Leeds Gender Identity Service - our response to the BBC Newsnight investigation

This information on this page is our full response to the BBC Newsnight programme's investigation into access and waiting times for NHS gender identity services across the UK. Any statements on this page can be attributed to a spokesperson for Leeds and York Partnership NHS Foundation Trust.

The Leeds Gender Identity Service offers assessment, treatment and support to people aged 17 and above with Gender Dysphoria across England, principally Yorkshire and the Humber, Lancashire and the North East.

We accept referrals from GPs or NHS healthcare professionals. We also accept self-referrals to the service.

We are a small multidisciplinary team of around 20 psychologists, psychiatrists, endocrinologists (hormone specialists), pharmacists, GPs, nurses, speech and language therapists, our Gender Outreach Workers, plus our dedicated admin support.

Our team complete a full assessment of people referred to us which includes looking at mental, social and physical health. Once the assessment stages have been completed, service users may be offered a diagnosis, and may be ready to move forward with physical treatments on our care pathway.

The care pathway includes a hormone clinic that can make hormone treatment recommendations to the patient’s GP. We can offer individuals psychological therapy, voice and communication therapy, discuss surgical opinions and gender reassignment surgery as appropriate. We offer peer support through our nationally recognised Gender Outreach Worker Programme.

What problems are we facing?

Our waiting lists for first assessment and treatment are unacceptably long. This creates huge problems related to access to health care, including poorer health outcomes for people waiting to be assessed for treatment, and then waiting for that treatment to begin.

Patients are experiencing increasing levels of frustration with not being able to move forward with their gender transition. Gender Dysphoria is linked to poorer mental health outcomes such as anxiety and depression and access to gender affirming treatment is known to reduce psychological distress and improve quality of life for most patients.

There are currently 4,259 people on our standard waiting list to be seen.

We have been receiving around 160 referrals per month for a first assessment per month, and we have seen a 50% increase in referrals in the 12 months from December 2022 to December 2023. We also saw a dramatic increase in the transfer of care requests following the closure of the Tavistock Gender ID service.

We are currently booking appointments for people who were referred in approximately March 2019. Meaning our average waiting time for a first appointment is approximately five years.

Calculating waiting times for people on the waiting list now, or joining the waiting list today, is not an exact science. Waiting times for individual patients fluctuate depending on numerous factors. For example, there are new pilot programmes for gender services offering more fast-tracked appointments to patients in particular geographic areas who are on an existing gender service waiting list.

For appointments such as the second assessment appointment and surgical opinions for surgery, there are waits of approximately nine months currently, however internal waits once patients are on the care pathway are open to fluctuation and have been shorter in more recent months.

For a hormone appointment, there are currently 136 people waiting. The next person to be allocated an appointment was placed on this list in July 2022. This has seen a sharp increase due to staffing changes and challenges with GP prescribing across the primary care networks.

The Leeds Gender ID Service sees many transfers of care from former Tavistock Centre patients who are presenting with increased clinical complexity. We are also seeing increased clinical complexity due to reductions in general mental and social care support for people nationally.

Like most other health and care services, the Leeds Gender ID Service was adversely affected by the Covid 19 pandemic, during which our capacity to offer first appointments was vastly reduced – and we are still recovering from this global event.

The Trust takes the issue of waiting times very seriously. The Leeds Gender ID Service publishes information about its waiting times on its website (see Waiting Times Explained), and their performance data, including waiting times, are reported to our public Trust Board meetings every two months. 

Examples of what we are doing about these problems at the Leeds Gender Identity Service

Patient Initiated Follow-Up (PIFU) in Gender Services

This is a new strategy to increase efficiency with the use of follow-up appointments (currently 6 monthly) with patients referred for gender affirming surgery – we are hoping that this will free up first appointment slots.

Flexible resourcing

We manage our own resource across different parts of the care pathway – which includes using our assessing clinicians for transfer of care appointments, follow-up appointments, hormone appointments and surgical assessments.

Gender Outreach Workers

Our Gender Outreach Workers offer peer support to those patients who are waiting for an appointment. This includes one-to-one support and group support. This initiative was shortlisted for a National Diversity Award in 2022.

Working with Primary Care

The current arrangement is that once patients have been through specialist assessment at the Leeds Gender ID Service, they will then be prescribed hormones in primary care based on our recommendations. We have worked hard to develop an extensive range of resources and offer training to support the clinical activity in primary care so that colleagues can increase their skills and confidence to take on prescribing for their gender patients. This is a work in progress.

Training programmes

The Royal College of Psychiatrists has been commissioned to provide a training programme for staff coming into gender services. The staff at Leeds Gender ID Service offer bespoke training to clinical psychology, medical training programmes, speech and language therapy and nursing in addition to training placements at the clinic. We also have a history of offering training placements within our team and offering training events across other clinical settings to improve trans healthcare throughout our regional networks.

 

Changes we would like to see across the health and care system to address these problems for the longer term

We would like to see the following:

1. National system wide investment, including the development and expansion of specialist services in tandem with primary care hubs that would support pathways that tailor care appropriately to the needs of patients.

2. Creating a recognised talent pipeline for training and professional development of gender ID health professionals and broadening the scope of professionals in the ‘Lead Clinician’ role i.e. someone who can diagnose gender dysphoria, and a training programme for new surgeons entering the specialism.

3. Parity of esteem for the condition of gender dysphoria. It is against the law to discriminate against anyone because of gender reassignment (Equality Act 2010).

4. Reduce the stigmatisation, abuse and harassment faced both by the transgender community and Gender ID staff alike (which causes good people to leave the profession). 

 

For more information please contact:

The Communications team.

Leeds and York Partnership NHS Foundation Trust

T: 0113 85 55989

E: communications.lypft@nhs.net

 

About Leeds and York Partnership NHS Foundation Trust:

Leeds and York Partnership NHS Foundation Trust provides specialist mental health, learning disability and neurodiversity services to the people of Leeds, and across the North of England.