Non–binary equality action plan 2023-2028: progress report 2024

Healthcare

Gender Identity Healthcare

This section is set out differently to the rest of the Report. The commitments are being taken forward as part of ongoing work and we are therefore not taking forward specific actions. These commitments are being progressed substantively as part of our December 2021 Strategic Action Framework for NHS gender identity service improvement 2022-2024. The National Gender Identity Healthcare Reference Group advises on this work. The aims and ongoing actions as part of the framework are consistent with the purpose and aims of this Non-Binary Equality Action Plan and the needs of non-binary people continue to be considered across this work. All commissions made as part of the 2021 Framework’s work have been inclusive of non-binary identities.

Commitment 2

What we said we would do

Transform the way transition-related healthcare is delivered in Scotland and designing services collaboratively with trans and non-binary people.

What we have done so far

The majority of the commitments (15 out of 17) of the Strategic Action Framework for NHS Gender Identity Service Improvement 2022-2024 have been delivered. This work has included collaboration with trans and non-binary people through the Lived Experience Co-ordinator Role and through third sector membership of the Advisory Reference Group.

Next steps

We will start to take forward outstanding action on clinical provision to under 18s in Scotland. This includes substantive work to replace the current offering, via Sandyford, with a new model of holistic care based within a paediatric clinical setting. Action in this space is now underpinned by the 5 July Chief Medical Officer report to Scottish Parliament in response to the Cass Review.

Timescale

Medium-term

Status

In progress

Commitment 3

What we said we would do

Develop national standards for gender identity services that are accountable and enforceable.

What we have done so far

Healthcare Improvement Scotland have now produced national standards for NHS Scotland gender identity healthcare for adults and young people, published on 3 September 2024. The overall aim of these standards is to support the best outcomes and experiences for people accessing gender identity healthcare in NHS Scotland.

Timescale

Short-term

Status

Complete

Commitment 4

What we said we would do

Engage with Health Boards to consider sustainable funding for transition-related healthcare beyond the current commitment to the end of 2024.

What we have done so far

Funding allocations have been issued for the 2024/25 financial year to all health boards with a gender identity clinic to support improvements to service delivery and for those waiting.

Next steps

We will complete an independent evaluation of the impact of funding, learning and challenges, to inform sustainable longer term funding arrangements to Health Boards.

Timescale

Medium-term

Status

In progress

Commitment 5

What we said we would do

Ensure that trans and non-binary people have equal access to transition-related healthcare.

What we have done so far

As part of fulfilling commitments made in the 2021 Framework, key recent publications to help improve local service delivery includes

• Healthcare Improvement Scotland’s national standards for gender identity healthcare service;
• NHS Education for Scotland’s Transgender Care Knowledge and Skills Framework for NHS staff; and
• An updated Gender Identity Healthcare Protocol for adult services in Scotland.

Next steps

NHS Education for Scotland will continue to explore further training opportunities for staff.

Timescale

Short-term

Status

Complete

Commitment 6

What we said we would do

Transition-related healthcare to be in accordance with current NHS Scotland referral to treatment standards.

What we have done so far

Public Health Scotland was commissioned by the Scottish Government to develop a quarterly, aggregate data collection for NHS Gender Identity Clinic waiting times, focussing on number of new referrals and length of wait from initial referral to first outpatient consultation with a specialist. An annual return for its first year of data collection was published on 5 November 2024.

Next steps

Public Health Scotland will continue to collect, collate and publish waiting times and patient cohort data, to help inform future service improvement and delivery.

Timescale

Medium-term

Status

Complete

Commitment 12

What we said we would do

Consider treatment pathways so that access to primary care support and referral is equitable for all patients.

What we have done so far

NHS Education for Scotland developed a Transgender Care Knowledge and Skills Framework for all NHS staff, published on 3 September 2024. Healthcare Improvement Scotland have now produced national standards for NHS Scotland gender identity healthcare for adults and young people, published on 3 September 2024. The overall aim of these standards is to support the best outcomes and experiences for people accessing gender identity healthcare in NHS Scotland.

Next steps

NHS Education for Scotland will continue to explore further training opportunities for staff.

Timescale

Short-term

Status

Complete

Mental Health and Primary Care

Commitment 7

Ensure person-centred mental health services and support is available for trans and non-binary people.

Commitment 8

Fund mandatory training for mental health providers on trans and non-binary healthcare needs.

Commitment 9

Conduct robust Equality Impact Assessments for mental health policies and actions, ensuring that they address the specific needs of trans and non-binary people.

Commitment 11

Fund mandatory training for primary care providers on trans and non-binary healthcare needs.

Action 3.1

What we said we would do

We will work with NHS Boards, councils and integration authorities to strengthen accountability for public bodies delivering mental health services in order to support how mental health inequalities are addressed at a local service level, identifying the levers available to effect change in mental health service delivery.

What we have done so far

We asked NHS Boards to report on the actions that they are taking to tackle inequalities to accessing mental health services in their 2024/25 Delivery Plans. We have developed and piloted a local self-assessment for the mental health core standards with three health boards areas. The self-assessment has a focus on equalities and governance, which will support increased accountability.

Next steps

We will ask NHS Boards to list their mental health services priorities under the Public Sector Equality Duty, and to reference impact assessments undertaken in their 2025/26 Board Delivery Plans.

Timescale

Medium-term

Status

In progress

Action 3.2

What we said we would do

We recently published quality standards for mental health services. These standards will initially apply to adult secondary mental health services, and we will work with mental health services more widely to explore how the Core Mental Health Standards could apply across a wider range of services in the future. Building on the work of the CAMHS service specification, a national service specification for Psychological Therapies and Interventions has also been published and a specification for Eating Disorder services is currently in development. The standards have an equalities, human rights and person-centred approach at their centre. We expect them, alongside strengthened local accountability, to support how health inequalities are addressed at a local level and effect change to mental health service delivery.

What we have done so far

We published core standards to support general adult secondary mental health services, which have a focus on supporting equality groups. Working with Healthcare Improvement Scotland, we have piloted implementation and measurement of the standards. Healthcare Improvement Scotland are supporting implementation of the core standards and have launched a self-assessment in all board areas in Autumn 2024.

Next steps

Healthcare Improvement Scotland will use the findings from the self-assessment to engage individually with boards to provide light support for organisational readiness and completion of the local assessment. We expect returns from boards in December 2024. These standards aim to improve the quality and safety of mental health services and the delivery of psychological therapies and interventions for all groups, including for non-binary and trans people.

Timescale

Medium-term

Status

In progress

Action 3.3

What we said we would do

We will continue to develop a series of impact assessments, including an Equality Impact Assessment (EQIA), for the proposed actions in the new Mental Health and Wellbeing Workforce Action Plan. This will ensure that they address both the challenges facing the mental health and wellbeing workforce as well as ensuring that the workforce are supporting the needs of trans and non-binary people.

What we have done so far

We published an Equality Impact Assessment (EQIA) alongside the Mental Health and Wellbeing Workforce Action Plan in November 2023. This helped us identify and inform what we need to do to address inequalities in the mental health and wellbeing workforce. Actions are designed to improve the diversity of the workforce, encourage, and promote inclusive workplace practices to support recruitment, retention, and wellbeing.

Next steps

We will report on actions within our Mental Health and Wellbeing Workforce Action Plan, including those that address workforce training needs. These actions will be reported on through established governance routes such as the Mental Health and Leadership Board. We will continue to listen to feedback from people with lived experience as well as the workforce to ensure that the needs of non-binary and trans people are met.

Timescale

Medium-term

Status

Complete

Action 3.4

What we said we would do

Improve Equality, Diversity and Inclusion training for the Mental Health and Wellbeing workforce to incorporate up to date messaging within existing training and relevant information on equalities, including non-binary, transgender and LGBTQI+ equality.

What we have done so far

The NHS Education for Scotland (NES) Equality, Diversity and Human Rights Team continues to support NES on embedding equality, diversity and human rights into all its work providing relevant education and training resources for staff. In 2023 NES launched a new e-learning module, ‘Introduction to equality, diversity and human rights,’ designed to meet the essential learning needs of the health and social care workforce. More recently, it has promoted the Transgender Care and Knowledge Skills Framework which sets out the knowledge and skills required by healthcare staff providing care for non-binary and trans people. We have promoted the updated e-learning module and framework to Health Boards through our regular engagement with them and using a circular newsletter. We have also ensured that updated resources have been included in work underway to create resources for Primary and Unscheduled Care in Mental Health.

Next steps

We will continue to promote updated materials, resources and training to employers and the workforce, as they become available, to ensure practitioners are more aware of and can better meet the needs of non-binary people and the wider trans community. We will monitor and report actions as part of our agreed governance processes. We will continue work to promote this essential learning and understand any gaps.

Timescale

Medium-term

Status

In progress

Action 3.5

What we said we would do

We will look closely at developing capability and capacity in the completion of Equality Impact Assessments (EQIAs) as part of the programme of equalities and human rights work being taken forward in the Scottish Government’s Mainstreaming Strategy.

What we have done so far

As part of our Equality Impact Assessment Improvement programme, we have been developing and delivering comprehensive training sessions and materials for staff involved in policy development and implementation, focusing on how to conduct effective EQIAs. We have been creating and updating guidelines and best practices for conducting EQIAs that explicitly mention non-binary people as a group of interest. We regularly review and update EQIA practices to ensure they remain current and effective in addressing people’s needs. We continue to engage with colleagues across different government departments to share knowledge and ensure consistency in EQIA practices, including in relation to non-binary issues. We disseminate case studies found in this research paper on Using intersectionality to understand structural inequality in Scotland, that demonstrate how to effectively incorporate intersectional considerations into EQIAs. These ensure that equality and inclusion are fully embedded in all aspects of policy making.

Next steps

We will continue to develop a supporting toolkit to support Scottish Government and the wider public sector to achieve mainstreaming, as part of our Mainstreaming Strategy. This toolkit will aim to define the practical steps that an organisation can take to mainstream equality and human rights, providing supporting guidance, best practice examples and information whenever possible. We expect to have completed the toolkit by the end of 2025

Timescale

Short-term

Status

Complete

Action 3.6

What we said we would do

We will put in place structures within the Mental Health Directorate to ensure we meet Commitment 9 going forward as part of the programme of work being taken forward by the Mental Health Equality Champion Network.

What we have done so far

The Equality Champion Network (the Network) has put in place structures to ensure robust Equality Impact Assessments (EQIAs) for mental health policies that address the specific needs of non-binary and trans people. We continue to run EQIA training workshops for the Scottish Government Mental Health Directorate and offer discussion of impact assessment related issues at Network meetings. The Network has also widely shared our Mental Health Equality Evidence Report across the Directorate and NHS Boards. The report contains evidence on LGBTQI+ mental health, including the experiences and mental health inequalities faced by non-binary and trans people. This evidence base provides a strong foundation for robust EQIAs. Within the Directorate, we have established an EQIA tracker to collate and record EQIAs undertaken, which allows senior leadership and the Network to review the EQIAs as well as share learning. Finally, EQIA monitoring has been built into the programme reporting for the Mental Health and Wellbeing Strategy.

Next steps

We will continue to build in EQIA reporting into the Governance of the Mental Health and Wellbeing Strategy and timing of the Delivery Plan to be reviewed by the newly established Mental Health and Wellbeing Leadership Board in 2025 as part of the governance structure. The Board will be jointly chaired by the Minister for Social Care, Mental Wellbeing and Sport and the COSLA Spokesperson for Health and Social Care. It will support and oversee the delivery of the Mental Health and Wellbeing Strategy and related actions. This includes ensuring the joint Chairs have access to information to inform decisions relating to the delivery of the Strategy and providing constructive support, scrutiny of progress and challenge as appropriate. The Equality and Human Rights Forum and Diverse Experiences Advisory Panel will have direct access to the Board as key advisory groups, ensuring perspectives of non-binary and trans groups are directly heard and advising them to properly fulfil their role.

Timescale

Short-term

Status

In progress

Action 3.7

What we said we would do

We have commissioned NHS Education Scotland to develop a transgender healthcare knowledge and skills framework for NHS Scotland staff, including those working in primary care and mental health services.

What we have done so far NHS Education for Scotland developed a Transgender Care Knowledge and Skills Framework for all NHS staff, published on 3 September 2024. This Framework was promoted in the October health board circular.

Timescale

Medium-term

Status

Complete

Fertility Preservation

Commitment 13

Ensure that trans and non-binary people have equal access to fertility preservation treatments, including access to the information needed to make informed choices.

Commitment 14

Work with the UK Government to provide clarity to trans and non-binary people about their legal rights regarding fertility preservation, access to assisted reproduction services, and status when creating families, and work to prevent discrimination in realising these rights.

Commitment 15

Fund training for fertility preservation providers on trans and non-binary healthcare needs.

Action 4.1

What we said we would do

We will develop patient information leaflets for fertility preservation by 2024.

What we have done so far

We have drafted leaflets for non-binary and trans people on egg and sperm fertility preservation.

Next steps

We will update the fertility preservation leaflets once we have finalised the fertility preservation guidance. This has taken longer than expected due to additional work, including stakeholder engagement. We expect to publish the leaflets in Spring 2025.

Timescale

Short-term

Status

In progress

Action 4.2

What we said we would do

We will finalise and implement the fertility preservation guidance for all groups of patients that may require access by 2024.

What we have done so far

We have completed the stakeholder engagement on the draft national fertility preservation guidance, which included gathering feedback from non-binary and trans stakeholders.

Next steps

The fertility preservation group will discuss further the issues that have been raised during the stakeholder engagement on the draft national fertility preservation guidance. Following this, the guidance will need ratification by the Fertility Steering Group, National Fertility Group and Ministerial Approval. We expect to publish the guidance by Spring 2025.

Timescale

Short-term

Status

In progress

Action 4.3

What we said we would do

NHS Inform will be updated with information on fertility treatments (assisted reproduction services) that are available for trans and non-binary people in Scotland by 2024.

What we have done so far

NHS Inform contained no information on fertility treatment. We have created the information with NHS Inform and it is now on the NHS Inform website. It includes information for non-binary and trans people.

Next steps

We will continue to work on additional information for donor insemination and IVF and will look to have a page specifically on fertility preservation during 2025.

Timescale

Short-term

Status

Complete

Action 4.4

What we said we would do

Fertility Scotland National Network will arrange training webinars once the fertility preservation guidance has been published for early 2024.

Next steps

We will deliver the webinars in 2025 after the guidance has been published, expected during Spring 2025. The timescale of this action has been adjusted from short-term to medium-term due to additional work required on the national guidance for fertility preservation, including stakeholder engagement and issues raised during this engagement.

Timescale

Medium-term

Status

Not started