This is why the London gender identity clinic ending its NHS contract is an opportunity, not a crisis

London’s transition services need radical improvement, trans health expert Jess Bradley writes

West London Mental Health Trust (WLMHT) announced yesterday that it has served notice on the contract it has with NHS England to provide care to trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
patients at the Charing Cross Gender Identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
Clinic.

In the recent government Trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
Inquiry, I had the opportunity to give evidence in the health panel on behalf of Action for Trans Health, a patient advocacy service I work for. At the inquiry I raised the excruciatingly and often illegally long waiting lists for treatment at gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
clinics, a constant source of criticism for the WLMHT’s management of Charing Cross.

The challenge of reducing the waiting times at Charing Cross is a significant one, especially when considering that the number of adult trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
people presenting at Gender Identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
Clinics is rising up to 50% per year. In the announcement, WLMHT talked about this challenge which, reading between the lines, seemed to form a significant driver for this move. In a later addendum to the announcement, the lead clinician at Charing Cross, Dr. James Barrett, stated that the decision was mutual, and driven from the GIC’s side by a feeling that gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
care should no longer sit under the auspices of a mental health trust.

This is seemingly a welcome move as trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
activists have long argued that being trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
is not, in itself, a mental health condition. The gatekeeping, gaslighting, and inappropriate questions that many trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
people still receive from clinicians within the current system, discussed both at the Trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
Inquiry and widely on the # transdocfail hashtag, is considered by many to be a feature of trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
healthcare’s organization under a mental health banner. The move of gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
care away from mental health towards a different sector of the NHS may provide a significant opportunity to move to less pathologising models of treatment.

However, it is unlikely that patients will see an immediate change in the way gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
care is conducted once Charing Cross has moved to a different provider, unless NHS England significantly change the spirit of the contract that is being put to tender. It is expected that the staff will stay the same, and will remain stuck in their usual ways of doing things. Over time, though, trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
healthcare will inevitably be influenced by the culture and practices of wherever it finds its new home.

The move itself presents its own challenges. If not mental health, then where? Trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
healthcare provision is currently a mixture of psychiatric evaluation, hormonesChemical substances that control and regulate the activity of certain cells or organs; see also: sex hormones., and surgeries; it doesn’t fit neatly under either mental health, endocrinology or surgery.

Perhaps the fact that gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
care straddles different sectors explains the reason why it seems that Charing Cross are struggling to find a new home. After all, it seems strange that WLMHT would publicly announce that they have given notice on their tender without first finding another provider to replace it.

More likely, though, is that trusts are put off by the long waiting lists and the ever increasing numbers of patients presenting for treatment. Without a significant increase in funding and staffing levels, or a change in the way that trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
healthcare is conducted, the new provider will be taking on not just a gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
clinic, but a massive headache too. Perhaps the adoption of the informed consent model of trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
healthcare, which promises to be more streamlined and less pathologizing process, would help.

It is unsure how long the handover to a new provider will last. From the announcement we know it will take at least six months, but it could be many more than that. What we do know, however, is that WLMHT is unlikely to be implementing the significant changes to provision that trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
activists are asking for, as gender identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
care will shortly become someone else’s problem.

Change within the mental health sector typically takes place at a glacial pace, and is often even slower to implement in other areas of the NHS. This switch in service provider offers a crucial opportunity for trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
activists to influence provision, if we move quickly. The key demands we must be taking forward to NHS England are an increase in funding and staffing levels, as well as a switch to a less pathologizing model of treatment such as the informed consent model. Only after a new supplier is chosen and these demands secured will NHS England be able to provide the reassurance and stability that trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
patients are desperately need.

Jess Bradley works with Action For Trans Health, a charity fighting to improve trans• Trans is an umbrella term used to describe people whose lives appear to conflict with the gender norms of society. Whether this is in their clothing, in presenting themselves or undergoing hormone treatment and surgery. Being trans does not imply any specific sexual orientation.
• Trans is an umbrella term that describes a wide range of people whose gender and/or gender expression differ from their assigned sex and/or the societal and cultural expectations of their assigned sex; includes people who are androgyne, agender, bigender, butch, CAFAB, CAMAB, cross-dresser, drag king, drag queen, femme, FTM, gender creative, gender fluid, gender non-conforming, genderqueer, gender variant, MTF, pangender, questioning, trans, trans man, trans woman, transfeminine, transgender, transmasucline, transsexual, and two-spirit.
people’s access to healthcare.

Source – http://www.gaystarnews.com/article/london-gender-identity-clinic-ending-nhs-contract-opportunity-not-crisis/