Views on improving healthcare

Yeah so the old process was you go to your GP, and they refer you to the community mental health team, they tick you off, and then a funding negotiation basically happens, negotiation, and they say, Oh we can work, NHS Wales will fund your transition and they’ll hand over that money to NHS England, and your care will be taken care of by Charing Cross, and you’ll be put on that waiting list. Now luckily we have a, this is I’m hoping the system, like the rest of the UK will also adopt, because I do think it’s better, especially so you get referred to the Welsh Gender Service, and at the moment there’s only one clinic in [city], the hope is to expand that to different parts of Wales, and they will see you for your initial appointment, essentially. And they’ll talk like, you’ll talk to a not a psych, again there’s no actual psychiatrist or anything like that but it’s just someone who’ll like, and they are trained in the gender stuff, and stuff like that.

And there’s, and so there’s no, so your GP can directly refer you, so there’s no like middle person to like negotiate or gate-keep with, and they’ll talk to you and they’ll like they’ll ask you like what kind of care do you want. And essentially and that doesn’t matter if you’re a binary trans person or a non, or a non-binary. So if you, if you have an idea of what care you want, or if you need to be talked through that, like what they can do for you, that is something they can do. Which is much more affirming in care, especially so.

Like so the Welsh Gender Service, they don’t, they don’t they can’t refer you to surgery yet, that’s still done via Charing Cross, so but they can do everything but that. They can do a surgery sign-off, so you can get your initial signature, so they’ll like discuss your options, so they’ll be like for, obviously I’ve only experienced the AMAB trans fem route, so it’ll be like, We’ve got HRT, we’ve got we can refer you to voice therapy, we can obviously get the HRT sorted and we can also think about discussing surgery options in the later appointment when you feel comfortable, or whatever

And so yeah, and so essentially that’s basically it, and then it gets, goes to primary care, which is where it should be realistically, so they’ll be like, okay we’ve told your GP this is what you need, and so your GP will prescribe it to you and they’ll monitor your bloods and stuff, like that, so you don’t have to travel to the Welsh Gender service again and again, and they’ll be like and at the moment like, so the eventual goal of the system is that all GP’s will be able to prescribe and do it, but some GP’s still don’t feel as comfortable doing it yet.

So in the interim, I say interim, I think it may become semi-permanent to an extent, I think it has, there’s a local gender team, and so this is a gender team in each county so like regardless of where you are in Wales there will be a gender team in each county and they will do, they will do the prescriptions and if there’s no nurse that won’t do the jabs in your practice for example, they’ll also do the jabs. they’re like that’s what’s happening to me, so I’m going to the local, I’ll go to the local gender team, and that means especially for people in Wales with terrible travel links especially, like going from North to South and stuff, so if say someone gets referred from the North to the Welsh Gender Service, they may have their initial appointment in [city], but the rest of it will be communicated through the local gender team. So, they’ll just have to see them instead of having to travel.

Which it makes sense to do it in a primary care model, and that’s the hope that like, we’re trying to set the standard and we’re trying, I’m in, helping with talk with people like I’m actively been talking with the government and well the group I’m part of, and like we were involved in putting, getting that statement put out by the Welsh government. And we’re hoping, one of the aims for these future meetings too is to expand the service to under 18’s, because at the moment Wales also doesn’t have an under 18 service. They still have to be referred to Tavistock and go through that route. And we’re hoping to make, essentially give what we’ve got the primary care model we’ve got now, and essentially do it for under 18’s too.

So the thing that really stands out to me is that when I tried to access Trans healthcare services prior to having the conception that I wanted to be a binary Trans man as that was how I identified, I really felt a lot of pressure to have all the answers going into the GP or going into even CliniQ actually, going into any health service I felt this pressure to have a very cut and dry conception of what my gender was and how, what trajectory I wanted to take and what services I needed and whether that was medical or non-medical and I felt like there needs to, it needs to feel safe in order to like for someone to, to not have the answer to any of those questions. And for them to feel like they’re still gonna be held in the same way and receive the same level of service as someone that knows that they wanna medically transition and has like has an idea of like a timeline in terms of like, you know, surgeries. Because I think that yeah I think people who are sort of less sure about these things can kind of get lost on the wayside. And they, yeah and they risk not being able to sort of have the same level of care in services, yeah.

Abolish gender identity clinics, informed consent, hormones for all over 16’s because that’s you know, Gillick component stuff and then for potentially for under 16’s on a case by case basis you know, as assessed or as discussed and, you know, found appropriate by their doctors I think is probably the best way forward, I might be, you know, might be happy I could be wrong on that, I don’t know enough about, you know, under 16’s healthcare specifically but I think it’s something that needs to be done, you know, you can’t just blanket say no, none of it, I think it depends on the person it may be appropriate or it may not be appropriate and it depends also on their family and how accepting their family’s going to be. If their family is, you know, unaccepting of this person being Trans it may not be appropriate for them to have hormonal therapy or at that point puberty blockers for example may be appropriate because, you know, you don’t necessarily need to tell your parents or they may not necessarily know. But that’s another kind of issue entirely, but yeah I think maybe informed consent models are good which should definitely be for over 18’s and, you know, or over 16’s and then case by case informed consent for anyone younger that it applies to although again, you know, no-ones saying that seven year olds should be having surgery or hormones, I’m certainly not saying that [laughter]. And just, yeah in general our healthcare providers be more aware and yeah just not these arbitrary gate keeping long windows that are there as a relic of the past essentially.

I think it would be really nice to see like changes from like pretty much like the beginning of the process of like you go to your GP, the form is inclusive, people are trained to use inclusive language, you know you don’t need to have a title if you don’t want to, but if you do that’s like a Mx option. And I think justI think healthcare services as a whole really need to like de-pathologize , there needs to be like moving away from, again putting people into boxes, and thinking you know well there’s cis male, cis female, and here are the issues that they have, because it impacts everybody right, it impacts so much in terms of like what healthcare is provided, what services are offered, what problems are considered, you know. You hear all the time people with like uteruses, and wombs and stuff like that, like always their health, you know is often very problems are dismissed and problems aren’t identified where they might be, you know like with endometriosis and stuff like that, and that comes from this like really I think ingrained framework of like just ticking boxes, and just having these biases of like what, what problem might be caused by and like not being able to adapt to like the person in front of you. And I think having like trans specific healthcare services I think is really important, because I just think it’s, you know in the same way that we have like mental health services, like to have really like thoughtful, with like good training spaces for people to go where, you know, in an ideal world, you know is like people will understand what services I need to access here, and you know you could, like again in an ideal world you can trust the people in these spaces to know options for you, and for your specific needs. You know I would, yeah, I would love to see more of that in mainstream healthcare as well, and in your GP’s stuff like that. But yeah. I’m sorry, Utopian dreaming.

Well, they need to train more clinicians at the GIC. They need twice as many as they have now. Three times as many don’t just bring in two more people and don’t start to, you know, train them now for ten years in the future. Bring in a lot of people. Train them up and move to a bigger venue and just you need to be able to cope with the number of people who need this service. And like and just stop asking, stop asking us about our sex lives. Stop asking us about stuff that isn’t relevant, you know. Stop asking me about my childhood when I transitioned two years ago. Ask me about my trans, ask me about my transition, you know? Like just, do away with the, you know what also hormones have to be more readily available. A trans person should be able to go to the GP and say, I want hormones and get hormones, because it is not going to cost the NHS that much. And it is not that risky and people should be able, people know what they need, and yeah. That like greater access to hormones is a really, really big thing because that causes so much anxiety for trans people in this country. Training up more people at the GIC. More GICs. Like, yeah, why not? More greater awareness among trans like trans specialists and healthcare professionals in general about who trans people are and who non-binary people are and like, you know, what dysphoria is and what it entails.

Education. Information. Even it if means giving NHS staff, you know, like ideas of like pronouns and updating of systems and that kind of thing. I think there needs to be also a slight deviation from the NHS and like the government and legislation. I think the paperwork of one becomes so much the remit of another, so the idea that my medical transition will be held off because of a name change that I do or don’t make, when that has nothing to do with my health, is a bizarre two-step. I think doctors need support and training, particularly GP’s. I think we need more doctors, certainly more specialists, so that the waiting lists can cut down. And investment, there just needs to be an investment in, in understand that this is going to continue to be something that, that if numbers are anything to go by, it’s increasing year on year. Which means you can’t just go with how things are, and it would be great I think to see the UK take gender and things seriously. I think the thing that’s exciting I guess from a medical perspective is that they have the opportunity to be at the top of the field, for showing what it is that standardised state care could do, and how to embrace the challenges of it. It would be great to see more of that rather than the dread of, Oh no, we’ve got to learn another thing about something that we don’t really care about Cos that’s a boring idea.

So many thing [laughs]. Shorter wait times at the clinics, mostly. But that would require, I mean, we need more gender specialists in general so that we can reduce the waiting times and a better funded NHS for that as well. Better informed GPs is something I’ve already mentioned. And just a slightly more tolerant society, as ridiculous as that sounds would be a relief.

Shorter waiting times. More doctors, better informed doctors and less gate keeping.

How do you think that could be done best?

[Laughs] Overhauling our entire medical system. [Laughs]. No, I think we need better incentives for doctors so that we get more doctors so better funded NHS in general as well. More gender specialists. I think that’s one of the key reasons the waiting list is so long is just because there aren’t enough doctors. And with a growing trans population they can’t meet the demand and that’s why the lists are getting longer and longer and longer.

And then maybe if we had more doctors and there was less, it was seen as something in its own right, rather than a subsidiary of well, less so for Tavistock now, but was previously a subsidiary of the mental health services when obviously transness isn’t a mental health issue. And so being able to get away from that kind of stigma and if it was kind of recognised in its own separate branch, not separate, but kind of individual branch of, of medicine and healthcare. We might also be able to get a better standard for treatment across the board.

I did have to correct a GP recently who was a, so he kept, I had to, he yeah we were talking about a specific situation and then he, a specific treatment and he kept talking about had to correct his saying women and I was like oh excuse me I’m like can you say people with vaginas instead of like repeatedly saying women and I think he was a bit taken aback that someone would say that to him because he was obviously like in this position of power and, and being quite like mansplaining to me and I think I was just like you, you keep saying like women and this is kind of like it’s not like an appropriate to this situation, yeah. But he did correct himself but I think he was like quite taken aback actually.

Big one for me is I think the lack of support. You know, I don’t see the GIC as somewhere that should be just as assessment-based place, that your only interaction with them is being assessed. Support prior to you know, there’s a huge waiting list for the GIC’s, I get that, they can only see people as quickly as they can see people on limited resources, a hundred percent understand that, but the fact that there is nothing between that point of referral and the point of, and the point of getting to that first appointment really, really does worry me. You know you think, the, you know the vulnerable positions that a lot of people are going to be in, the mental health implications of that are huge.

Yeah, I just feel like there’s a, there’s a lack of a space to discuss things with anyone. You know you sort of go to the GP and have to, feel like you have to be in a position where you’re sure enough to convince them to refer you, and then the next person you interact with is the one who’s assessing you to decide whether you can have hormone treatment or not. Or whatever it is you’ve gone there to, to access. Nowhere in the middle is there anyone to, to, where it feels like you can have an actual discussion with, and work things through. And for me I feel like I’ve only had that through going and seeking private counselling to find that space. So, it, in the healthcare setup as it is now, I do feel that is lacking.

I have no bitterness towards the NHS or professionals, because it’s under a lot of strain and it’s a bit annoying when you get referred to Tavistock or the other closest gender clinic or wherever that may be or CAMHS even and the waiting list is like a very long time. I think Tavistock I find still on the waiting list. I still have about fifteen months which is, I think by that time I might be eighteen, I’m not 100% sure, but I might be eighteen by that point. I might just take my name off Tavistock actually, because I think I’d be like holding up dead space on that list. It’ll be quicker to refer myself as an adult, but. it’s just, I think, as a whole, mental health needs a bit more like funding support for young people needs funding, cos it’s not just trans people. Like, if you get better support for people who are struggling and unable to cope healthily, that will help general mental health. I know it’s not like mental health trans like it’s not like they go hand in hand, because as much as they’re very closely linked, just because you improve one doesnt mean you’re necessarily improve the other like you can give someone a million and one healthy coping mechanisms and they will still feel terrible gender dysphoria from time to time or they’ll still feel incredibly like unhappy with their life. If you give more support to people and give them spaces to talk about it, because to be quite frank not everyone finds it enjoyable when the school has mental health days and tells them, hey, are we gonna talk about our issues. Not everyone enjoys that, but if you give them the spaces to reach out then I think it would be a lot better.

There were times when I walked out of that appointment literally so devastated because it, I feel like I’ve not moved any further, any, what’s the term, haven’t moved forward with my transition. So I’ve just travelled 5 hours, I’ve had to get up at 4 in the morning, and you know to take multiple trains, a bus and I’ve gone there, only to basically tell me something that I already know and send me off. And nothing has, I haven’t moved any, any further forwards in my transition. And it’s been years like, so it really does get you down at times. And you know a lot of other people are, have been in the same position, like with the London Tra- clinic, sometimes, I’ve heard that there can be a years’ wait in between the appointments. So, there’s a long waiting time and there’s that, huh, it’s, and the thing is at least if there’s literally absolutely nothing that can be done about these waiting times provide some sort of support for people like, because you know if you go to, to you know a mental facility they don’t know how to deal with you, because obviously the gender clinics are the where all the, the professionals are. So there, everyone else outside of gender clinics they don’t know about these things. So you know it could, it could be very beneficial if they provide some sort of support while you wait because obviously the wait is very extensive, you know we’re talking three to four years, just to have your first appointment. And obviously make more options available in terms of partnering up with your GP to support you, maybe even, even get you on you know bridging hormones. Like there needs to be something to, to keep you going because if they’re really not going to put more money into it, to maybe add another gender clinic or more, more staff for the ones that exist, then there needs to be, there needs to be something because it’s just, it’s awful how long that you have to wait, and that’s the main thing that is that’s the main hurdle. You know it, the situation itself is already terrible and then on top of it is the fact that the wait makes you feel like a second rate, do you know what I mean? It makes you, it make you feel like well, you know, well, we’re all just you know not that important, and what we think is not that, that important, and we just have to deal with it because you know we’re lucky to be having this done. Which shouldn’t be the case.

I think the biggest thing that needs to change is the Tavistock and it is difficult to even confront that because it feels like it needs such a major overhaul that it feels almost impossible to change it. You know, I’ve listed previously what I’d like to see changed about phone calls instead of meetings and all that but I think that is certainly part of it, the Tavistock shorter waiting times easier accessibility to blockers less of a focus on trans medicalism and more of a focus on there being medical aspects to transition for some people but not all people and acceptance on the validity of maybe not wanting that medical transition so much and maybe being happy just with social transition. But certainly the Tavistock I think just needs a major overhaul and CAMHS is the best, I think the best it can be I think they struggle because they’re under resourced and I’m sure the Tavistock is to an extent but I still think that even within how the Tavistock’s working right now it could do better with its resources so really yeah and overall, an overhaul of the Tavistock in all the ways that I mentioned before would be great to see.

I would like to see general practitioners and general services become more practically affirming of trans people, and by practically affirming, I mean not just saying, not just doing the bare minimum, not just saying, I support you, I think what you’re doing is great but actually training themselves to have the knowledge to support people, support trans people to not have to co-ordinate their own care, and to not have to explain to the professionals and educate the professionals themselves. I guess I would love for the onus to not, and the pressure to not be on trans people to educate their own healthcare professionals. That’s how I’d like to see it change.

And I know that that has to start, that has to start with the education, and that has to start with trans people. So, you know I know that that has to start somewhere, but I don’t think it has to happen in a clinic room. I think that I’d like to see healthcare professionals and healthcare systems as a whole adopting a willingness to be educated in a, in more formal settings.

And I think it’s right that trans people lead the way on that, but then we need to, we need to be putting ourselves forward and not feel pressured into having do, having to do that if that makes sense? If that distinction makes sense.

I would obviously as I don’t think there’s a single trans person who is okay with the fact that the waiting lists are four years long right now. So, I would love to see those change, and obviously that comes with greater funding for support for gender specific, gender clinics essentially, and gender specific healthcare, that’s probably asking a bit too much. But then again is it? I don’t know. I don’t think it is.

And I would love to see projects like this, I mean this, a project essentially and this research is, I think an excellent example of how we change the, how we change the culture of healthcare, and how we change, how trans, how we as trans people interact with healthcare, cos whilst I’d hope that this educates trans young people like you said, and just trans people like me in general, cos I’d love to get so much out of the stuff that you’re gonna produce. I would like to hope that maybe healthcare professionals also are able to access this, because ultimately I feel like this is the level that they need, and that’s, maybe this isn’t the right format but it’s these kinds of things that they need to know about, that they don’t.

Mental health services in particular as well. Cos I a big kind of bug bear about that and a big, a big passion about that. Trying to think if there’s anything else really. Certainly regarding kids, I think, you know the service that my, that the CAMHS service that I work for has a, the GD pathway, gender dysphoria pathway, is a great example of how services can support trans kids and trans young people, and trans people in general, you know if, if the community mental health team in adults mental health services had the same kind of support group, that in itself could be transformational for, for trans people, it doesn’t have to be for young people. So those are the sorts of spaces I’d like to see as well, that promote people’s mental health. So, I hope it’s not too much to ask is it, all of that? I don’t know. Those are the things that I’d love to see, and able to see improvements there.

It’s ridiculous. And it’s disgusting. I understand there has to be a wait, a wait, for a while. And I understand that, you know, they cant just rush and see everyone immediately. And when you get there I understand they have to do assessments and they have to do assessments and checks to make sure you are making the right decision and stuff. But, it’s too much. And I understand, the idea of the 6 months assessment I think is when the waiting list was so short, someone could come out as trans, get referred, a month later, they could go and talk. So, of course they do a 6 months assessment and then possibly another 6 month assessment. So that person would be forced to live as their, you know, their true gender for a certain amount of time and make sure they were comfortable with it. But now that the waiting list is 2 years long, by the time someone’s got to the top of the list, they’ve already been living as their assigned gender, not their assigned, their true gender for 2 years and they don’t need an assessment anymore, because, you know, not for more than a couple of weeks or a few questionnaires. You know, theyve already been doing it for 2 years. I think it’s, it it’s too long of a wait.

And especially with being moved to the adult list. If you’re moved off the child list, all that happens is you get moved to the bottom of the adult list. There is no separate thing. There’s no, well, this adult’s been waiting 6 months, but you’ve been waiting 2 years so you go above. It’s nothing like that. It’s just, sorry, bottom of the list, pretty much. Unless youve already had your assessment done in which they only move you up by about 6 months. I’m like, it’s ridiculous. There are people who have been waiting, who will get to the top of the adult list and they’ve been waiting 4 years which is what they’re trying to do for me. The NHS clinics are trying to do for me and they’ve been waiting 4 years. Some trans people aren’t gonna live through 4 years of this or they’re just not gonna make it, the stress, you know, people who already have mental health problems as well, you know, and then have this on top of them. They won’t, either they wont make it or they’ll develop more problems, you know, the number of trans people especially trans men who develop eating disorders because they’re trying to help their body in some way, because they’re, you know, desperately don’t want to be viewed as, as female and they just can’t wait any longer. You know, you get people self-medicating which causes health problems and they die from self-medicating and stuff and it’s… the wait is horrible.

And you know, I think that the Tavistock especially don’t understand just how awful it is to wake up every day in a body that is wrong. How awful dysphoria is. How awful it feels to be misgendered. How awful it feels to be trans when all, when you know 100% for certain all you want is your hormones. And they seem to think that, ‘Oh you think that you’re… it’s gonna magically fix your problems’. No, we don’t think it’s gonna magically fix our problems. I think it’s gonna magically get rid of half of my dysphoria, because I’ll have the hormones and I think they don’t, they don’t get just how awful it is to wait that long and then just be moved. And then, you know, when you get there and it’s a 6 months assessment, it’s ridiculous. They need to take into account that now the wait is a very long time and therefore when people get there, suddenly going through ‘Were gonna do a six months assessment and are you sure you want hormones?’ All of that is just, it’s offensive that they do that when you get there, so.

Yeah, I think the thing that, there needs to be people that are experts and are going to show that expertise, I can’t be the expert in my own healthcare. That’s not always the best situation. I mean sometimes it’s a good thing but it’s like more often than not I need people that know something, at least know something. And I can see on a regular basis. I don’t know, I think that it just needs to be, well it needs to be more with it, I guess. Honestly, I don’t know. Like I think for me if I had seen them on like, a less, if there was less of a wait time and they were closer, that service would have been fine. It still wouldn’t have been like the best thing ever, but it would have been fine, it wouldn’t have been like the kind of mess it is now. I think it’s all just you know, it just needs to be like accessible at some point. it’s nothing really, that’s the first thing that needs to happen before anything else, and I don’t know, I don’t see the point of like tinkering around the edges when you’ve got that huge gaping failure. It just doesn’t matter. It just, it doesn’t matter like you can, like I don’t care, and I guess this is very like, the way it is to me is kind of a very classical transsexual, but it’s like you can’t really change language, you can’t really change like, at some points it needs to be there, it needs to actually function. And it doesn’t.

How would you like to see healthcare services change in the future?

For them to be actually free fair and equal. To prioritise Trans health but like prioritise Trans healthcare but not prioritise it above anything else because it’s an, it’s a service that should be accessed as much as any other service should be able to be accessed and it just means that NHS needs a whole lot more funding and the ways that we think about Trans people needs to transform it needs to change and the longest you should wait is like a couple of weeks before you like, the process needs to just, the process is built on a basis of like transphobia, it’s built on a basis that like Trans people don’t know themselves, that we need however X amount of time before we can truly decide like once we’ve actually, it’s just built on like a very harmful and toxic structure and so just, for that to just be completely overhauled and just make services accessible to whoever needs them.