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…”

See this man?

This is Peter Robert Forster, the Lord Bishop of Chester.

He wants to deny my genderqueer friends and trans children protection from discrimination. (see Clause 7)

Some of my friends are regularly abused by their parents, beaten up in school, or regularly receive abuse at university. They have been shouted at, taunted and raped. They have been harassed on the streets, in the workplace (if they can get a job) and by the police.

Fuck you, sir. I bet Jesus is really fucking pleased with you.

Take your fancy pen and fucking well shove it up your arse.

Brief update on the Equality Bill (and PFC)

I’m not in the mood for a full update on this, but since a previous entry contains heavy criticism of Press For Change, I feel it’s worth a brief summary of what happened next.

Following heavy criticism of the draft briefing by PFC, a new briefing was issued that better addressed the problems faced by trans people with non-binary identities. At a meeting with the Equality and Human Rights Commission, every trans group present (bar a:gender) argued strongly for a fully inclusive equality bill.

In June, an amendment was proposed by Lynne Featherstone MP (Lib Dem), Dr Evan Harris MP (Lib Dem) and Tim Boswell MP (Cons) that would extend protections in the Equality Bill to non-binary trans people. Unfortunately this was then struck down byVera Baird (Lab), the Solicitor-General. A report of the debate can be found here, under “Clause 4”.

Since then, I believe various trans organisations – as well as independent activists – have continued quietly lobbying for full inclusion. Press For Change have indicated that they are now fully behind this.

Update: a:gender have since supported a fully trans-inclusive Equality Bill.

Press For Change does a HRC

Update: After this post was written, Press For Change began to campaign openly for a fully trans-inclusive Equality Bill. Fair play to them. I originally wrote the title of this post in anger, but now feel that PFC have demonstrated that – unlike groups such as Stonewall and the HRC – they are prepared to listen to others and revise their position.

Contrasting somewhat with the approach of the Scottish Transgender Alliance and Gender Spectrum (see previous post) is that taken by Press For Change, the UK’s most high-profile trans rights group. As an “insider” group, they’re in the privileged position of being able to prepare a briefing for the Equality Bill Select Committee.

That doesn’t guarantee that the briefing’s proposals will be taken forward by the government or even individual politicans who wish to take on the cause, but it’s one of the most influential things any part of the trans community can contribute at the moment. Unfortunately, there are a couple of serious issues with this document.

1) Press For Change speaks on the behalf of “ALL trans people”, but has not consulted widely on this issue. The text of the briefing implies that PFC has attempted to consult with “several organisations who work the transgender community” (sic) rather than the community on the whole. This is understandable given the rapid turnaround that has to be undertaken by individuals who are essentially volunteers in order to prepare this kind of document at very short notice. However, it was perfectly possible for the Scottish Transgender Alliance and Gender Spectrum to create a basic survey at short notice, which is being passed around by word of mouth. By their own admission, PFC have access to 1800 people through their mailing list: why didn’t they even ask for opinions on this vital issue? Given the circumstances, I may have considered this forgiveable, if it wasn’t for this:

2) Press For Change seem intent on pushing for the rights of transsexed people at the expense of all other trans people. This accusation is increasingly levelled at PFC by members of the trans community, and this document appears to confirm that. PFC describe themselves as “the leadership of Britain’s campaign for the social inclusion and non-discrimination of transsexual people”, and describe “trans” as shorthand for “transsexual”, making a mockery of their “ALL trans people” slogan. When criticising the government’s choice to protect individuals on the grounds of “gender reassignment” and suggest that a term such as “gender identity” be used instead (a position widely agreed upon by many trans organisations and individual activists) they then clarify this by stating:

“we feel that to ensure clarity of purpose the bill should refer to gender identity as the defining characteristic including transsexual and transgender people, with by way of the explanatory notes a clarification to refer to people intending to live, or living permanently, in their preferred gender role which is opposite to that of their natal sex”

This would mean that those trans people who are unable to transition or are discriminated against because of a non-binary identity would continue to recieve no recognition or protection: exactly the problem that providing protection on the grounds of “gender identity” is meant to overcome!

This is horribly reminiscent of the approach of the Human Rights Campaign (HRC) to the Employment Non-Discrimination Act (ENDA) in the USA. That supposed LGBT rights group received heavy criticism from those trans people it was meant to be representing after supporting a trans-exclusive version of ENDA.

Important Equality Bill survey

The Scottish Transgender Alliance and Gender Spectrum – who are attending a meeting with representatives of the Equality and Human Rights Commission in a few days time – have launched a survey to gather ordinary trans people’s views on the Equality Bill in order to properly represent our interests. Their stated intent is to gain the imput of as wide a range of individuals as possible, from different backgrounds and with different identities.

If you’re a UK-based trans person, please take the time to fill this in, and pass it on to others if you’re able to.

The deadline is Saturday 23rd. The survey has only been live a week or so, but there isn’t much time left for Parliament to make significant amendments.

*****
Press Release from the Scottish Transgender Alliance & Gender Spectrum UK
Tuesday 12th May 2009
*****

The Scottish Transgender Alliance (www.scottishtrans.org) & Gender Spectrum UK (www.gsuk.org ) wish to announce the launch of an on-line survey for the Gender Variant community with regards to issues that have come to light through the publication of the Equality Bill.

https://www.surveymonkey.com/s.aspx?…oYOUAxsg_3d_3d

or

http://tinyurl.com/plz9bc

This is an important Bill and introduces some positive lines of protection for everyone.

Whilst the Bill itself covers several different strands, we wish to specifically concern ourselves with the issues that affect the Gender Variant community.

The survey will be anonymous and should take around 10 minutes to complete. The results will be published on the websites of both the Scottish Transgender Alliance and Gender Spectrum UK.

The closing date for this survey is Saturday 23rd May.

We would truly appreciate YOUR views on the priority issues within the Equality Bill.

ID card proposals pose serious risk to trans people

It’s now too late to respond to the consultation, but please sign the petition (http://petitions.number10.gov.uk/TransID) and tell everyone you know about this!

Gender Spectrum have worked extensively on ID Cards and their potential effects upon trans people throughout all stages of transition and our subsequent lives. I would ask readers to consider supporting them in their efforts to ensure fair treatment for all trans people.

Best wishes,

Angela Clayton
Vice President, Press for Change

——– Original Message ——–
Subject: Fw: [Press Release] [UK] National ID Card Petition
Date: Fri, 6 Feb 2009 15:45:45 -0000
From: Robyn Peel
To: Angela Clayton

***** Press Release from Gender Spectrum UK *****
Friday 6th February 2009

Gender Spectrum UK ( http://www.gsuk.org or http://pollik.org.uk/forum/index.php ) wish to announce the launch of an on-line petition aimed at ensuring the safety of members of the community who do present themselves in a manner which is not the same as the gender to which they were assigned at birth.

The petition is asking the Government to address the current issues surrounding the draft guidelines for the National ID Card.

These guidelines require people to have their gender (determined as either Male or Female as reflected by their Birth Certificate) announced on the ID Card.  If a person wishes to present in a manner that is not the same as their Birth Certificate they will have to undergo a process to obtain a Gender Recognition Certificate (GRC) or hold 2 ID cards.

This means that unless a GRC is obtained, the person will need to have two ID cards.  Both will be in the person’s legal name, but one will identify the person as male, the other as female.  The one in the birth gender will be valid for travel throughout Europe, the other will not.

Once a full GRC has been issued, a single ID card will be issued in the acquired gender.

Each of these individual cards must be paid for in full.  The initial proposed fee of £30 will only remain until 2012.  Anyone who wishes to obtain a Passport must also obtain an ID card under the proposals.

The guidelines also state that the database will also keep details of your birth gender, even after a GRC has been issued.

We believe that there are a number of issues that need to be addressed. We believe that a person carrying two ID cards, each bearing details that conflict with the other, will be become vulnerable and at risk from harm from foreign security services or members of the public, particularly in volatile countries and/or situations.  We believe that this puts many people’s lives at risk.  We also believe that this puts many people who do not have a GRC in a vulnerable position.

For this reason we have taken two specific actions and would appreciate your support by taking action.

We have drafted a letter that you are welcome to download and send to Robin Woodland at the Home Office.  You may use it in its entirety or as a template to compose your own letter We have started an on-line petition which we would love you to sign

The document is available for download from:
http://www.alisonwhelan.co.uk/id_cards.htm

It is available in both Word Document format and PDF format.

The on-line petition is available at:
http://petitions.number10.gov.uk/TransID

Due to the closing date of the consultation period drawing near  13th February 2009), we have chosen to limit the petition to just one month.

It is therefore important that anyone interested in supporting this
takes action now.

The following is the text of the petition:
We the undersigned petition the Prime Minister to ensure that the safety of the Transsexual, Transgender, Intersex and gender-queer Communities is not placed at risk by insisting that harmful data is kept on the National ID Database and that many should carry hold 2 ID cards, identifying them as belong to both male & female genders.

The draft guidelines for the National ID Card as they currently stand, with regards to transsexual people and others who choose to present in the gender opposite to that of their birth assignment them to: a Apply and pay for up to four different ID cards b Have two separate ID cards before a GRC can be obtained

The Database will keep a record of the birth gender, contrary to Government agreement when the GRA(2004) was passed into law. This is despite the fact that many people cannot obtain a Gender Recognition Certificate (GRC) and that it is illegal to disclose whether a person is in possession of a GRC without explicit permission.

4 groups of people fall into a dangerous areas:

1 A transsexual person who has obtained a GRC

2 A transsexual person who lives full time in their acquired gender but have not yet applied for a GRC either:
a Because they are not yet entitled to apply for GRC
b Because they qualify to apply for a GRC, but are unable to apply for
reasons such as pre-existing marriage or lack of reqrd medical evidence
c Because they choose not to apply for, or are unaware of the
availability of, a GRC.

3 A person who lives part time in each gender

4 A person who lives outside the gender binary

—————————————————–

Gender Spectrum UK

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I also oppose the introduction of ID cards broadly on grounds of   preserving civil liberties, but this is a battle that needs fighting on several fronts. If the government blindly goes ahead with introducing them anyway, we need to limit the damage they do to vunerable individuals.