National Gender Identity Healthcare Reference Group: winter 2023 to 2024 update

Work taking place

Funding

The NHS gender identity services strategic action framework (the Framework) commits to providing funding to services to improve how they are delivered and waiting times to access them. Since December 2022, the Scottish Government has invested over £2.8 million to support this national work, with over £2.2 million of that allocated directly to NHS health boards with gender identity clinics, to support them to improve access to, and delivery of, their services.

Standards for gender identity healthcare

In the Framework, the Scottish Government committed to develop national standards of care for adult and young people’s gender identity services. The Scottish Government has commissioned Healthcare Improvement Scotland (HIS) to develop these standards. The reference group has helped to develop and offer feedback  on that commission.

HIS is a special health board, whose aim is to enable the people of Scotland to experience the best quality of health and social care.

The overall aim of these standards is to support the best outcomes and experiences for people accessing gender identity services.

The standards will help:

• patients, carers and staff to make decisions about a person’s care
• people to get the best care available, no matter where they live
• improve the quality of gender identity healthcare across Scotland

Standards are not the same as clinical pathways, clinical guidelines or standard operating procedures.

To develop standards, HIS brings together a group of people from across Scotland, including:

• NHS staff (e.g. doctors, nurses, GPs, psychiatrists)
• staff from areas such as education and social work
• people with lived experience
• staff from the voluntary sector

A public consultation on the draft standards is expected to open in December 2023, and the publication of the final standards is planned for summer 2024. If you would like to know more, please contact HIS at his.genderidentitystandards@nhs.scot.

Data and statistics

In the Framework, the Scottish Government committed to establish robust national waiting times data collection, monitoring and reporting for gender identity services. Having regularly published high quality information on waiting times helps the NHS to work to improve services. The Scottish Government has commissioned Public Health Scotland (PHS) to carry out this work.

PHS leads and supports work across Scotland to prevent disease, prolong healthy life and promote health and wellbeing. Among many other responsibilities, PHS provides statistics and data analysis for NHS Scotland and the Scottish Government.

Over time, it is expected that PHS’s data collection will support waiting times management. PHS’s immediate focus is on waiting times for patients from initial referral to first outpatient appointment with a gender identity specialist.

In November 2022, PHS conducted a pilot data collection exercise with the four NHS gender identity clinics in Scotland. PHS reports to the National Reference Group on the data it collects, and will continue to monitor quality and completeness of its data from the four gender identity clinics. In 2024, PHS expects to begin publishing its quarterly data on its website.

Skills and training

In the Framework, the Scottish Government committed to develop a Transgender Care Knowledge and Skills Framework, and to explore opportunities for staff training and improved resources to support best care of trans people accessing services in  the NHS. To take forward this work, Scottish Government have commissioned NHS Education for Scotland (NES). The reference group helped develop and comment on that commission.

NES is an education and training body and a national health board within NHS Scotland. It is responsible for developing and delivering healthcare education and training for the NHS, health and social care sector and other public bodies.

NES has used the Scottish Government funding associated with the commission to recruit subject matter expertise and administrative support. Development of the Knowledge and Skills Framework began in summer 2023.

NES is engaging with a wide range of stakeholders in the Scottish Government and NHS Scotland, as well as professional bodies and people with lived experience. Final publication of the Knowledge and Skills Framework is anticipated by summer 2024.

Updating the 2012 Gender Reassignment Protocol

In 2012, the Scottish Government published the Gender Reassignment Protocol (GRP), one of the first of its kind in the world, which aimed to improve and standardise gender reassignment clinical pathways in NHS Scotland.

NHS National Services Scotland (NSS) provides advice and services to the rest of NHS Scotland. NSS’s National Services Division (NSD) supports the planning, commissioning and coordinating of high-quality, person-centred specialist services, networks and screening programmes.

In 2021, the Chief Medical Officer wrote to the NSD, proposing a review and update of the 2012 GRP. A draft update has now been submitted by NSD to the Scottish Government for consideration. The Scottish Government has agreed with NSD on further work which is required to take place prior to publication of a revised protocol. This work is being undertaken collaboratively with the Scottish Government.

Research

In the Framework, the Scottish Government has also committed to work with the Chief Scientist’s Office to develop research proposals and make funding available for additional research on long term health outcomes for people who are accessing gender identity healthcare.

The Reference Group developed the potential areas of research focus for that funding call. The Scottish Government has now awarded a grant to the University of Glasgow to deliver a programme of research into long term health outcomes of people accessing gender identity healthcare.

This programme of research on long term health outcomes for people accessing gender identity healthcare will help contribute to the evidence base on best care of trans people.

Lived Experience Co-ordinator

The Scottish Government is committed to listening to and involving those people who have experience of accessing specialist healthcare services for trans and non-binary people in its policymaking decision process.

It has awarded a grant to Scottish Trans to host a Lived Experience Co-ordinator role.  The Co-ordinator’s role is to engage with trans/non-binary people across Scotland who have lived experience of accessing, or waiting to access, gender identity services, and to represent their voices on the National Gender Identity Healthcare Reference Group.

Surgery

Gender reassignment surgery is a very specialised field of surgery and is primarily  carried out in the UK under a four-nations contract, managed by NHS England.

The Scottish Government has commissioned NHS National Services Scotland to undertake work to scope the feasibility of providing gender reassignment surgery in Scotland.