National Gender Identity Healthcare Reference Group minutes: January 2023

Attendees and apologies

• Dr Ewan Bell (Co-Chair), Associate Medical Director, NHS Dumfries and Galloway
• Adam Black, Nurse Consultant/Clinical Nurse Manager, NHS Lothian
• Neil Ferguson, Head of Planning, NHS Greater Glasgow and Clyde
• Linsey Galbraith, Principal Information Analyst, Public Health Scotland
• Dr Fiona Gibson, Clinician, 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, Service Manager, NHS Grampian
• Jennifer Layden, Healthcare Improvement Scotland
• Kirstin Leath, Head of Gender Identity Healthcare Access, Scottish Government
• Kimberley MacInnes, Service Manager/Lead Nurse, NHS Highland
• Rhoda Macleod, Head of Sexual Health, Prison and Police Services, NHS Greater Glasgow and Clyde
• Dr Louise Melvin, Interim Clinical Lead, NHS Greater Glasgow and Clyde
• Dr Christine Mimnagh, CMAGIC Clinical Lead, Mersey Care NHS Foundation Trust
• Katrina Mitchell, Development Worker, LGBT Health and Wellbeing
• David Parker, Lead Clinician, National Gender Identity Clinical Network for Scotland
• Dr Ruth Pearce, Lecturer, University of Glasgow
• Parent Representative, TransparentSees
• Vic Valentine, Manager, Scottish Trans Alliance
• Dr Fiona Wardell, Standards and Indicators Team Leader, Healthcare Improvement Scotland
• Dr Michelle Watts, Senior Medical Adviser – Primary Care, Scottish Government
• Dr Sarah Weldon, Consultant Clinical Psychologist, NHS Greater Glasgow and Clyde
• Lived Experience Coordinator

Apologies

• Professor Nicola Steedman, (Co-Chair), Deputy Chief Medical Officer, Scottish Government
• Dr Anna Lamont, Medical Director, National Procurement Commissioning and Facilities, NHS National Services Scotland
• Colin Briggs, Director of Strategic Planning, NHS Lothian
• Jenny McNicol, Acute Director of Nursing and Midwifery, NHS Grampian
• Mairi Watson, Information Consultant, Public Health Scotland

Items and actions

Welcome and minutes of previous meeting

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

An initial update was given to the Group, noting that funding has now been allocated to the four Health Boards providing a gender identity clinic and that £2 million had been allocated for gender identity healthcare improvement next financial year, following the draft 23/24 Scottish Budget. Recognition was given to the pressure currently facing Health Boards, primarily as a result of workforce challenges. 

Minutes of the previous meeting were approved and EB noted these will now be published online. Progress and completion of previous actions arising from the last meeting were noted.

Policy update

Scottish Government provided an update on current workstreams, including highlighting current risks to delivery. 

Concerns relating to additional pressures if a national application of waiting time standards to gender identity services without a phased introduction were raised. Additional risk to progressing improvement in this space were discussed, including ongoing workforce pressure and recruitment challenges. Secretariat will update relevant documentation prior to the next meeting to reflect this challenge. 

The Cass Review

Scottish Government provided a verbal update to members on engagement to date with Dr Hillary Cass and the Cass Review Team. 

Some concerns relating to the Cass Review were raised by some members, particularly associated with research being established in England. These concerns were noted by the Group. It was however recognised that it was important for Scottish Government to continue to have dialogue with the Cass Review team. 

Lived Experience Coordinator 

The Lived Experience Coordinator provided an update of engagement work underway and planned. Some of this work includes running a survey to discover how trans, including non-binary people, want to engage with their post as well as the creation of a mailing list for community members and connecting with various community groups. 

Group members noted their thanks for these contributions and work achieved in such a short time in post. It was noted comms alignment would be helpful, between the lived experience coordinator and various workstreams underway. 

Information sharing / liaison group proposal 

Scottish Government shared a proposal to establish a ‘liaison group’. The proposal set out that the forum would consist of members of the group from Public Health Scotland (PHS), NHS National Services Scotland (NSS), NHS National Education for Scotland (NES) and Healthcare Improvement Scotland (HIS), and the group would initially meet quarterly to facilitate information sharing and reduce duplication of effort across work by national boards.

Establishment of the National Board Liaison Group was agreed. Secretariat will take this action forward. 

Public Health Scotland update  

PHS gave an update on progress of their commission to collect, collate and publicly report standardised waiting times and associated patient cohort information. 

A draft data template and guidance has been developed following consultation with gender identity clinics and the Group. These draft templates are now being piloted with clinics and their Health Boards. The template will be revised if necessary following the pilot period. 

Gender reassignment protocol for Scotland

NSS and Scottish Government policy team gave an update on the completion of the review of this protocol. All documentation has now been submitted to the Chief Medical Officer for consideration. 

The updated protocol will now be considered by the Chief Medical Officer and Scottish Government. 

Health Board updates 

Health Boards were asked to outline how they planned to spend funding allocated this financial year for their gender identity services, including outlining challenges. 

Most Health Boards confirmed their intention on how to spend allocated funding. However most were experiencing issues with workforce recruitment and retention. This was, in part, exacerbated as a result of late allocation of funding due to last year’s Emergency Budget Review. NHS Lothian however noted they were not facing similar issues and had managed to recruit into multiple posts since funding was confirmed, contributing to a reduction of waiting times to access their service. 

Discussion was had around new approaches to delivering healthcare, for example through greater involvement of primary care.  

In summary, the Group agreed the need for a piece of work focusing on a detailed operational analysis on what is happening within services, a need to consider skill mixing and different methods of delivery, and the need for workforce issues to be escalated beyond this group to SG/Health Boards. 

Healthcare Improvement Scotland - draft standards and consultation 

HIS updated the Group on its progress on developing standards of care for gender identity healthcare.

Consultation is due to start on the scope of those standards on 23 January and will be open for three weeks. The aim of that consultation is to obtain feedback from stakeholders which inform the scope of the development of the standards. 

AOB and close

No further business was raised. 

EB Thanked members for their time and contribution to the meeting