SRS at Charing Cross restricted to CHX GIC patients only

[Steph]

Following this issue originally raised by ClaireWYorks back in April 2009 and experienced by myself since the start of the year, I thought it was time to bring this back into the public area again.

Just to clarify some of the issues and to provide a response as to what is being done.

Effectively, anyone wishing to have their SRS at Charing Cross Hospital on the NHS, but whom have not been through CHX GIC itself, will be expected to undergo further assessments/referrals at CHX GIC in order to do so. Charing Cross presently will not recognise any opinions/referrals for surgery that have been obtained from any other NHS regional GIC, or recognised and registered consultant psychiatrist in the field of Gender Identity Disorder outside of those three at CHX GIC.

In my own case, having had funding for SRS at Charing Cross agreed with my PCT (on grounds of NHS Choice) and having obtained the neccessary opinions from two regional GICs, when I was onwardly referred to the Gender Surgery Unit at Charing Cross, I was informed that they could only accept referrals directly from CHX GIC.

The expectation was therefore to undergo two brand new assessments/opinions for surgery, at a cost IRO £950 per appointment to my PCT - disregarding the two referrals for surgery already obtained. In addition to this, there was no appreciation that one has already been through a lengthy care pathway at their own GIC (having completed assessments, psychotherapy, etc), or that they have already been subject to sufficient psychiatric examination as it is.

As a patient will be also be considered as a new referral to GHX GIC, they will be subject to their already lengthy timescales for appointments. In my case, this has added almost one year wait to getting surgery from when I first referred. In various communication with a consultant psychiatrist at CHX GIC, the attitude shown towards me and other consultant psychiatrists involved in my care has been frankly one of utter contempt.

At the beginning of the year, I was only aware of my own case, however, throughout the year it has been learned that this is affecting people up and down the country. The reality is that it's probably been affecting people for years, but such is the visibility problem within the trans community that we simply do not know the true numbers this is affecting or has in the past affected.

Following discussions between my PCT and Charing Cross, as well as enlisting support from Stephen Whittle (PfC), Terry Reed (GIRES) and Denise Anderson (GSUK), this issue was first publicly raised at the CHX Stakeholders meeting in October 2009.

The psychiatrist representing at this meeting said that they would take this forward to Charing Cross, and assured us that this was a policy set by Imperial NHS Trust. This is also supported by my own correspondence with a prominent surgeon.

In the meantime, Terry Reed has raised the issue with the Parliamentary Forum on Transsexuality. Following this, Terry Reed, Dr Lynne Jones MP and myself have since been communicating with Imperial to seek further clarification and information as to why this restrictive policy exists. This is now ongoing through the Parliamentary Forum.

Given that there are only 3 NHS SRS surgeons in the country, the current policy between Imperial and CHX GIC means that 2 of these surgeons are effectively ring-fenced to only those that have been through CHX GIC. This would appear to even run against the NHS's own charter where NHS Choice supports the patients right to undergo surgery in another part of the country or with a specific hospital based on their preferences of peri and post-operative care and support.

Whilst this remains at present an ongoing and unresolved issue, I would ask any persons that are suffering the same problem (or if you are aware of someone who is), that they inform GSUK, GIRES, PfC, or even via their local MP or Dr Lynne Jones MP directly, so we can not only gain a better picture of just how many this is currently affecting, but by adding unified strength to the campaign we can succeed in getting this somewhat unfair and discriminatory policy eventually over-turned for the benefit of all trans people in the UK.

[Helen_Mortimer]

Steph, many thanks for resurrecting this posting.

[foibey]

Wow. CXH's arrogance is astounding.

[Steph]

Just to let you know that this is ongoing, with both Dr Lynne Jones continuing to take this forward where possible at the Parliamentary Forum, but also I have been speaking recently with the Yorkshire and Humber Specialised Commissioning Group whom are now also in extensive discussions themselves with Imperial and Charing Cross over this whole issue.

As I am neither closely involved with either Parliamentary Forum or the YHSCG, and have become somewhat party myself now to merely updates from them both, there is little I can actively pursue in this area any further - I'm happy that we've been able to create the groundwork and GSUK has been a platform for the issue to be raised, discussed and managed so that those in higher levels can now progress with it.

Thanks to those here for being able to make this possible, however, following careful deliberation I feel its time for me to now move on - I've got plenty of other pressures at the moment from elsewhere, not helped really the last year by trying to walk a careful line between becoming politically involved/active whilst also maintaining my social stealth, and finally, in other news it looks like I will finally be having SRS which I have been utterly desperate. Of course, I hope that I can continue to keep GSUK posted outside of this forum of any developments with this particular issue if/when I am made aware of them.

[paula_p]

Hi

This directly affects me. I had a surgical referral in 2004 (obviously having fulfilled ALL required criteria and been judged fit for surgery) which was messed up by an internal mix up between my clinic and the sourcing of a psychiatrist appointment for the second referral.

My clinic has now closed with the retirement of the consultant and my funding PCT are internally contracted to CHX for ALL gender related matters.

I have attended CHX for their "initial assessment" meeting which I found was the same level of arrogance and deliberate disregard to the facts of my case and situation. I am now to be pushed through the full 2+ years of "psychoanalysis" and real life TEST (not experience.. they lay the "guidelines" down as carved in stone with no regard for care or law) with no regard for my previous qualification and completion.

As a result of their "healthcare procedures" I have suffered a massive amount of damage to my mental health this week. Twice I have needed suicide prevention intervention from the emergency services.

Can somebody show me in law please where "full time employment" is a hard and fast requirement for surgery or to proceed through the system? I work four days a week in a voluntary role for a charity already having been on higher rate long term incapacity benefit for 12 years as a result of a complete nervous breakdown caused by work related stress and abuse. I was in full time employment until I became too ill to work

After a personal consultation with the welfare disabilities advisor at the local job centre they class me as a disabled person who will need support and help as a disabled person to gain any training or employment. They feel this requirement is abusive and very probably illegal under the terms of the disabilities laws. They feel that the law is being ignored with regards to the rights it gives me as a long term ill person, and that I am now being illegally denied state funded treatment because I qualify as borderline disabled. As the denied "treatment" is regarded as the "cure" for my condition I don't see how they can defend themselves from a legal challenge. Any person who has been diagnosed and is (and has over 9 years) receiving treatment for a condition which lists as a "mental illness" can and does qualify as a disabled person under the law.

I think we have very solid grounds for a case of abuse and illegal denial of treatment against CHX (and also against Imperial). This is over and above any grounds for legal challenge concerning unnecessary duplication of diagnosis and treatment and wasting public funds. Also worth considering is the legal obligation for every NHS region to provide services within their region. Clearly in the North West they are failing in this obligation by the use of restrictive internal contracts.. again there looms the spectre of denial of patient choice for no other reason than the determination by CHX to put themselves into an almost godlike role as "the only providers" of services on a national level.

I have months now to "comply or be denied" so I am open for suggestions as to how to proceed. I think the disabilities welfare branch of the Employment Service may be most helpful in finding out about the actual legal status of this "policy" from another angle.

[Helen_Mortimer]

Paula, your situation sounds appalling, but at least you are thinking about steps to wrest back some control.

My view is that you need to think carefully about taking the NHS to court - that's in no way to say I think you shouldn't, quite the reverse in fact - but as someone with a history of work-related stress you need to consider whether you would be able to cope with the stress associated with a court case. If you are seriously considering the legal route then you probably need to contact Stephen Lodge (a barrister with much experience in trans cases) initially for his advice. Also, have you used the other "complaints procedures" within the NHS? I suspect that the legal system would want you to have at least tried to resolve the situation amicably.

To answer your other question regarding eligibility, I haven't been able to think of any other situation since considering my future in 2002 where medical care is dependent upon you being employed to the satisfaction of medics. I've known a couple of TS people in there 60s who had to get voluntary jobs to satisfy the ChX psychs before they were prescribed hormones. I can understand the psychs wanting some kind of proof that you are functioning in your chosen role (whatever that is), and I suspect that they have simply landed on employment as an easy way out because any other approach would require more effort (and hence more resource) to check. But it seems to me to be just another "one size fits all" approach and, I suspect as you do, falls foul of anti-discrimination laws, particularly in the current economic climate where just waltzing into a job to satisfy medics is not going to be terribly easy.

Finally I do wonder how many people are getting caught out by this seemingly new policy and are just remaining quiet because they're afraid of the possible repercussions should they take things further.

I wish you well.