy surrounds the way those with a definite
desire to change gender are treated shortly after the onset of
puberty.

Christine Burns, a member of the Department of Health’s LGBT advisory
group, says the service does not administer drugs to suspend puberty
until the age of 16, a policy which goes against the practice in other
countries, including Holland and the US.

“Some of the physical changes at puberty, such as a male’s voice
breaking, are irreversible, while others are very expensive, or
involve invasive surgery, to remove,” she says.

“If you use drugs that block the body’s hormones and postpone the
onset of puberty, you buy a bit of time for the child to become older.
That way if they decide when they are 16 or 17 they are definitely
going to change gender for life, they start with the best possible set
of circumstances.”

Her view is backed by Margaret Griffiths, liaison officer at Mermaids,
a family support group for children and adolescents with gender
identity issues.

Focus on gender education

Griffiths believes these drugs should be available – in the right
circumstances – part way through puberty, because the full
transformational experience can be hugely traumatic, with a number of
children attempting suicide as a result.

She says more focus should also be placed on educating children about
gender issues to help prevent bullying.

“Those of us on the committee actually prefer children to be treated
early with more proactive and consistent treatment,” she says. “We
also believe children should be educated from an early age about
gender issues and the affect that not accepting them can have.

“For some of these children, gender issues may be just a phase they
are going through, but it can cause a lot of problems. They can be
extremely lonely, finding it difficult to join social groups. They
often contemplate suicide and some succeed.”

CASE STUDY – WHEN A CHILD IS BORN THE WRONG GENDER

Sharon Brown’s daughter Nicky is 15. Born a boy, she was diagnosed
with gender dysphoria at the age of seven.

“It wasn’t a surprise,” says Brown. “You could see something was going
on from a very young age. I raised it with my GP when she was four,
but he told me to see how it went. By the time she was seven I had
become aware of the work at the Tavistock clinic and asked for a
referral.

“Fortunately the mental health services guy I saw had worked at the
Tavistock and referred us immediately. It was a lucky break because I
know other parents have had real trouble getting a referral.

“The Tavistock diagnosed her with gender dysphoria. They came and
spoke to teachers at her school and helped us to deal with bullying
issues.

“As she became older, she was dreading the onset of puberty. She was
being badly bullied at secondary school and took four overdoses.

“At the Tavistock they believe children cannot be certain until they
reach puberty, so they do not use blockers before the age of 16.

“My GP was very supportive and eventually we got treatment in the US.
It costs £6,500 a year as we have to travel to Boston every month. I
think if we hadn’t, she would not have been with us by the age of 16.”

Children & Young People Now is the official publication for members of
the National Children’s Bureau and The National Youth Agency.

© Haymarket Media

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1 Response to “Trans care for under 18’s to be centralised!”


  1. 1 Sarah Brown 19 March 2009 at 10:45 am

    We were discussing commissioning (in this case, for adult GIC referrals) at TransLondon on Tuesday – specifically, how it would probably be useful to eliminate PCT’s from the equation for GIC referrals and handle it centrally, thus ending the postcode lottery and stopping places like Oxfordshire and Wales pulling their shit. It would also hopefully eliminate the need for the initial psych referral.


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