Legally enshrine the right of adults to physically transition using NHS services

Introduce a law to legally protect the right of those aged 18 and over to transition using NHS services. This should specifically cover physical transition, including hormone treatment and surgery, as otherwise I believe it could potentially be interpreted as including conversion therapy.

I believe that transgender people in the UK have experienced a rise in hatred towards them over the past few years. Many people believe that transgender surgeries should not be funded by the NHS.

Many trans people are unable to afford private healthcare, and their quality of life is severely limited without access to treatment.

Gender dysphoria is serious, and surgery and hormones are an important part of treatment for many.

The government is committed to ensuring that all patients, including trans adults, get care that is high-quality and clinically appropriate. The published NHS Constitution establishes the principles and values of the NHS in England. It sets out legal rights to which patients, the public and staff are entitled. This includes the legal right to access NHS services and the right to receive care and treatment that is appropriate, meets patient needs and reflecting their preferences.

Regarding services for trans adults specifically, they can access care at 12 specialist NHS adult Gender Dysphoria clinics in England.

NHS adult gender services work to national service specifications: Gender Identity Services for Adults (Non-Surgical Interventions) and Gender Identity Services for Adults (Surgical Interventions).

As set out in those service specifications, the delivery model for adult gender services relies on access via primary care, and the principle of multidisciplinary and interdisciplinary teams and networks who work and collaborate in the provision of care. Gender Dysphoria Clinics assess and diagnose individuals, directly provide some interventions and arrange for referrals to other services, including for medical and surgical treatments. Access to surgical intervention is only by referral from a specialist Gender Dysphoria Clinic that is commissioned by NHS England, in accordance with the criteria set out in the Surgical Interventions service specification.

These services, like all NHS services, are patient centred. Decisions around the treatment and management of gender incongruence are made through a process of Shared Decision Making. As set out in the service specifications, patients will be provided with the necessary information about all of the options available to them so that they may ask questions, explore the options available and take an active role in determining a treatment route which best suits their needs and preferences, and is clinically appropriate. For some, this may involve a process of medical transition – for others, it may not.

Introducing legislation that creates a right to medically transition may fundamentally alter the careful balance of clinical decision-making in the care of trans adults. It is not appropriate – nor is it necessary – and the government has no plans to do so.

The government recognises that waiting times for these services have surged and we are determined to change that. NHS England has significantly increased investment in adult gender services, with the rollout of five new adult gender pilot clinics since July 2020. Three pilots have been awarded longer term contracts with NHS England and their evaluation reports can be found at the following link: https://www.whatdotheyknow.com/request/pilot_gender_clinic_evaluation_r

In line with a recommendation of the Independent Review of gender identity services for children and young people (the Cass Review), NHS England is currently carrying out a review of adult gender services, with the aim of producing an updated service specification (non-surgical). The Review, which is chaired by Dr David Levy, will examine the model of care and operating procedures of each service, and will carefully consider experiences, feedback and outcomes from clinicians and patients. The Terms of Reference of the Review can be found at the following link: https://www.england.nhs.uk/publication/review-of-the-nhs-adult-gender-dysphoria-clinics-in-england-terms-of-reference-and-key-lines-of-enquiry/

The government is steadfast in its dedication to listening to LGBT+ people. The Secretary of State for Health and Social Care has taken steps to build bridges with the LGBT+ community and stakeholders by hosting constructive, open and honest roundtable discussions, and has set out his intention to maintain an open dialogue and to continue to listen to all views.

In addition to what has been described above, we continue to progress work to advance the rights and protections afforded to LGBT+ people. We are clear that conversion practices are abuse – such practices have no place in society and must be stopped. That is why, through the development of our Conversion Practices Bill, the government will deliver on its manifesto commitment to bring forward a full, trans-inclusive ban on conversion practices. We are also working with the Home Office to deliver our commitment to equalise all existing strands of hate crime to make them aggravated offences.

Any ban must not cover legitimate psychological support, treatment, or non-directive counselling. It must also respect the important role that teachers, religious leaders, parents and carers can have in supporting those exploring their sexual orientation or gender identity.

Department of Health and Social Care