Non-Binary Working Group - gender identity clinics sub-group minutes: 2 September 2021

Attendees and apologies

Group members

• Dr Ben Vincent, (chair)
• Mhairi Crawford, LGBT Youth Scotland
• Paul Daly, LGBT Youth Scotland
• Oceana Maund, Scottish Trans
• Vic Valentine, Scottish Trans
• Megan Snedden, Stonewall Scotland
• Katrina Mitchell, LGBT Health and Wellbeing
• Dr Carolynn Gray, University of the West of Scotland
• non-binary community members

Secretariat

• Emily Green, Equality and Inclusion Division, Scottish Government
• Laurie Donaldson, Equality and Inclusion Division , Scottish Government

Attendees

• Kirstin Leath, Gender Identity and Healthcare Access, Scottish Government
• Ewan Walker, Gender Identity and Healthcare Access, Scottish Government

Items and actions

Note of key points and actions

Key discussion points

The group discussed:

SG update

• SG wrote to the National Gender Identity Clinical Network for Scotland (NGICNS) requesting they review and update the Gender Reassignment Protocol (GRP)
• the draft agreement between SG and the Scottish Green Party, including the shared policy commitment to improve Gender Identity Clinic (GIC) services
• the Programme for Government commitment to publish a national plan for improving services by the end of 2021
• the group would be sighted on, and included in, ongoing work to improve GICs

Gender identity clinics and the gender reassignment protocol (GRP)

• framing recommendations around the relationship between the GRP, what GICs are delivering, and the role of health boards
• GICs and health boards not always delivering everything in the GRP and the variation between health boards
• the importance of building buy-in from health boards to ensure services are delivered
• the elements of gender - or transition-related care - that should be the focus for progress and recommendations and the need to draw attention to the current system

Waiting and clinical pathways

• the need to consider waiting times for GICs beyond the understanding that current waiting lists are long and damaging
• within GICs, particular pathways becoming expected or assumed for non-binary people seeking treatment
• complexity around an individual’s gender identity leading to delays in treatment
• what is not covered by GRP terms and how the updated GRP should take account of recent medical evidence regarding testosterone and hysterectomies
• post-discharge care and the significant challenges in accessing this
• expecting that reviewing GRP would be an ongoing process of regular reviews
• the importance of other protocols also taking an inclusive approach

Research

• the need to fund further research into trans healthcare, to strengthen evidence base for gender reassignment treatment and care provided by NHS Scotland

Care beyond GICs

• the important role primary care plays and the need to improve training for staff
• drop-in trans healthcare services

Equity of access and parity of care

• introducing binding national standards and nationwide funding
• creating Local Gender Teams (LGTs)
• the lack of consistency within adult GIC provision in Scotland
• barriers to care on the basis of BMI and barriers faced by neurodivergent people
• creating a recommendation around equity of access to services
• the need for respect and understanding specific issues for non-binary people
• issues around decisions being hard-wired to gender markers (within CHI identifiers), and the need for a more patient-centred approach
• barriers faced by young people when accessing care
• sexist attitudes within healthcare settings

Action: Gender Identity and Healthcare Access team to circulate relevant links, and remain in contact with the Working Group about work to improve GICs.

LGBTI Equality Team

September 2021