Paula's Place

Paula's Place

Friday 25 November 2022

The Crisis In the British Healthcare System

There is currently a consultation process (yes yet another!) this time about health care of young trans and gender non-conforming people within the NHS. There is so much wrong with the proposed system it's hard to know where to start, but in order to help inform my response I have had a bit of a poke around on the internet and found a couple of things I would like to share with you.

The first is from a Blog I have only just discovered, it is by Dr Ruth Pearce, a widely accepted authority on Trans Health Care and formerly a member of the NHS England Gender Programme Board ~ so to put it another way she knows her stuff. I would strongly recommend that you take look and read of her blog for yourselves, but here I will just share a letter she has put in the public domain.

Dear all,

I am emailing to share my great alarm at the proposed service specifications for child and adolescent gender dysphoria services. It is my expert opinion that, if implemented, these proposals will cause great harm to young people. Moreover, in opening such poorly designed and unevidenced specifications to consultation and media commentary, NHS England has already caused harm.

The fact that this consultation is happening at all represents an enormous failure on the part of every professional involved.

I stepped down from the Gender Programme Board earlier this month due to clashes with my teaching schedule. However, given the severity of this situation, I would be remiss in my ethical duties if I did not also email you directly to share my concerns.

My three main areas of concern are:

  1. Social transition should not be subject to medical oversight. This would represent a gross abuse of power on the part of commissioners and practitioners. Choosing to wear different clothes, and possibly use a different name and/or pronouns – is a personal, non-medical decision related to a person exploring their identity and/or coming out. Preventing a young person from choosing a social transition amounts to an attempted conversion practice.
  2. Punishing young people and their families by subjecting them to investigation if they access private services will not help them access healthcare. Young trans people who access private healthcare in the UK or abroad generally due so due to the severity of NHS failures.  It will increase the likelihood of young people hiding the fact they are accessing external treatment from NHS clinicians, and of people turning to black-market hormone providers rather than private doctors. I am not sure that members of the Gender Programme Board are fully aware of how prevalent and dangerous the home-made substances already in circulation can be.
  3. Requiring that young people become research subjects as a condition of accessing treatment is completely unethical. This is a well-established principle in the trans health literature. There is no way in which you can truly obtain informed consent for research participation from individuals who will be denied healthcare if they refuse to participate. I fully support the expansion of NHS-funded research into trans healthcare, but participants must not be recruited through coercion.

I will end by inviting all recipients of this email to reflect on what they do not experience, and what they do not know.

Most members of the Gender Programme Board have not experienced gender incongruence or gender dysphoria.

Most members of the Gender Programme Board are not members of a trans community. It is likely therefore that you – even if you are a clinician – have never found yourself in a position where you are confronted with the true impact of NHS failings on young trans people who rely on community support. You do not know what it is like to be trying to look after many extremely damaged members of your community dealing with complex trauma and self-harm from people who have been repeatedly abused by NHS clinicians and processes. We, in the community, are the ones left picking up the pieces of your failings, finding ourselves on constant suicide watch and scrabbling to keep people alive. Invitations onto bodies such as the Gender Programme Board, where we are expected to be polite while fighting for scraps – only to be ignored – do not right these overwhelming wrongs.

It is now on you to rebuild trust.



Although this is specifically about the care of trans and gender non-conforming young people it does highlight much of what is currently wrong with NHS care, and indeed attitudes towards Trans and gender non-conforming people in the UK in general.

As so often happens with me, reading one thing on the internet leads to another and then another. This morning I discovered this YouTube video from Philosophy Tube. This takes it a bit further and through personal experience demonstrates so much of what is wrong in the NHS in general, and trans health care in particular. It is quite a long watch and can be a bit "challenging" in places, but I urge you to give it the time required, it is entertaining as well as informative. I don't necessarily agree with all her conclusions (but I mostly do), and her experience is not necessarily mine, but there are similarities. Certainly this is increasingly the experience of trans people seeking medical treatment in England at the moment (Scotland Wales and Northern Ireland have separate, if not better, systems).

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