Why the NHS shake-up leaves me baffled

If you live here in England, you’ve probably noticed that the government has decided to give £80 billion of public money to GPs (read: private companies working with GPs) and scrap primary care trusts. David Cameron claims “We are not reorganising the bureaucracy, we are scrapping the bureaucracy.”

One of my biggest problems with the NHS is that the bureaucracy of the health system is incredibly unwieldy. All too often the left hand doesn’t seem to know where the right hand even is, let along what language it speaks. I’m also usually in favour of devolution and the localisation of services. I can’t conceive of how this particular change will be an improvement though.

We currently have 150 primary care trusts (PCTs) and the government is proposing to replace them with between 500 and 600 GP consortia – in order to save money. Surely though the cost of doing this in the first place is going to be ridiculous?

Surely this move will do nothing to remove the NHS bureaucracy: it’ll just shift it from (publicly owned) PCTs to (privately-owned, but publicly funded) consortia. This will mean that thousands upon thousands of people working in admin will lose their jobs…and thousands of new jobs will be created elsewhere. It’s being claimed that individuals who currently work for a PCT could seek work with a consortium but…this is just stupid. Thousands of admin workers will basically be relocated to new bodies, and this is going to cost a huge amount of money: it’ll cost to close down the PCTs, it’ll cost to make redundancies, it’ll cost to advertise for the new jobs and to run interviews and to basically re-train pretty much all of the non-hospital admin staff for the NHS in England. What planet is Andrew Lansley living on?

Additionally, each PCT tends to have its own individual policies, guidelines, patient booklets and outreach/advertising schemes for various services. It costs money to produce all of this: surely it’s going to cost more money for 500+ variations on a theme than 150?

Okay, so suppose the government is right about how best to save money whilst providing better services on the NHS (hah!) and all of the above will be cancelled out by the long-term savings. How easy will it be to hold all of this hundreds of these new consortia to account?

A few days ago I posted up a new policy for trans name changes we’ve sorted out with the local PCT. Within three years that change is probably going to be a bit pointless, and I won’t be surprised if things regress within the Coventry area. There’s a lot of very decent GPs out there, but others aren’t: a bunch of them are bigoted arseholes who will deny treatment to LGBTQ people at the drop of a hat. If GPs are going to be responsible for deciding who gets funding and hospital referrals, trans people who seek medical treatment could be in a lot of trouble. I’m not just talking about trans people who want to transition medically: I’m talking about any trans person who wants any kind of treatment, since the whole “we don’t serve your kind here” attitude is still highly prevalent. Of course, under current rules the NHS as a whole in the UK has to provide treatment (including aspects of medical transition) for all trans people, but that hasn’t stopped certain areas (such as, say, Wales)  from refusing to provide treatment.

Right now, if we’re lucky enough to have the PCT on our side (as we finally do in Coventry…tentatively, at least) then we can have them pressure the GP to sort it out. This system is far from perfect, since many PCTs simply don’t want to listen (see: Oxfordshire) but I imagine it’s going to be far harder to bring about positive social change in five or six local consortia than it is with a single PCT.

Moreover, one of the biggest problems with the NHS is communication. One of my friends was given a referral to Charing Cross gender clinic by a psychiatrist after years of waiting, but then had to move house and ended up in a different PCT. The PCT refused to acknowledge the referral and made her start again from scratch, effectively postponing her access to hormones by two years. I can’t imagine that this kind of thing will be less common with the NHS split up into more bodies.

So what can we do? Well, I suspect there’s very little we can do, but now is the time to act. We should be fighting on every front: writing to politicians, talking to the media, participating in protests and taking part in any consultation event we can find out about, and at every stage we should be asking awkward questions about how these changes will impact minority groups such as trans people (‘cos I’m pretty certain it will disproportionately screw over others, such as people living in poorer areas).

Finally, a couple of thoughts from The Guardian:

GPs are doctors, not accountants

“Imagine this bedpan is full of money…”

What’s in a name? (the importance of free deed polls)

This post is part one of my response to misha the Duck of Doom, who commented on this post.

In the United Kingdom we’re pretty lucky: we’re able to change our names for free, as long as it’s not being done to commit fraud. I believe this is not merely a privilege that we’re fortunate enough to have though; it’s an important right.

This applies to anyone who wants to change their name, but is particularly important for many trans people because of the sheer importance a name can have. A name denotes identity, is usually tied to a particular gender role and accompanying gender expectations, and tends to carry a fair amount of personal history with it. No wonder then that a name change can be a key moment for those who transition. A free name change means that everyone has equal access to this right, regardless of age and financial status.

There are several means of changing your name under UK law, but the most simple is to simply announce to the world that you’ve changed your name. You don’t actually need to do anything other than this. It might help, however, to sign a piece of paper as evidence of your doing so. Maybe you could also get someone else to witness it, perhaps a solicitor. This tends to help with getting organisations such as banks, educational institutions and the Inland Revenue to recognise your name change: hence the existence of deed polls and statutory declarations.

Solicitors – and various websites – can charge a pretty penny for preparing your statutory declaration or deed poll. The amount they might ask you for varies, although as a general rule I note that the more fancy-looking the document is, the more it costs. What baffles me is that these individuals and organisations are getting away with this when you can easily make your own document for free. There are some organisations trying to make money from this through advertising, whilst other pages make them available simply out of a desire to help others. My own (free) deed poll was emailed to me by a particularly helpful individual working for the university I was applying for a few years back. I’ve used it to change my details with pretty much every organisation which will ever need to use my name, including the NHS, a Student Union and the Job Centre.

Of course, not everyone who charges for evidence of a name change charges a lot. misha the Duck of Doom suggests:

“Go to a solicitor who swears oaths.
They have the uk courts authority to swear in
a Stat Dec name change.
When doing this, they are recognised as an agent of the court.

It costs £5 IIRC
plus £2 per stamped copy. You need about 15 copies for tax, council, education certificates, utility companies
so they change your name & sex.”

This looks relatively reasonable and not too pricey. I have three major problems with this option though:

1) “Affordable” can be two very different things to different people. The above suggestion actually costs £35 (£5, plus £2 multiplied by 15 is £35). That’s a fair amount of money if you’re a teenager, a student, on minimum wage, unemployed or permanently on incapacity benefit. Of course, many solicitors would provide you with a number of copies for no additional charge, and I’d suggest you could save a lot of that money by creating photocopies and using a stamped, self-addressed envelope when you do need to provide the original, but you’re still spending money. £5 can go a long way towards other things when you’re a teenager, and has to go a long way if you’re on benefits or minimum wage. I can make several days worth of meals on £5. Sure, even the poorest can fork out for this, but would prefer spend money on better things if it’s possible to do so.

2) Trans people are more likely than the general population to have anxiety issues or problems interacting with other people. Transition has given nerves of steel to many of us (and huge amounts of confidence when things are going well), but this doesn’t apply to all. Dealing with this kind of thing via a solicitor or courts could waste a lot of spoons. In this instance, self-created evidence of a name change is clearly preferable.

3) There’s an issue of principle! Regardless of money and spoons, why should we have to spend money on evidence of a name change when, legally speaking, we don’t have to?

This is why it particularly gets my back up when a Gender Clinic decides that it’s above free deed polls, and demands that they’re witnessed by a solicitor. It’s also bizarre that they accepted a free deed poll from a trans woman and then decided to later reject the very same document. I’m glad that Charing Cross no longer seem to be doing this – and in fact have apparently written a new policy to ensure that it doesn’t happen again – but it’s quite telling that they don’t seem to have made this new policy public at all.

Charing Cross gender identity clinic outlaws DIY deed polls

A friend of mine who changed her name a few months ago received a phone call from Charing Cross yesterday to inform her that her deed poll (which had been seen and approved of in her presence by both receptionists and medical staff working at the clinic) was “inappropriate”. As such, they will revert to using her male name in correspondence.

She says that: I have found out that my deed poll is ‘inappropriate’ because it has not been signed by, and I quote, the “Government Deed Poll Issuing Authority”.

They didn’t like her deed poll because she printed it herself, using a free template (similar to this one). A lot of young trans people do this because we often cannot afford to “buy” a deed poll. Others on low income or benefits are likely to use these deed polls too.

These documents are widely accepted. My friend whose deed poll was not good enough for Charing Cross has successfully changed the name on her driving license with hers, for example.

Apparently this wasn’t a one-off case. My friend pointed out that she knew others with similar deed polls which had been accepted by the gender clinic. She was informed: “then they are most certainly in our pile of deed polls to return and names to revert to the original name on the deed poll.”

I honestly don’t know what the hell they think they’re playing at. My own DIY deed poll was used to change my name with a university, the NHS, a couple of banks and on my passport. I fail to understand what makes Charing Cross gender clinic so special that they get to not-accept someone’s (perfectly legal) change of name, just because it hasn’t been witnessed by a solicitor.

This policy seems to demonstrate once again that Charing Cross do not have their patients’ best interests at heart. Rejecting deed polls like this will be a blow to many trans people who already have low confidence or self-esteem, and could be dangerous for those who have already changed their name and are living “stealth” if the clinic sends them correspondence addressed to their old name.

Edit: Following complaints, this policy was reversed.