National Services Division

National Services Division

National Gender Identity Clinical Network for Scotland (NGICNS)

Annual General Meeting

Tuesday 30th August 2016 from (AGM) 12.00pm to 2.30pm

Venue: The Epilepsy Centre, Quarriers, Govan, Glasgow

1. Welcome,Shape and Purpose of the Session

Catriona Renfrew, the Chair of the Network welcomed all members to the NGICNS Annual General Meeting, and introduced herself as Director of Planning for NHS Greater Glasgow and Clyde. She noted the work of the Network over the past year, and explained that the key focus of the Network was to improve access to, and quality of, NHS services relating to gender reassignment.

1. Presentation – the work of the Gender Identity Network in 2015-2016, ongoing work and future priorities

Dr David Gerber, NGICNS Lead Clinician gave a presentation on the work of the Network in the preceding 12 months, and suggested areas to concentrate on for the future.

Please clickon the Microsoft Office icon to view a copy of the presentation:

1. Annual report

The annual report was circulated for discussion

Dr Gerber welcomed questions on his presentation and on the Annual Report.

1. Plenary Q&A - This section sets out the themes raised by people attending the meeting

4.1Waiting Times and Resources

Concerns about waiting times and resources.

Sandyford waiting list has increased from 9 months to 1 year, with a substantial increase in referrals. More staff have been recruited, however adult referrals have gone up 50% and young people 80-90%. Catriona Renfrew highlighted that waiting times are too long and they are working to reduce them. The Network is working to improve data received from each health board, which helps inform the Network of what resources might be required.

More parents have children who are approaching puberty and are on a 1 year waiting list. This is really difficult for parents and patient.

Sandyford are focusing on seeing younger patients as a priority. Further details regarding specific cases should be discussed with Dr Gerber in a separate discussion.

Funding is provided by Boards across Scotland when patients attend Sandyford. Approximately £120,000 has recently been invested to expand staffing. Sandyford need to predict demand for the next 2 or 3 years to make the best choices about recruitment. They have not encountered any unwillingness to fund the service.

4.2Hormones

A number of issues were raised about access to hormones including in relation to self-harm. With regard to young people waiting to access services, it was noted that GPs could prescribe bridging hormones or hormone blockers.

James Morton noted that Sandyford involve local Endocrinology Consultants, who do have the required skills as they prescribe for precocious puberty. Dr Wilkinson noted a need to develop a protocol to address this issue. Dr Gerber invited the service users to email direct to him or via the NGICNS email on the website or his attention to address any specific cases.

The Network has been liaising with GPs and health boards to ensure better services. GMC guidance has been provided on bridging hormones. There was an anxietyamongst clinicians that some patients self-prescribe hormones which are not right for them. James Morton noted that some GPs were anxious,but if someone was young and healthy starting hormones, if properly consented, there was not a high risk there for them.

It was noted that A&E was not the place to start providing health care over a long period of time. There would be a more positive impact if we can move forward to GP prescribing for hormones, as this would allow consistent monitoring over time.

4.3Surgery

The criteria for surgery was raised as a concern.

These issues have been raised with NSD and the process has changed. Following receipt of referral from GICs,NSD will ensure that the referral is from a specialist clinician, and the patient has had appropriate psychiatric assessment for chest reconstruction and/or genital surgery. If both criteria are confirmed, referral will be approved. All referring clinicians will meet in October 2016 to discuss the communication and referral system to ensure that there is a clear agreed process for when a gender specialist refers to a chest reconstruction surgeon.

4.4Service Provision

There is a disparity in services provided across Scotland regarding hair removal, the provision of wigs, and facial feminising surgery. Why are all other health board areas not providing the same services?

Services do vary across the 14 health boards, and Catriona Renfrew, the NGICNS Chair, has written to them all providing guidance on what a reasonable service should look like, however, each health board has the final decision, the network can only make recommendations, and cannot force the health boards follow the Scottish Government Guidelines. NGICNS will keep working to level up provision and ensure an equitable service is achieved.

Patients are not clearly being made aware of what services are chargeable, or when the funding stops (example provided re. hair removal services in Forth Valley). This can have a possible effect on delaying surgery. This treatment should not be classed as ‘cosmetic’ or incur a funding issue as it is treatment in preparation for surgery.

Catriona Renfrew to liaise with Stephen Sheach and will write to all health boards detailing the issues raised during this AGM.

NHS Tayside have openly explained via a sperm donor letter that transgender patients are not allowed to be sperm donors due to welfare issues for the child.

Transgender Alliance will send Catriona Renfrew a copy of this letter for her to action.

There is concern about access facial feminisation surgery (FFS)?

We are working with the acute division to look at access to this service.

Why do patients not have the option to choose their own surgeons?

There is only one surgeon in Scotland at present who can carry out FFS.

Are there training groups/courses to help educate transgender people on lifestyle skills, make-up,

posture, etc to help them fit in to the community?

LGBT Health and Wellbeing can help. We will aim to signpost to their information on the NGICNS website and also there are services advertised within GICs.

Not enough is being done for non-binary service users from a GIC perspective, service users have difficulty accessing hormones and surgery.

A non-binary working group has been set up to learn about what the issues are and what can be done to address them.

Can you use gender retrieval terms such as ‘genome’ as much as possible, as other terms used – very specific sexed terms - can make service users uncomfortable.

This point was noted and would be taken back to the Network.

4.5Service User Representation and NGICNS

Should there be more patients on the steering group?

NGICNS aims to use representative organisations that are interacting with a broad range of service users. This is how service user input it generally managed in the NHS. Many service user events are held to gain an understanding of where we need to improve services. NGICNS will again consider the different options to include service users.

Why do these meetings only take place during the day?

Meetings have and do take place in the evenings. Not all transgender patients wish to speak in a public forum, however, please let us know if more meetings are required, day or evening.

It was agreed to continue the Q&A session as long as time allowed, as this was proving an effective way of capturing the views of all the individuals present.

4.6Scottish Government

You are required to be with your partner for 2 years before you can access assisted conception services. Regarding surrogacy, the surrogate mother has complete autonomy over the child, with her husband entitled to parent the child. Can the long term entitlement be extended, as the transgender couple would have no autonomy over raising the child, and this is unfair?

There is a proposal by the Law Commission England and Wales to review surrogacy legislation – there is a consultation at present with a review initiating in 2017. Birth certificates are different to England and Wales. Not sure if there will be a formal review of the process any sooner that 4-5 years in Scotland, but there is awareness that the legislation requires review.

Progress with the Gender Recognition Act for Scotland?

Simon Stockwell (present) is responsible for Justice at Scottish Government, which includes policy on Gender Recognition in Scotland and involved in the reform of the Act across Scotland. He met Angela Constance, Cabinet Secretary with the plan to carry out a public consultation. The current Act has clauses which they want changed. We would like a Scotland process rather than a UK process, with the view to having the age of surgery lowered from 18 years of age and to review the Self Declaration. Ireland has taken a while to get there but now a positive experience. Looking to bring forward legislation in the Scottish Government next year – a Legal Gender Recognition Act. STA view is very positive overall.

Non-binary is not mentioned in the Manifesto?

The Scottish Government are aware this needs to be addressed and is looking to take this forward, despite the consultation paper highlighting in 2015 that gender should not matter. We can learn from Ireland, our commitment is to look at best international practice. Nicola Sturgeon talked about non-binary recognition. There is a need now to see what Ministers recommend.

We want the Scottish Government to address the findings of the House of Commons women and equalities report, and look at non-binary issues from a Scotland point of view.

We will not wait for Westminster. We have our Manifestocommitments but will talk to our Westminster colleagues, as some of the areas are covered by their legislation.

The Manifesto does not mention intersex people.

This area also needs to be addressed, as well as birth registration etc. We recognise this is currently different for Scotland compared to England, this may require a separate intervention on intersex.

In relation to the changes taking place, is Westminster involved with the LGBT community? Are they represented?

The Parliamentary Committee are involved, although Simon Stockwell does not have the same level of involvement with Westminster. The Women Equality Committee would like to have involvement. Angela Crawley MP has been very helpful and could act as liaison between MPs and MSPs to ensure best practice. She is a member of the Women’s Committee and is is keen to ensure Governments and Parliaments act together.

The movement in Scotland is positively influencing trans people in terms of justice in the prison service, the health push over the past few months in England, and now with gay marriage there is a push forward from Scottish government initially.

The World Health Organisation is looking to remove the stigma of transgender dysphoria being seen as a mental health issue, but what happens with funding if they are no longer classed as a health issue?

Funding comes from a wide range of healthcare areas, and isn’t dependent on this classification.

It would be good to have more of these events in order to have an input to the decision making during the Consultation period via the Scottish Government.

The Scottish Government have ‘Roadshows’, so please look out for these.

Priorto consultation regarding gender recognition, what is the process for service users to be asked questions and get the answers before decisions are made?

Please email Simon Stockwell with any legal process questions only, and he willforward them to the Scottish Government during the Consultation process.

Dr Matson Lawrence introduced the current research project underway, and invited that any queries or interest from service users be directed to:

At the end of this question and answer session, it was noted that while NGICNS wasa network that did a large amount of service user engagement, there was still room for improvement, and the good work of Sandyfordwas also highlighted, with the hope that plans to increase resource are met to ensure continuity ofthis level of service.

James Mortonshared with members that Transgender Alliance have had strong candidates applying for the Voluntary Sector Counselling position.

Catriona Renfrew thanked all AGM members for their time in attending the meeting today, and hoped that everyone had the opportunity to raise and discuss any issues they have, and highlighted that the presentation and notes from the meeting would be available on the NGICNS website in due course.

Action: Mary Adams

Details of the NGICNS Steering Group can be found on the NGICNS website: and queries can be directed to any members via the NGICNS email address:

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