Scottish protocol for Gender Services (largely) adopted in England

It appears that much of the widely-lauded NHS Scotland Gender Reassignment Protocol will be adopted in England from 1st June 2013.

This will be a temporary measure, taken as the result of “inconclusive feedback through the consultation exercise on specifications and policies” for the English Protocol. Last year, the draft English Protocol was criticised by many trans people for failing to live up to the progressive standard set by the Scottish Protocol. I wrote about this here.

This information comes from a letter written to stakeholders in the Gender Identity Services Clinical Reference Group.


What will this mean for English patients in the short term?

As the Scottish Transgender Alliance noted in July 2012, the Scottish Protocol “is not perfect but it is an important step forward for trans people in Scotland“. It incorporates a number of clauses that ensure relatively swift access to services (including hormone therapy and surgeries) for those already “in the system” and on the books of a Gender Identity Clinic (GIC).

Key features of the temporary Protocol for England would therefore include:

  • that psychotherapy/counselling, support and information should be made available to people seeking gender reassignment and their families where needed.
  • that two gender specialist assessments and 12-months experience living in accordance with desired gender role are needed for referral for NHS funded genital surgeries
  • only one gender specialist assessment is needed for referral for speech therapy, hormone treatment and FtM chest reconstruction surgery and that these can take place in an individualised patient-centred order either prior to starting the 12-month experience or concurrently to the 12-month experience.

(Bullet points from the Scottish Transgender Alliance. Emphasis mine.)

All of these provisions should (in theory!) entail a more rapid, efficient access to services for patients at many English GICs.


Exceptions

Unfortunately, several particularly progressive aspects of the Scottish Protocol will not be adopted in England. According to the letter sent out to stakeholders, these include:

  • Referral to Gender Identity Clinics (access)
  • Facial hair removal
  • Breast augmentation

Discussion on these areas” is being “deferred” because “it is recognised these need further discussion and also because England’s health service is structured differently and therefore a slightly different approach will be necessary

The first point (“referral to Gender Identity Clinics”) is somewhat ambiguous, but appears to mean that provisions made in Scotland for self-referral and referral by GP to GICs will not be implemented in England, at least in the short term. Most English GICs currently only accept referrals from mental health specialist such as psychiatrists, so this looks set to continue.

The letter further states that:

“[…] decisions relating to direct access, facial hair removal and breast augmentation being deferred by all NHS England Area Teams until after the June meeting when further work can be undertaken to reach the interim NHS England Policy and Specification for adoption. Where an individual has already had agreement for any of these procedures then these would go ahead, the deferment relates to decisions not yet made.”

This would appear to imply that no new referrals will be provided for facial hair removal and breast augmentation on the NHS in England, at least for the time being. In most parts of the country this is the norm, but in some areas this will effectively be a step backward.


What about young people?

A final significant aspect of the Scottish Protocol is that it provided for the provision of better services young trans people:

  • that young people aged 16 are entitled to be assessed and treated in the same manner as adults in terms of access to hormones and surgeries.
  • that children and young people under age 16 are entitled to child and adolescent specialist assessment and treatment as per the relevant section of the WPATH Standards of Care.

(Bullet points from the Scottish Transgender Alliance. Emphasis mine.)

It’s not clear whether or not this part of the Protocol will come into play in England, but I suspect that this counts as “access to Gender Identity Clinics”, meaning that nothing will change – in the short term at least.


Analysis

I would suggest that this development is, on the whole, a positive one for the majority of trans patients in England. It will hopefully ensure a number of improvements in access to treatment, particularly for individuals seeking hormone therapy and individuals on the transmasculine spectrum seeking chest surgery (including for individuals seeking chest surgery prior to hormone therapy, or chest surgery without any accompanying hormone therapy). It should encourage GICs to acknowledge trans diversity and provide treatment more adequately tailored to individual circumstance.

Moreover, the implementation of this Protocol means that some of the more regressive elements of the draft English Protocol (such as the requirement for GPs to undertake a “physical examination” ) will hopefully not see the light of day.

Of course, there will continue to be resistance from some of the more conservative GICs. However, the existence of the temporary protocol should empower patients who wish to make the case for better services from these bodies.

It is important to note once again that this is a temporary measure, and that the new English Protocol that is eventually implemented may not necessarily reflect the Scottish Protocol to such a great extent. A meeting will be held in June for members of the Clinical Reference Group to discuss what might happen next. We can only hope that the outcome will be a positive one for trans patients.

However, this move sets an important precedent. A set of relatively progressive new rules are being put in place, meaning that it should be harder for GICs to justify inadequate service provision. This is a new benchmark which health campaigners can use as a starting point for future campaigns.

Finally, the “inconclusive feedback” from “consultation” suggests that pressure from trans health advocates is actually having an effect, particularly as many GICs will no doubt have been pushing for a continuation of the status quo. Credit is due to all those individuals and organisations that responded to the consultation on the draft English protocol a year ago, and members of the Clinical Reference Group who are pushing for positive change.

Laura Jane Grace subverts MTV with style

Having previously written a little bit about Against Me! frontwoman Laura Jane Grace’s recent appearance on MTV’s House of Style, I finally got around to watching it.

And, you know what, I really am impressed.

Grace makes the most of every moment of air time: she seems determined to convey a whole series of positive messages. It seems like the editing team who put together the short were pretty respectful of this. The whole programme is also largely free of the usual transphobic tropes, which is an achievement in and of itself.

I’m not normally a fan of this kind of thing. I don’t care how celebrities dress. I don’t care how they “choose” their “style”. I associate such programmes with shallow consumerism and damagingly limited ideas about how people should and shouldn’t express themselves.

But the messages that come from Grace are powerful, important and – to my mind – broadly feminist. Be true to your tastes and interests (“You can see like the texture of it? That’s real dirt”). Dress in a way that makes you feel good. Passing doesn’t need to be an end in and of itself. If you’re a young trans people, it’s okay – other trans people exist, in public!

Grace is self-consciously making herself into a role model. That’s not always a good thing, but the message here isn’t “be like me”, it’s “be yourself”. Sod the naysayers: this is punk as fuck.

Video embedded for readers who (like me) aren’t based in the US, and hence can’t watch this on the MTV website.

See trans performers in London tomorrow!

Trans youth charity Gendered Intelligence are running a fundraiser at London’s Royal Vauxhall Tavern tomorrow (Friday 13th July).

On the off chance you’re around, you should totally come because it’s going to be amazing.

There will be performances from a whole bunch of trans artists and allies, including:

Lashings of Ginger Beer Time

Bird la Bird

CN Lester 

Naith Payton

Cyndi Rogers

…and DJ sets from myself and Puja Maniar.

Entry: £8 (£6 concesssions)

Doors: 7pm – 2am

There’s a Facebook event page here.

New coming out guide for young trans people

LGBT Youth Scotland have produced a fantastic new booklet with advice on coming out for trans people. Some of the information and language is a little Scottish-specific but there’s some good stuff in there that could be useful to anyone.

Contents include general advice on coming out to friends, family and in school/college/uni etc, as well as links to further resources in terms of general advice and UK law.

You can download the guide in PDF format here:

Coming Out: a coming out guide for young trans people

In a gender liberated world…there would be no moral panic over trans parents or trans children

And so the Bizarrely Busy Month of Trans News rolls on.

On the subject of trans parents, the Daily Mail has effectively outed a trans father; on a slightly brighter note, Green MP Caroline Lucas has tabled an Early Day Motion condemning the ongoing media witch-hunt that’s currently targeting pregnant trans guys. Kudos once again to Trans Media Watch and Jane Fae for their ongoing work on this. Meanwhile, bookmakers Paddy Power are under fire for a transphobic advert, and today saw a five-year-old trans girl splashed all over the tabloids (including front page stories in the Metro and the Sun).

Paddy Power will no doubt defend their advert (basically a “spot the tranny” competition themed around Ladies’ Day at Cheltenham) on the grounds of humour: it’s just a laugh, right? Meanwhile the tabloids will continue to defend their almost fetishistic obsession with the private lives of trans people on the grounds of “public interest”. Both actions serve to dehumanise and objectify trans people even as they build public interest in the queer freak show we supposedly offer.

This is all, of course, of massive concern to the so-called trans community. But we’re not the only ones who are affected.

In today’s front-page article, the Metro quotes “social commentator” Anne Atkins (who?) Atkins – clearly a great expert on gender diversity – says:

“Between the ages of about five and eight, I wanted to be a boy more than anything in the world. Acute though my longing was, it was relatively shortlived. I am grateful to say that there was no one around at the time to diagnose me with GID [Gender Identity Disorder]”

If I had a pound for every well-meaning cis friend who’d told me this at the beginning of my transition…well, I wouldn’t have a huge amount of money, but I’d definitely be able to afford a better toaster. But my problem with this isn’t one of cis privilege. It basically runs as follows:

What’s intrinsically wrong with a kid spending part of their childhood as a “boy” and part of their childhood as a “girl”?

What’s intrinsically wrong with the idea of a man having a baby?

What’s intrinsically wrong with (or, for that matter, funny about)  gender being complex or fluid or aligned with their body in a non-normative fashion?

I’ve not come across a single answer to any of those questions that isn’t inherently sexist in one way or another. We shouldn’t have to subscribe to an ideology of gender difference that necessitates people being placed in boxes that restrict their self-expression. We shouldn’t have to rely on old-fashioned gender roles. At the same time, we shouldn’t have to demand that “gender” be obliterated altogether. Why can’t five-year-old Zach live as a girl? Why couldn’t Anne Atkins live as a boy for a few years before settling into womanhood?

In a gender liberated world, gender expression would be free and fluid. Adults could be men, women, genderqueer, polygendered or non-gendered as they desire. Children could be children, and explore gender as one set of social possibilities amongst many. And everyone benefits, not just trans people. We’d all have more space to be ourselves.

If you think this is hopelessly utopic and ultimately impossible, try dropping by spaces such as Genderfork and Wotever, where users/attendees are pioneering gender liberated approaches to language and social interaction.

We don’t need to do away with gender, but at the same time we don’t need to subscribe to fixed, binary ideals of gender in order to live in a decent world where people value one another’s work and care for one another.

In a gender liberated world, neither the media nor the medical world would care about five-year-old trans girl, a pregnant man or a trans person at Cheltenham because it simply wouldn’t be a big deal.

The trans girl could live out her childhood as she desired and privately transition physically – or not! – at an appropriate point in her teens. The man could access appropriate care during his pregnancy without fearing the consequences of doing so. And at Cheltenham…well, isn’t the very concept of “Ladies’ Day” totally regressive?

10-year-old trans girl launches petition as Leveson Enquiry tackles transphobia

Jane Fae wrote a powerful post
today
highlighting the connection between two important events this week for trans people in the media.

The first of these events is the launch of a petition that calls upon the press to stop using dehumanising and othering language to describe trans people. The petition was started by the family of Livvy, a 10-year-old girl who became one of the most recent examples of trans children hounded by the news media.

They argue that transphobic language can ultimately kill:

People with gender identity issues are being murdered, beaten, threatened with their lives, bullied, teased, intimidated, disowned and are prone to suicide both attempted and successful and self harm. The Press being an extremely powerful medium has the responsibility to ensure they are not aiding peoples ignorance and hatred and increased lack of self esteem.

Meanwhile, the Leveson Enquiry is due to receive evidence  from Trans Media Watch this afternoon (a live video stream will be available here, as well as an archived video and transcript following the hearing). Josephine Shaw posted the following announcement on the group’s Facebook page:

“[…] Helen Belcher will be representing us at the Inquiry, next Wednesday – February 8th. She’ll be doing so following a detailed written submission made by TMW a few weeks ago, a public version of which is available via the downloads page of the TMW website.

There have been a very large number of written submissions to the Inquiry – only a small number have resulted in Lord Leveson calling witnesses in person. We’re absolutely delighted to be counted in that number […]

TMW’s aim next week is simple. To give voice to the pain and anger of all those trans and intersex people whose lives have been invaded, even ruined, without any cause or warning by the British press. Who deserved accuracy, dignity and respect. Or who simply deserved privacy. And to try and represent our community in calling for a profound change in the attitude of the press and an end to the incessant outrageous and unwarranted intrusion into the lives of innocent trans and intersex people.”

This week therefore sees two significant responses to the ongoing media assault upon trans lives. The two met this morning on the BBC’s Breakfast show, when Livvy and Trans Media Watch’s Paris Lees spoke about transphobia in the media.

It’s really heartening to see all of this happening. I agree with Jane that we have good reason to remain cynical, but equally we have plenty to celebrate at this juncture. For too long, journalists have been getting away with inflaming public opposition to trans liberation, and people in power are finally beginning to listen to our howls of outrage. This is an early step towards a more fair and friendly world, but an important one.

I was fortunate enough to meet Livvy a few months back and was inspired by the sheer determination of both her and her family; we have a lot to learn from them! I was also struck by my own surprise role in Livvy’s story via a sensationalist piece published by the Sun back in September:

But yesterday a row broke out after a parent claimed that kids as young as EIGHT at Livvy’s school were shown a film about sex-change surgery.

In the footage, made for the NHS website, Ruth’s Story describes how she was born a boy — but knew from the age of 16 she wanted to be a woman.

One parent said: “We are not against the child. It’s that the children are being asked to treat her differently and watch a transgender video without parents knowing.

The video in question was made for the NHS a few years back, and at the time I had no idea it could ever be shown to a primary school assembly! I would probably phrase a few things differently now but ultimately I’m still pleased with how it turned out. I became involved in the project by responding to an email from a mass trans mailing list: someone else could just have easily done it.

Ultimately I suppose my point is that every bit of effort counts. Every signature on Livvy’s petition, every angry letter to an editor, every trans awareness workshop and every intervention within public conversations. Let’s keep up the pressure, because it’s the only way we stand a chance of winning!

Government Equality Office to consult trans youth: Thursday 28 July

Boosting the signal on this one. It’d be great to see a load of outspoken young trans people at this event – if you don’t represent an organisation, it’s probably worth giving it a shot anyway!

Dear friends and colleagues,

The Government Equalities Office would like to invite you to a trans youth workshop we are holding on Thursday 28 July at the Home Office, 17.30-19.30.

The Government published Working for Lesbian, Gay, Bisexual and Transgender Equality: Moving Forward on 14 March 2011.  This document included a commitment to publish the first ever Government transgender equality action plan by the end of 2011. The action plan will outline commitments that the Government will deliver within specific timescales, to improve equality for trans people, including young trans people.

To shape the development of this action plan we will continue to talk to the widest range of people, including groups or individuals we have not spoken to substantially in the past.  This includes young trans people.  The workshop will be a fantastic opportunity for trans people aged 14-30 to tell us directly what has gone well, what are the specific challenges they face and how we may be able to address them, whether it’s at college, university or when starting a career.

The meeting will be held at the Home Office, 2 Marsham Street, London SW1P 4DF.  A map can be found here.  A detailed agenda will be sent closer to the workshop.

Reasonable travel costs (standard rail fares) will be reimbursed. This is train fare only – other expenses or non-standard rail fare must be agreed in advance.

Can you please confirm to me by Friday 15 July whether you or, if applicable, another representative of your organisation will be able to attend? Please note places are limited so we are accepting responses on a first come, first serve basis.  Because of security reasons, you will not be able to attend unless you have confirmed attendance with us first.  

Please note that the usual procedure to enter Home Office buildings is to bring photo ID.  If you have photo ID we would be grateful if you could bring it with you.  However if you are unable to produce photo ID please let us know in advance and we will make sure you can enter the building.  Please let us know if you have any disability needs.

I look forward to seeing you at the workshop.

Regards

Anne-Yael Halevi

Government Equalities Office

Anne-Yael.Halevi@geo.gsi.gov.uk

Want to get involved?  Please check our second transgender e-bulletin here.