I think theres 2 different issues here. 1 is the system of gatekeeping with GRCs and the 2nd is the provision of treatment with long waiting lists and a a limited number of clinics (none in Wales, only 1 for the under 17s which is being closed).
GRCs, NHS, and Being a Transgender Adult in the UK
- Thread starter IglooDame
- Start date
In the linked video, the person notes that for the London region of NHS, a few years ago there were ~10K people waiting for appointments at the 'transgender clinic'. On an average month, there were fifty appointments at that clinic. But that's if you actually get on the list for appointments in the first place. The person in the video also notes that she first went to her GP and said "I'm trans, and I want an appt at the transgender clinic in order to get a diagnosis and start the process. Her GP said "come back in a month, if you still think you're trans I'll send the necessary letter to the clinic." She came back a month later (still trans!) and so the GP sent the letter at that time. Except the GP didn't. After six months of no word, she went back to the GP, who said "Oh, here's the letter (unsent), it didn't get sent for some reason." (paraphrasing, just watch the video please) So there's seven months before one joins the ten thousand people waiting for one of those fifty-per-month appointments.
Exactly so!
I thought it worth noting that @Noble Zarkon 's point about 'there's a system by which one gets GRCs, including two gender dysphoria diagnoses' fails to take into account just how difficult and how absurdly long it takes to even get an appointment in order to be evaluated for gender dysphoria.
Getting 2 gender dysphoria diagnoses is a bit like getting 2 doctors to agree you need an abortion. Not so bad if you live in an urban area with a specialist clinic, not so good if you live in a rural area and the specialist in the local hospital is opposed to the procedure. Except specialists are much rarer for gender dysphoria.
Chukchi Husky
Lone Wolf
I feel I should mention again that I've been waiting to see a doctor since August.
Zardnaar
Deity
That's not to bad last I heard the wait time here was 40 years for surgery.
They threw money at it but the bottleneck is only 1 surgeon who does it.
All of that sounds bad. It being worse somewhere doesn't make a horrendous wait time elsewhere less horrendous, except by comparison. Which doesn't help anybody on either list.
sophie
Break My Heart
It seems like you’re conflating grc and medical transition. The “jump the queue” is not to bypass the 2-year proof of living in your true gender required for the grc, but in bypassing the wait time for gender clinic appointments.
For example, the GIC in London for just the month of May of last year offered first appointments for those who scheduled in January of 2018, serviced 50 first appointments, received 327 referrals, and had a waitlist of 11,407. The wait time then (keeping in mind the wait has continued to get worse over the past year) was 4 yrs 4 mos for a first appointment and another 1 yr 6 mos for the second appointment meaning time from referral (so, not accounting for how much time will need to be spent finding a gp who will actually give you a referral) to getting drugs in-hand is just short of 6 years (assuming you said the right things in your evaluation, your blood work was ok, you were lucky enough to avoid extremely common ableist and fatphobic barriers, etc. - all things that happen very regularly and get you thrown back into the back of the line). And keep in mind that WPATH advises check-ins every 3-4 months during the first year to check levels and titrate dosages. That horsehocky is right out the window.
And, again these are the timelines now for if you scheduled your first appointment back in 2018. In 2021, The GIC processed roughly 450 new patients in a year, and received referrals for 3-400 each month for that year, meaning the waitlist for a first appoint for those who scheduled in 2021 was 25 years.
And the GIC is not an outlier. In November 2022, Tyne and Wear was taking first appointments for those who scheduled in February of 2017 and taking second appointments for those who had their first appointment in March of 2019. Sheffield is taking first appointments from those who were referred in April of 2018. Exeter is taking first appointments from those who were referred in June, 2016.
This is not a Tory thing. Labour leadership is perfectly happy with this arrangement and will doubtless make no effort to improve conditions should they gain control of government. Starmer has said as much.
The NHS as a whole is failing due to chronic underfunding. That much is true. But this is not a consequence of underfunding. This is the government taking on extra expense to create an entire separate apparatus just for us that is explicitly designed to make accessing care as onerous and excruciating as possible. It is a torture device devised specifically to make trans people needlessly suffer as much as possible to the satisfaction of both parties (and the LibDems).
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My view is that these surgeries / treatments should not be offered on the NHS at all, but that you should pay privately if you want to access them.
Perhaps from @schlaufuchs post this is essentially the case already.
Perhaps from @schlaufuchs post this is essentially the case already.
Cloud_Strife
Deity
Why do you actively want to make British trans people's lives worse off?
Zardnaar
Deity
Might be faster if you go private idk. The money is there for the surgery the specialists are not. That's not unique to trans care.
I'm not sure if throwing money at it helps as the cost of living+ Australia next door doesn't help.
"Not too[sic] bad"? Are you kidding me? Seriously?
Yes, waiting effectively forever for surgery is very very bad. Hire a few more surgeons. But structuring things so that legal recognition or any medical transitioning whatsoever is administratively held up for really no reasons except for some unspecific desire to make transphobic cis people feel safe is also very very bad.
I was able to schedule an initial appointment for two weeks into the future, got my "diagnosis" at that appt plus a blood test, and got a prescription for HRT (hormones) the next day. And I wasn't even in a rush. And it wasn't because I have good health insurance. It was a little clinic, 30min drive away. And then I changed my legal name, that took... one business day, all electronically, in New Hampshire, and I think $60 fee, waivable in certain circumstances. Changing the name and gender marker on my driver's license took a 1hr visit to the DMV, a $30 fee. Passport was another month, another hundred dollars or so. And actually none of the legal stuff required anything like a medical diagnosis.
You don't need to hire surgeons for that. For that matter, for the (non-surgical) medical transitioning part you don't really need to even hire additional doctors - it was a Registered Nurse that I worked with at the clinic, under a doctor's auspices. You do need a bunch of lawmakers and civil administrators to stop being gits, though, and clearly Terf Island does not have enough non-git MPs.
With regards to modern medicine, and I’m going to preface this by saying I don’t know what is in general covered by the NHS and what isn’t, I think the general consensus is now that the scope of procedures covered include some of those things that are not medically necessary to sustain life—if someone has chronic back pain, it may not be life-threatening but the patient still has the privilege of receiving treatment to improve their quality of life.
I don’t see transsexual surgery to be any different: not purely of medical necessity to sustain life, but a quality of life matter that is medical and would therefore fall under the scope of treatment covered by the NHS.
Zardnaar
Deity
Hiring surgeons is easier said than done and we're competing with Australia who pays a lot more with better conditions.
And NZ is among the worst in the world with cost of living (number 6 iirc).
California prices Colorado wages and richer neighbor next door with visa free travel.
Liberals here kinda screwed themselves (immigration). Although it's kinda other way around it's the right pushing for more migration (cheap labour, pushes up house prices).
Only thing I've got is social housing for critical skills (then the poor get hosed pick your poison).
The not to bad comment was sarcasm btw I admit it didn't come through though.
Often the surgeons are available. Otherwise queue jumping would not be possible.
And the NHS is perfectly happy to throw money at private healthcare to clear backlogs in other areas.
I don't regard that as the solution for the deficiencies of the NHS but both Tories and Labour have done that.
sophie
Break My Heart
Private is not much better. Remember, trans people as a whole are very poor and very marginalized. I cannot find economic data for the uk that specifies trans people, but as I’ve mentioned before, one in three trans people in the US lives below the poverty line - and given the reported rates of housing and workplace discrimination in the UK, I can’t imagine the numbers are much better over there.
From what I’ve seen, costs of going private in the uk with medical transition is about £300 for a first appointment with a psychiatrist for the gender dysphoria diagnosis, and £250 for the endo appointment. If you can get a GP to accept shared care, then from there it’s ~£100 for a first prescription and ~£10/mo from there. Otherwise it’s about ~£100/mo for your drugs forever. So sure, if you have an extra £1200/yr to throw around in a population that is disproportionately more likely to be homeless and unemployed, then private is definitely the solution.
From what I’ve seen, costs of going private in the uk with medical transition is about £300 for a first appointment with a psychiatrist for the gender dysphoria diagnosis, and £250 for the endo appointment. If you can get a GP to accept shared care, then from there it’s ~£100 for a first prescription and ~£10/mo from there. Otherwise it’s about ~£100/mo for your drugs forever. So sure, if you have an extra £1200/yr to throw around in a population that is disproportionately more likely to be homeless and unemployed, then private is definitely the solution.
As far as surgeons, I was talking about New Zealand, since that was what Zardnaar was talking about. When it comes to surgery I have no idea of wait times or access in either New Zealand or Old England. I think legal transition and access to hormones usually come first (as far as I know, no surgeon will take a GRS patient who hasn't been on hormones for at least six months to a year) so I tend to focus on that barrier first.
I did somewhat deliberately put it out there to be contentious…
I do think the NHS should cover quality of life issues (it is not just A&E). However I am opposed to surgical interventions to treat non-physiological conditions (not trans specific - I have had bad experiences in this area)
Zardnaar
Deity
Here the cost in public service is $40000 NZD (approx $25k) mtf, 100k (($65-70k usd) ftm. Circa 2019.
Not sure how much private is, if it's available or requirememts. I'm terrible at health I just do what ze doctor recommends.
It's probably cheaper to fly to India or Thailand. Think our first transgender who got surgery flew to Australia in the 70's or 80's they didn't have any specialist who could do it.
They might have more than 1 by now idk.
Sidenote, "transgender" is an adjective, not a noun.
sophie
Break My Heart
Once again there seems to be a conflation of two separate issues. On the one hand there are gender affirming surgeries (top, bottom, face, tracheal shave, etc.), which are constrained by an actual lack of supply. Bottom surgery is a complicated procedure in a niche field of practice and there is a small number surgeons globally who actually do reliably good work, so wait times are consequently and understandably (if regrettably) long.
On the other hand there is the GIC system in the UK which is an entirely manufactured problem invented by a people who see us as an infestation to be managed rather than people who deserve dignified care. We know this because most countries who have implemented self-id do not experience this problem.¹ So then the problem isn’t due to budgetary constraints or convoluted interlocking bureaucratic systems or medical exigencies - indeed the GICs add to budgetary constraints by necessitating an entire parallel bureaucracy of gatekeepers to limit service for a comparatively minuscule population; and WPATH has maintained for a half a decade now that self-identification is sufficient for a gender dysphoria diagnosis. Parliament could vote tomorrow to end the GICs and move to a self-id system, and while many problems would remain - both with the NHS and with trans care - the problem of wait times for HRT would resolve almost overnight.
¹In Chicago I made the mistake of trying to go through an endo at a time when specialists were on massive backlog due to COVID, so I had a 3 month wait for my visit, but once the visit day arrived,the time from entering the clinic to drugs-in-hand was about 90 minutes.
On the other hand there is the GIC system in the UK which is an entirely manufactured problem invented by a people who see us as an infestation to be managed rather than people who deserve dignified care. We know this because most countries who have implemented self-id do not experience this problem.¹ So then the problem isn’t due to budgetary constraints or convoluted interlocking bureaucratic systems or medical exigencies - indeed the GICs add to budgetary constraints by necessitating an entire parallel bureaucracy of gatekeepers to limit service for a comparatively minuscule population; and WPATH has maintained for a half a decade now that self-identification is sufficient for a gender dysphoria diagnosis. Parliament could vote tomorrow to end the GICs and move to a self-id system, and while many problems would remain - both with the NHS and with trans care - the problem of wait times for HRT would resolve almost overnight.
¹In Chicago I made the mistake of trying to go through an endo at a time when specialists were on massive backlog due to COVID, so I had a 3 month wait for my visit, but once the visit day arrived,the time from entering the clinic to drugs-in-hand was about 90 minutes.
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