National Gender Identity Healthcare Reference Group minutes: March 2022

Attendees and apologies

Attendees:

• Professor Nicola Steedman, ( Co-Chair), Deputy Chief Medical Officer, Scottish Government
• Dr Ewan Bell (Co-Chair), Associate Medical Director, NHS Dumfries and Galloway
• Dr Fiona Wardell, Head of Standards and Indicators Team, Healthcare Improvement Scotland
• Katrina Mitchell, Development Worker, LGBT Health and Wellbeing
• Kay Black, Development worker, LGBT Health and Wellbeing
• Dr Christine Mimnagh, CMAGIC Clinical Lead, Mersey Care NHS Foundation Trust
• David Parker, Lead Clinician, National Gender Identity Clinical Network for Scotland
• Kathryn Kinnear, Service Manager, NHS Grampian
• Jenny McNicol, Acute Director of Nursing and Midwifery, NHS Grampian
• Rhoda Macleod, Head of Sexual Health, Prison and Police services, NHS Greater Glasgow and Clyde
• Jennifer Jamieson, Service Manager, NHS Greater Glasgow and Clyde
• Kimberley MacInnes, Service Manager/Lead Nurse, NHS Highland
• Jane Harris, Head of Programme, Postgraduate and Post-registration Education and Continuing Professional Development, NHS Education for Scotland
• Dr Anna Lamont, Medical Director, Procurement, Commissioning and Facilities, NHS National Services Scotland
• Aileen Ferguson, Programme Manager, NHS National Services Scotland
• Colin Briggs, Director of Strategic Planning, NHS Lothian 
• Adam Black, Nurse Consultant/ Clinical Nurse Manager, NHS Lothian
• Peter Martin, Service Manager, Public Health Scotland
• Policy Team, Scottish Government 
• Dr Michelle Watts, Senior Medical Adviser - Primary Care, Scottish Government
• Oceana Maund, Community Engagement Officer Scottish Trans Alliance
• Dr Ben Vincent, Research Coordinator, Trans Learning Partnership
• Evelyn Sheerin, Parent representative, TransparentsTees
• Dr Richard Anderson, Deputy Director Centre for Reproductive Health, University of Edinburgh 
• Dr Ruth Pearce, Lecturer, University of Glasgow

Apologies:

• Maruska Greenwood, Manager, LGBT Health and Wellbeing
• Dr Louise Melvin, Interim Clinical Lead, NHS Greater Glasgow and Clyde
• Dr Fiona Gibson, Clinician, NHS Highland
• Kirstin Leath, Head of Health Equity and Equalities Unit, Scottish Government
• Vic Valentine, Manager, Scottish Trans Alliance
• Megan Snedden, Campaigns Policy and Research officer, Stonewall Scotland

Items and actions

Welcome and introductions

Nicola Steedman (NS) welcomed attendees to the first meeting of the National Gender Identity Healthcare Reference Group (the Group). Introductions were made and apologies noted. 

Context

The Scottish Government Gender Identity and Healthcare Access policy team provided an overview of the background to the establishment of this Group. Recent Scottish Government commitments to improve access to, and delivery of, NHS gender identity services were highlighted. 

Oceana Maund (OM) highlighted this Group and its aims were welcomed by trans people living in Scotland. OM emphasised the present time is an opportunity to be ambitious, and noted future work must not just concentrate on reduction of waiting times but holistically consider the whole of gender identity healthcare within NHS Scotland.

Anna Lamont (AL) stressed the importance of ensuring primary care is fully included in this process. Michelle Watts (MW) provided an overview of primary care direction and challenge in broader context of COVID-19 pandemic recovery.

Brief discussion on the concept of diagnosis as currently understood and workstream progress. David Parker (DP) highlighted many of these discussions are also happening within the current Gender Reassignment Protocol for Scotland review.

Draft terms of reference and membership

The draft Terms of Reference were introduced. Comment was invited.

Substantive discussion took place on how the Group will hold itself accountable, in particular through identifying key goals, milestones and deliverables. Colin Biggs (CB) highlighted the need to have in place outcomes by which success could be measured against. The Group agreed it was important to have in place from the beginning how outcomes which will be met. Rhoda Macleod (RM) raised the need to build in appropriate accountability across all levels and tiers of care, in particular through links with Health Board structures.

Kathryn Kinnear (KK) asked consideration be given for incorporating Health and Social Care Partnerships to work to improve NHS gender identity healthcare. Noted as critical to link in with community partners.

Action: Secretariat to discuss with Kathryn Kinnear regarding role and input of Health and Social Care Partnerships.

Christine Mimnagh (CM) shared experiences of “pilots” in England and noted collaboration across all agencies is key in making successful changes for the future. Highlighted importance of this Group being clear on its expectations from the beginning of process to improve services.

David Parker (DP) reiterated themes in discussion which link to the work ongoing in the Gender Reassignment Protocol for Scotland Review.

Action: Secretariat to amend Terms of Reference in line with Group discussion for next meeting, with focus on drawing out strategic aim and deliverables. 

NS asked members to review the group membership and identify any gaps.  

Clarification was sought from Group on how a proposed lived experience grant should be dealt with regarding declaration of interest. It was noted purpose of member declaration of interest was to promote openness and transparency across all work.

It was noted the finalised Terms of Reference, membership and meeting minutes will be published on Scottish Government website in due course.

Framework update and lived experience

The Scottish Government Gender Identity and Healthcare Access policy team provided an overview on the work that has taken place so far on the commitments contained within Scottish Government’s Strategic Action Framework.  

The Group were also invited to consider proposals for a grant funded lived experience coordinator, to inform the work of the Group and represent the voice of lived experience. 

This proposal was positively received and agreed. 

Funding principles

NS explained the planned process for the introduction of funded ‘pathfinder’ services and support for those waiting.

A subgroup will be set-up to evaluate, assess and inform bid allocation. It was noted any final decision on allocation will be made by Scottish Government.

Group recognised finalisation of principles will need to be completed at pace, for readiness for beginning of 22/23 financial year. 

AL queried the point about new services working with existing clinics. Concern this could create additional work and may adversely impact both current services and any new service(s). Rhoda MacLeod (RM) queried how clinics were expected to clear patient backlog as well as support set-up new service(s). Group highlighted that further clarity regarding the relationship between any pilot (or ‘pathfinder’) and current services would be required.

CM explained how their service was established and operated. Emphasised Group should be aiming to facilitate services being able to do the right thing, for the right people, at the right time. DP highlighted other learning from new NHS England services. RM stressed the need for robust clinical governance throughout new pathway services. Group agreed that such oversight should be included in proposals for funding. 

A discussion about complex care requirements with patient cohorts took place. The issue of complexity, or perceived complexity, was considered as part of how funding principles may be framed. CM noted Group must be ambitious and consider all options for how care can best be delivered for people, including combination of different approaches under one service.

Action: Secretariat to redraft Principles taking into account Group discussion.

Action: Secretariat to recirculate updated Principles for remote sign off by Group, in advance of next meeting.

Research commissioning

Comment was invited on research commissioning proposals.

Ben Vincent (BV) and Ruth Pearce (RP) highlighted existing and past qualitative work could inform proposals. Collectively noted that commissioning agreed by this Group should not substantively repeat research already available in other parts of the UK.

Members noted importance of having voices of lived experience embedded as part of management processes of academic management for research fund.

Development of research proposals relating to children and young people accessing gender identity services in Scotland were highlighted as being of value.

Action: Secretariat to arrange meeting to discuss current work elsewhere in the UK.

AOB

Document updating Group on progress of GRP was noted.

Meeting closed.