Our view on proposed service specification for new gender identity services

We had cautiously welcomed the development of new services as a move towards better accessibility, but this new service specification raises serious concerns.

The new centres were proposed after wait times at GIDS spiralled into years, and the Cass Review interim report found that the current system was unsustainable.

But the new service specification seems likely to repeat - even exacerbate - the problems already faced by GIDS. Changes seem intended to reduce the number of referrals and the scope of available treatments, rather than improve access.

A large number of additional gatekeeping measures have been introduced. Young people who are already receiving puberty delaying treatments or hormone therapies from private sources may find themselves threatened with safeguarding alerts and refused transfer into NHS services. This makes it more likely that people will avoid talking to their doctors about self-medication, and could force young people into a terrible choice between either detransitioning or being denied NHS care entirely.

There is also a perverse, completely needless pathologisation of social transition. Social transition includes changing names and pronouns, or the way a person presents themselves. Not only is it both harmless and reversible, it actually benefits young people to be able to safely explore their identities in this way. 

Despite this, the proposed specification seems to discourage doctors from a patient-led response, instead suggesting they put up further unnecessary barriers to social transition. All patients deserve to be able to present themselves as they wish, and to have safe, outcome-neutral discussions about their identities. Arbitrarily restricting personal choices like name and gender presentation isn’t just harmful and unenforceable in practice, it runs uncomfortably close to conversion practices. That this is even being considered by NHS England is dangerous. 

We, as an organisation and as communities, want to work with the NHS to build gender identity services that are fair, accessible, and safe for all who need them. But it is clear from this document that NHS England still treats transness as a bad outcome, something to be avoided. We will not fix the problems in these systems until we start listening to the people who need them. 

We will be responding to the consultation on the service specification, and are talking to our colleagues in the community about further action.

Editors: contact publicengagement@genderedintelligence.co.uk