NHS gender identity services: strategic action framework 2022-2024

Introduction

Over recent years the number of people referred to NHS gender identity clinics (GICs) in Scotland has increased. This increase in demand has contributed to longer waiting times to access GICs. These services were further impacted by the COVID-19 pandemic, as highlighted by service user experience.

People referred to GICs in Scotland, and throughout the UK, have described the distress they have experienced due to long waits to access gender identity healthcare. Increased demand for services is not unique to Scotland - increasing demand and long waiting times to access gender identity services have been seen across the UK.

The National Gender Identity Clinical Network for Scotland's (NGICNS) 2020/2021 annual report suggests that in early 2021 some patients had waited 35 months from referral for their first appointment. It is clear that waiting times for gender identity services must be improved.

The Scottish Government's Programme for Government 2021/2022 acknowledges this, and commits:

"To improve access and delivery over the next three years we will centrally fund Gender Identity Service improvements until late 2024. A plan for transformation of these services will be also developed and published by late 2021, and implemented in 2022‑2024. This work will include the voices of those with lived experience throughout."

This followed the September 2021 commitment in the Scottish Government/Scottish Green Party Shared Policy Programme to improve access to and delivery of services by:

• adopting a human rights based, person centred and multidisciplinary approach to improving trans healthcare provision
• bringing gender identity services within national waiting times standards;
• improving support to those waiting on a gender identity service appointment, including peer support
• examining, in conjunction with the upcoming revised Gender Reassignment Protocol for Scotland, different models of delivering gender identity services, with models to be adopted based on the principles of Realistic Medicine
• ensuring that the newly improved services are accessible to trans, including non-binary, people

It should be noted that this Framework uses "trans" people as an umbrella term for people whose gender identity does not fully correspond with the sex they were assigned at birth. This includes, but is not limited to, trans men, trans women and non-binary people.

In preparing this Framework we have engaged with organisations representing trans people in Scotland, the Scottish Government's Non-Binary Working Group, NHS clinicians delivering gender identity healthcare, NHS Boards and trans people using services. All have been clear that in order to achieve sustainable gender identity healthcare in Scotland more is needed than just increased capacity in current services and reduced waiting times. As the Scottish Public Health Network's 2018 Health Care Needs Assessment of Gender Identity Services recommends, we must consider 'alternative models of care for gender identity services to support the development of multidisciplinary, person-centred approaches which reduce [regional] variation'.

This Strategic Action Framework therefore recognises:

• the distress experienced by people waiting long periods to access services
• the need to address waiting times for services
• the challenges staff delivering these services have faced

However, it also recognises the opportunity to consider how gender identity healthcare is delivered across Scotland, to ensure it meets the needs of people using services, is sustainable and is built on the principles of Realistic Medicine (Annex A).

This Strategic Action Framework includes a series of commitments which will

• support and fund new work to address waiting times for accessing services
• bring gender identity services within national waiting times standards
• support new multidisciplinary models of delivering care
• increase support available for people waiting to access services
• improve collection of data and develop national standards for services
• provide a sustainable platform for gender identity service improvement from 2022

Core to delivery of this work is the establishment of a National Gender Identity Healthcare Reference Group, as well as centralised funding we will provide to support the implementation of the 17 commitments outlined here.