by Emma Underwood
It’s no secret that trans related healthcare in the UK is … clunky. You need only speak to anyone who’s sought medical transition to know that our community is being let down. Trans people being referred to gender dysphoria clinics (GDCs: previously gender identity clinics, or GICs) now face a wait of up to five years depending on which clinic they have been referred to.
At the same time, the growing popularity of private alternatives makes clear that we are in desperate need of radical and urgent improvements to a system which has barely changed in the last 50 years.
Calls for more funding are an understandable and desperate plea for improvements to the only system we’ve known. But funnelling more money into a system which continues to fail us is not the answer. As Dr Ben Vincent states – “The UK’s current system is no longer fit for purpose.” You can try to sellotape the hole in the hull as much as you want, but sometimes you just need a new boat.
But what could this solution possibly be, and how can we get to that stage? A good place to start is with a discussion of why trans healthcare is the way it is, which will help us understand how a new model could take us forward. LGBT Foundation’s research Transforming Outcomes states that “trans people are highly dependent on access to specialised services”.
This leads us to the first aspect of trans healthcare: it is “specialised” – seen as outside of the realm of most GPs, too advanced, and over all, somebody else’s problem. The second important aspect to consider is that it is near inscrutable. With very few regulatory bodies (other than the CQC), GDCs can operate freely with little oversight. This, in turn, makes them very difficult in control. Finally, those most invested in changing GDCs are those already using them, and faced with a history of discharging troublemakers, those wishing to make change from within must play a delicate game for fear of having their healthcare withdrawn.
The truth of the matter is that we are in desperate need of a brand new system, one that takes into account the failings of GDCs. With this in mind, a new trans healthcare system must be accessible, accountable, and adaptable. ICTA’s “Review of the Integration of Trans Health” explores in detail a wide variety of systems that seek to promote integration, from trans inclusive policy, to sexual health services.
The good news is that a system like this already exists, and is incredibly straightforward. It is, quite simply, the integration of trans healthcare into primary healthcare. This means making GPs and local surgeries the go-to people for accessing transition related healthcare. This would include hormone treatment, surgical referrals, mental health support, hair removal, and any other related medical treatment you might need in conjunction with your transition.
This system is being trialled as we speak. The Indigo Gender Service in Manchester seeks to begin integration of healthcare whilst being overseen by a larger body. The charity LGBT Foundation, and private healthcare provider GoToDoc have joined forces to offer this NHS service, where patients are seen first by “care navigators”, who act as signposters and mediators between patients and services, booking appointments and providing information.
This approach delivers a number of benefits. Whilst a nationwide rollout may be several years away, we can see how a system like this might be rapidly replicated in a number of local areas. 56 Dean Street’s 56T are already integrating their sexual health service with a more holistic trans health and wellbeing service, and it’s likely that we will see other services engage in similar healthcare initiatives within the coming years. However, action needs to be taken by the NHS, and Public Health England, Wales, and Scotland to ensure a fair distribution of services that target rural areas, and not just cities.
The future of trans healthcare lies before us. As unknowable as the future may be, we can fight for healthcare that addresses our needs, and be gladdened by the fact that generations from now, there will be those who look back with gratitude at the work we do, for ourselves, and for them.
Holti, R, Petch, M, Vincent, B, 2020, “Review of the Integration of Trans Health”, ICTA
Stafford, L, 2016, “Transforming Outcomes, LGBT Foundation
Vincent, B, 2018, “Transgender Health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care”, London, Jessica Kingsley Publishers
Pearce, R, 2018, “Understanding Trans Health: Discourse, Power, and Possibility”, Bristol, Policy Press
Emma Underwood is a Manchester based activist and writer.