Following a disappointing legal setback, Cara English – of trans charity Gendered Intelligence – argues that we urgently need to reduce the waiting times for gender-affirming care
Gender-affirming healthcare in the UK is well past crisis point. That isn’t an exaggeration: waiting times for a first appointment at a gender identity clinic (also called ‘gender dysphoria clinics’) are measured in years, not weeks. Last December, a coalition of individual claimants and nonprofits – including Gendered Intelligence, the charity for which I proudly work – took the NHS to court in a bid to challenge these drastically long waiting times. Unfortunately, it was announced yesterday that our case was unsuccessful, but the fight is far from over. We intend to appeal this decision, and to continue fighting for trans people’s rights to just and equitable healthcare.
While we are disappointed by this week’s result, our biggest priority has always been to shine a light on just how bad the situation is in hopes that we can ultimately help fix it. Whether trans people are able to access gender-affirming is currently a postcode lottery, with wait times averaging two to three years, and some spanning as far as eight. It’s worse for young people, who are referred into the service as teenagers and face years of anxious treading water before ‘ageing out’ and being put straight back into a different queue for adult services – sometimes without having had a single appointment. While this is supposed to be a simple handover, it is not, if it even happens at all.
The NHS constitution – the guidelines that govern the NHS – stipulates that 92 per cent of people should wait no more than 18 weeks between first being referred to specialist service and their first appointment. But trans people – and indeed anyone who wants to talk to a professional about gender exploration – are waiting years just for a preliminary conversation, let alone any kind of treatment. Although the whole of the NHS is under pressure from Tory cuts and lingering pandemic crises, gender identity services have been disproportionately under-resourced for more than a decade. The top-level NHS executives responsible for commissioning services have ignored calls from the trans community, and now their inaction has led to a state of agonising inertia.
All too often the people at the heart of this conversation get lost. With trans lives so heavily politicised, we can lose sight of the fact that trans people deserve the same access to healthcare as anyone. Denying this is an abdication of duty by the NHS, and one which is causing untold harm.
We’re not talking about a preference or a lifestyle, as is often implied in the press and even by the government. We’re talking about healthcare that – as evidenced by international medical research – improves mental and physical health, and ultimately saves lives. It’s a vital opportunity to have exploratory conversations about difficult subjects like gender identity in a safe environment. It can be the difference between a daily struggle with dysphoria and a fulfilling relationship with your body.
Gender-affirming healthcare isn’t hard to provide, either. It’s based on decades of research and safe, effective practice, despite it having come under attack in recent years as part of the wider culture war against transgender people. But people are not getting timely access to this care, which often means they are driven to take matters into their own hands. For some people, this means extortionately-priced private services. One trans man we spoke to is working three jobs, seven days a week, just to afford the hormone therapies which allow him a lease on life. Those who can’t afford private options may instead seek out solutions on the grey market, buying medications from unregulated suppliers. But although community guidance for self-medication has been around almost as long as medical transition, hormone therapies without proper monitoring are far from ideal, and may even be dangerous.
Transgender people face disproportionately high levels of precarious employment and housing. They are more likely to come from low-income households – up to 60 per cent beneath the average income. And yet it is increasingly the norm that this marginalised group is expected to fund its own healthcare, or else wait years in suspense. Is this a National Health Service that truly operates for all? Or one that marginalises and excludes?
"My transition has only been made possible through the endless generosity of my community, who have stepped up where the NHS has failed me so miserably and so often."
My own story of going through the GIC system is emblematic of a specialised service failing the very people who need access to it. I waited for a long time – around three years – between my GP referring me to the GIC and my first appointment. I sought private care and pushed myself into debt in the process; I was working part-time at two charities, so not exactly flush with cash. When I moved to a new city, my clinical notes and request for transfer were lost and I started from the bottom of the waiting list again – even though I was expressly assured this would not happen.
I’m now on year six of my GIC journey. I spent a great deal of money I didn’t have, begging strangers on the internet and taking out loans, all to reach a state of transition where my quality of life was good, or at the very least, not directly impacted by my transition status. But I can honestly say that my transition has only been made possible through the endless generosity of my community, who have stepped up where the NHS has failed me so often.
Trans people have been the subject of constant hack jobs in the media, portrayed as unreasonable and even threatening. But we just want our voices to be heard. It is reasonable and necessary to highlight that trans people are at greater risk of death by suicide, self-harm and mental ill health than our peers. A seemingly endless waiting list for life-changing healthcare can stand only to worsen these outcomes. We deserve better.
The terrible cost enacted by these delays could not be clearer. Sophie Gwen Williams was a Belfast-born trans woman whose life sadly came to an end last year, after she was forced to wait for a first appointment for five and a half years. Her friends lay the blame on the NHS for her death, with one asking “how is any working trans person supposed to survive nearly a decade amid a maelstrom of gender dysphoria and the repeated mental health crises that it brings on?” How indeed?