Non-binary equality action plan

Appendix 1 – Consider Further Recommendations

In July 2022, the Scottish Government responded to the Working Group on Non-Binary Equality’s report and recommendations. In that response, we committed to considering eight of the recommendations further where the recommendation and its impact was not fully understood at the time or its feasibility could not be established before publication. These recommendations were further evaluated over the following months and decisions have been made to either accept, partially accept, or decline these recommendations.

For each recommendation, we have set out the Scottish Government’s decision followed by a brief rationale. Our decisions are categorised into three types:

Accept

The recommendation is within our devolved competence, consistent with the Scottish Government’s policy objectives and otherwise achievable.

Partially Accept

The recommendation is agreed in principle but not to the full extent suggested by the Group.

Decline

The recommendation is not consistent with the Scottish Government’s overall policy objectives; or not achievable.

A summary of our decisions is below:

Actions based on these recommendations have been consolidated and included in the wider Non-Binary Equality Action Plan.

Decisions

Recommendation 4

Fund transition-related healthcare sustainably, in the long term, and beyond the existing Gender Identity Clinics.

Decision:

Partially Accept

Scottish Government Response

Scottish Government has provided funding directly to NHS health boards with a gender identity clinic to support work to reduce waiting times and improve services.

Following this year’s Scottish Budget, a total of £2 million has been allocated for NHS gender identity service improvement this financial year.

Scottish Government is unable to comment on the content of future spending reviews. Further consultation with health boards will be required to embed a sustainable funding model for gender identity healthcare across NHS Scotland, beyond 2024.

Recommendation 12

Desegregate treatment pathways so that interventions that are available via a GP referral for cisgender patients are similarly available via a GP referral for trans patients.

Decision:

Partially Accept

Scottish Government Response

GPs will make different referrals for different patients, based on clinical need.

We are expanding the wider multi-disciplinary workforce in primary care which means referrals can now be made by clinicians other than GPs. These referrals may be to other areas of primary care, such as musculoskeletal physiotherapy, or to parts of the secondary care sector, depending on local arrangements.

Work is ongoing with relevant stakeholders with lived experience to ensure treatment pathways for trans patients are equitable. Scottish Government has also commissioned Healthcare Improvement Scotland to produce national standards for accessing and delivery of gender identity healthcare. The role of primary care was part of the draft scope for standards development publicly consulted on early this year.

Recommendation 17

Develop a plan to use the data from the trans status question used in Scottish Government core surveys and the Scottish Census to produce evidence on non-binary people in Scotland that can better inform policymaking.

Decision:

Accept

Scottish Government Response

We accept that it is important to have data on the non-binary population so that this can be used to drive change and improvements for the benefit of society, including non-binary individuals.

The Chief Statistician’s guidance recommends that data on non-binary people is collected using a question on trans status that invites individuals to write in how they identify in their own words.

Officials from Scottish Government and National Records of Scotland will work together to analyse non-binary response data collected in our core surveys and the Census, with the aim of building a robust evidence base that can be used to inform decision-making and support policy development.

The level of detail published will be dependent on the number of responses provided to this voluntary question to ensure that data published is not disclosive and that results are robust. The scope of this work will become clear when the data is available.

Recommendation 21

Review IT systems, particularly in healthcare settings, to identify and remove barriers to non-binary people accessing services.

Decision:

Partially Accept

Scottish Government Response

We accept the principle of identifying and removing barriers to non-binary people accessing services. Our Strategy for Digital, ‘A changing nation: how Scotland will thrive in a digital world’ clearly articulates a commitment to creating an ethical digital nation where public services are designed through the lens of inclusion and the needs of users. Within healthcare, our recently published Digital Health and Care Strategy, and Data Strategy for Health and Care, make a specific commitment to taking a human-rights based approach and confirm our aim generally to support people in gaining increased access to the information held about them, and the ability to update this where appropriate. We are working with our delivery partners in support of the Data Strategy to develop its priorities in the coming year and will actively explore how this can be realised from the perspective of non-binary requirements.

We also recognise the scale and complexity of the systems that support Scotland’s health and social care services, and the need to fully understand their interaction. The scale and complexity of a comprehensive review across the thousands of existing public sector IT systems would be prohibitive. However, we have already committed to a review of the CHI number as the fundamental coding in the health and care system, to explore how this could be made non-binary, enabling trans people to be recognised in medical records. This more focused work is likely to identify how healthcare IT systems utilise CHI and, therefore, how and whether they are gendered, providing a significant degree of insight into the requirements of Recommendation 21.

We will also explore how the overall Digital Scotland Service Standard can be updated to include a specific commitment that the design and development of future IT systems and services considers how barriers to non-binary people are identified and removed.

Recommendation 22

Include a non-binary response option in the recommended sex question in the next update to the Chief Statistician’s Sex and Gender in Data Guidance.

Decision:

Decline

Scottish Government Response

The recommended question on trans status in the Chief Statistician’s Sex and Gender in Data Guidance allows non-binary respondents to record they are non-binary.

Although we accept that the Guidance will need to undergo a process of review and refresh, updating this is not an immediate priority. Time is needed to allow the Guidance to bed in before we can consider the effectiveness of the trans status question at collecting data on non-binary people.

The existing Guidance will be reviewed on an ongoing basis to ensure that it remains fit for purpose.

Recommendation 23

Review the Chief Statistician’s Sex and Gender in Data Guidance regularly and ensure better inclusion of trans and non-binary people in the review process.

Decision:

Accept

Scottish Government Response

The Chief Statistician adopted a robust and transparent approach to developing guidance for public bodies to use to inform how they gather data, including on the non-binary population.

This involved meeting with external stakeholders, equality groups and campaigners, members of the public and seeking the views of his working group members. The Chief Statistician considered and weighed up these various views when coming to a decision on the recommended questions in the guidance.

The guidance will be reviewed on an ongoing basis to ensure that it remains fit for purpose.

Time is needed to allow the guidance to bed in before we can consider the impact that the trans status question has had on the collection of data on non-binary people.

We are keen to ensure that we can identify and engage with a breadth of stakeholders who will have an interest in this work, including trans and non-binary people, to seek their views and experiences.

Recommendation 26

Review the use of, and take action to remove, unnecessary gender markers from identity documents, including by working with the UK Government to take action where ID is administered on a UK-wide basis

Decision:

Accept

Scottish Government Response

Action to review is already underway. The National Entitlement Card, which is sponsored by Scottish Government and issued by Local Authorities, does not display visible gender markers.

The Scottish Government is developing a reusable Digital Identity service which would reduce the need for repeated use of traditional identity documentation and reduce the need for organisations to verify and store unnecessary information about individuals.

Recommendation 30

Include non-binary people in Scottish Government strategies, policy frameworks, and resource allocation designed to eradicate gender-based violence

Decision:

Partially Accept

Scottish Government Response

The recommendation will be a long-term commitment as it requires further research and engagement with a range of stakeholders from the Violence against Women and Girls (VAWG) sector and non-binary people.

The Scottish Government welcomes that the working group supports the Scottish Government’s focus on women and girls within our policies which work to eradicate gender-based violence, which evidence shows is most commonly perpetrated by men and experienced by women.

We will continue to work across the VAWG and LGBTQI+ sectors to ensure that the support needs of non-binary people experiencing gender-based violence are fully understood.