National Gender Identity Healthcare Reference Group minutes: December 2023

Attendees and apologies

• Dr Ewan Bell, (Co-chair), Associate Medical Director, NHS Dumfries and Galloway
• Dr Richard Anderson, Deputy Director Centre for Reproductive Health, University of Edinburgh
• Dr Hilary Cass (guest), Chair of Cass Review
• Kerry Cairns, Service Manager, NHS Grampian
• Dr Paul Connelly, Clinical Lecturer in Diabetes & Endocrinology, University of Glasgow
• Graham Ellis, Deputy Chief Medical Officer, Scottish Government
• Neil Ferguson, Director, West of Scotland Regional Planning
• Linsey Galbraith, Principal Information Analyst, Public Health Scotland
• Sara Geater (guest), Head of Communications and Engagement, Cass Review Team
• Dr Fiona Gibson, Specialty Doctor Gender and Sexual Health Services, NHS Highland
• Jane Harris, Head of Programme, Postgraduate and Post-registration Education and Continuing Professional Development, NHS Education for Scotland
• Catriona Johnson, Associate Director, NHS National Services Scotland
• Kathryn Kinnear, NHS Grampian
• Dr Anna Lamont, Medical Director, National Procurement Commissioning and Facilities, NHS National Services Scotland
• Jennifer Layden, Healthcare Improvement Scotland
• Karen Macpherson (guest), Principal Research Officer, Health and Social Care Analysis, Scottish Government
• Rhoda Macleod, Head of Sexual Health, Prison and Police Services, Sandyford Gender Clinic, NHS Greater Glasgow and Clyde
• Niamh O’Connor, Deputy Director, Population Health Strategy & Improvement Division, Scottish Government, Scottish Government
• David Parker, Senior Educator, NHS Education for Scotland
• Dr Ruth Pearce, Lecturer, University of Glasgow
• Dr Alison Poupart, Interim Consultant Clinical Psychologist for the Adult and Young People’s services, Sandyford Gender Clinic, NHS Greater Glasgow and Clyde
• Dr Susan Rooney, Clinical Lead, Sandyford Gender Clinic, NHS Greater Glasgow and Clyde
• Dr Cliff Sharp (guest), Chair of the Standards Development Group, Healthcare Improvement Scotland
• Claire Smith, Deputy Service Manager, Elmwood Gender Identity Clinic, NHS Grampian
• Dr Fiona Wardell, Standards and Indicators Team Lead, Healthcare Improvement Scotland
• Dr Michelle Watts, Senior Medical Advisor, Scottish Government
• Lived Experience Coordinator
• Representative, LGBT Youth Scotland
• Representative, Scottish Trans Alliance
• Representative, TransparentSees
• Scottish Government Secretariat

Apologies

• Professor Nicola Steedman, (Co-chair), Deputy Chief Medical Officer, Scottish Government
• Adam Black, Nurse Consultant/Clinical Nurse Manager, Sexual & Reproductive Health, Chalmers Gender Identity Clinic, NHS Lothian
• Kimberley MacInnes, Service Manager, Raigmore Gender Identity Clinic, NHS Highland
• Dr Louise Melvin, Interim Clinical Lead, Sandyford Gender Identity Clinic, NHS Greater Glasgow and Clyde
• Dr Christine Mimnagh, CMAGIC Clinical Lead, Mersey Care NHS Foundation Trust
• Mairi Watson, Public Health Scotland

Items and actions

Welcome and minutes of previous meeting

Ewan Bell (EB) welcomed attendees to the fourteenth meeting of the National Gender Identity Healthcare Reference Group (the Group). Apologies were noted.

Minutes of the previous meeting were approved and EB noted that these will be published online in due course.

Actions arising from the previous meeting were reviewed and confirmed completed.

Dr Hilary Cass – presentation and discussion

EB welcomed Dr Hilary Cass, Chair of the NHS England commissioned Independent Review of Gender Identity Services for Children and Young People to the meeting. This Review is considering clinical service provision in this field as offered by NHS England.

Dr Cass outlined the background to the Review’s work including their remit, terms of reference and reporting process. She provided an overview of what is informing the Review and how evidence was gathered. This included available systematic reviews, quantitative research and qualitative research.

How the Review had engaged with people with lived experience and other relevant stakeholders was outlined. This includes young people on the waiting list, current and former patients of the NHS England commissioned Gender Identity Development Service (GIDS) and their families.

Dr Cass spoke further to her findings to date, the impact of the Review’s interim report and consideration of future service model options within NHS England’s commissioning system. Challenges including recruitment of staff with relevant expertise in this area of healthcare was raised. The negative impact of ongoing polarised public discussion of this clinical care was acknowledged, as was associated misunderstandings regarding the work the Cass Review is undertaking and how it was commissioned.

Questions and discussion followed, including on recruitment and expertise challenges, structure of clinical services and lines of governance, local/regional and national provision and factors for consideration in the context of NHS Scotland.

Dr Cass noted discussions between Scottish Government/NHS Scotland and NHS England were ongoing regarding its announced puberty hormone suppression study in children and young people as a treatment option for gender dysphoria.  

Reflections on the NHS Scotland clinical and commissioning context followed. The similar challenge experienced by NHS England of recruiting from a limited number of skilled and expert staff to tertiary services and the impact of this on already stretched secondary services was discussed.

EB thanked Dr Cass and her team for attending and providing an update.

Policy update

The Scottish Government provided an update on progress of current workstreams. The Group noted:

• A public consultation on HIS national standards of care opened on 4 December for 13 weeks.

• Following a second call, University of Glasgow has now received a number of high-quality proposals for small projects and applications for PhD studentship.
• New national waiting time standards guidelines which apply across healthcare services, including gender identity services, have been published on Scottish Government website. Further communication on this will be issued to Health Boards in due course.
• The Budget statement was due in Parliament in the afternoon of the Group’s meeting and officials confirmed they will liaise with Health Boards on next year’s allocation of funding in January 2024.

Public Health Scotland (PHS) – waiting times data update

PHS reported on continued collection of preliminary data within gender identity services. It was noted that the quality of available data requires further improvement in some areas, and this will continue to be worked on.

PHS will continue to work with Health Boards to refine and improve the data reporting. This remains an ongoing action.

National Services Division (NSD) – young people’s service commissioning

NSD provided an update on work to formally commission a young people’s gender identity service for Scotland. This includes continued consideration of embedding a consistent approach to provision of ongoing support at local and regional level alongside a national offering, pathways for referral to this and completion of a specification for the specialised national service with support from subject matter experts.

AOB

The next meeting of the National Reference Group was confirmed for 22 February 2024.

No other business was raised and the meeting was closed.