National Gender Identity Healthcare Reference Group minutes: October 2024

Attendees and apologies

• 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 Clunie, Consultant Psychiatrist/Medical Lead, Chalmers Gender Identity Clinic, NHS Lothian
• Professor Graham Ellis, Deputy Chief Medical Officer, Scottish Government
• Hayley Fairgrieve, Gender Lead Nurse/Advanced Sexual Health Practitioner, Chalmers Gender Identity Clinic, NHS Lothian
• Linsey Galbraith, Principal Information Analyst, Public Health Scotland
• Jane Harris, Head of Programme, Postgraduate and Post-registration Education and Continuing Professional Development, NHS Education for Scotland
• Dr Amber Keenan, Clinical Lead, NHS Highland
• Jennifer Layden, Health Improvement Scotland
• David Parker, Senior Educator, NHS Education for Scotland
• Dr Craig Wheelans, National Medical Advisor, Specialist Healthcare Commissioning, National Networks & National Planning, NHS National Services Scotland
• Dr Fiona Wardell, Standards and Indicators Team Lead, Healthcare Improvement Scotland
• Representative, * LGBT Health and Wellbeing
• Lived Experience Coordinator
• Representative, * LGBT Youth Scotland
• Representative, Scottish Trans
• Representative, Transparentsees
• Scottish Government Secretariat

Apologies

• Dr Ruth Pearce, Lecturer, University of Glasgow
• Dr Alison Poupart, Interim Consultant Clinical Psychologist, NHS Greater Glasgow and Clyde
• Catriona Johnson, Associate Director, NHS National Services Scotland
• Kimberley MacInnes, Service Manager, Raigmore Gender Identity Clinic, NHS Highland
• Dr Paul Connelly, Clinical Lecturer in Diabetes & Endocrinology, University of Glasgow
• Rhoda Macleod, Head of Sexual Health, Prison and Police services, Sandyford Gender Identity Clinic, NHS Greater Glasgow and Clyde
• Dr Susan Rooney, Clinical Lead, Sandyford Gender Identity Clinic NHS Greater Glasgow and Clyde

Items and actions

Welcome & minutes of previous meeting: Paper A (minutes)

Nicola Steedman (NS) welcomed attendees to the 20th meeting of the National Gender Identity Healthcare Reference Group (the Group). Apologies were noted.

Updated Terms of Reference

The Scottish Government presented a draft updated Terms of Reference to the Group which removed language relating to the Bute House Agreement which had ended and better reflected function of the Group.

An amended Terms of Reference was agreed and will now be updated on gov.scot.

Policy Update/Risk Register

The Scottish Government provided an update on the progress of current workstreams and highlighted changes to the risk register.

Completion of the Knowledge and Skills Framework by NHS Education for Scotland, and Gender identity healthcare: Adult and young people standards by Healthcare Improvement Scotland were highlighted and the Group and the teams thanked for their efforts on these important milestones.

Changes to remits, staffing and responsibilities were highlighted by some of the stakeholders. This included consideration of how National Services Division supports networks in the future.

Post 2021 Strategic Framework priorities – Next Steps

The current framework underpinning work to improve access to, and delivery of, NHS gender identity services formally ends on 31 December 2024. It was noted that a number of actions, for example the Task and Finish Group considering children and young people services, will continue into early 2025. However, the importance of information on next steps was noted to maintain momentum in collectively working to improve gender identity services and to ensure that the progress made so far is not lost.

A discussion took place on the Group’s views on the form Scottish Government policy on next steps for gender identity healthcare in NHS Scotland should take. A range of actions and policies were considered, with agreement that these should be summarised at the Group’s next meeting. These would then contribute to Scottish Government policy development.

NHS Lothian’s recently agreed shared care agreement was highlighted. Discussion was had regarding the need for the role of pharmacy to be considered in the context of both primary care and community support for specialist gender identity healthcare services. Need for a national clinical or strategic network within NHS structures to take forward work like this was emphasised.

The Group membership was invited to send any further thoughts on priorities for next steps to the policy team.

Commissioning Young People’s services

An update was provided on the establishment of work by Chief Operating Officer’s Directorate in Scottish Government to commission a Children and Young Person Gender Service for NHS Scotland in a paediatric clinical setting.

This was a recommendation in the Chief Medical Officer’s Cass Review: Implications for Scotland report to the Scottish Parliament on 5 July 2024.

It was noted substantive consultation with lived experience and those impacted by any future change would be embedded at the appropriate point in this process.

Discussion on structures, local responsibilities and remits, need for education and wider collaboration among services followed.

It was agreed that further updates to this will be provided at future meetings as the work progresses.

Evaluation

An update was provided by Horizons Research to the Group on the progress, findings, challenges and expected outputs of the independent evaluation on the impact of Scottish Government funding to NHS Boards for their gender identity clinic provision.

It was confirmed the report was moving to finalisation and submission to Scottish Government, subject to final factual review by Health Boards. It is expected that the report will be published, following standard procurement processes, in early 2025. 

Surgical Scoping

NHS National Services Scotland, National Services Division (NSD), provided an update on its scoping exercise on gender reassignment surgeries and advice to Scottish Government on how surgical provision may be strengthened in Scotland. It was noted no current option exists for these surgeries to be repatriated or delivered in NHS Scotland, outwith the current four-nations surgical contract led by NHS England. The current contract arrangement remains the best option for patients at this time.

NSD note there may however be scope for chest reconstruction surgeries to be offered via NHS Scotland in future although further scoping work would be required to consider this and, if appropriate, build a business case with options.

NHS Lothian’s pause to surgery referrals while they review internal governance processes was highlighted.

AOB & Close

No other business was raised.

Chairs reminded the Group members to send any thoughts regarding future priorities to the policy team for consideration at the next meeting.

The next meeting of the Group was confirmed for 04 December 2024.