NHS Policy Audit - working party -Thread #3

I can take a welsh trust

Just popping in to wave at you delightful vipers from the back room where I’m heaving boxes of Tunnocks around collating your impressive work. Can’t believe we’re nearly at the finish line - you are all incredible!

Thank you so much @Mipe Can you pick up Aneurin Bevan University Health Board and Betsi Cadwaladr University Health Board. I'll send you the new link.

@FarriersGirl I have submitted Wirral University Teaching Hospitals NHS Trust and Clatterbridge Cancer Centre NHS Trust so I'm ready for some more 😀

Next up for the vipers is Wales🐉

The structure is more similar to Scotland being mainly health boards that deliver both acute, and mental health and community services. There is one specialist trust and an ambulance service. Don't forget that you will need a new jot form link that will be DM on allocation of your first trust.

NHS Wales

Aneurin Bevan University Health Board
Betsi Cadwaladr University Health Board
Cardiff and Vale University Health Board
Cwm Taf Morgannwg University Health Board
Hywel Dda University Health Board
Powys Teaching Health Board
Swansea Bay University Health Board
Velindre University NHS Trust
Welsh Ambulances Services NHS Trust

"If you auditors can press on with Wales & Northern Ireland while all the English data is being worked up, then with a fair wind, we might be ready for follow up stories at the end of the summer?"

This should be doable, the NW has taken a while but its a big beast of a region. Wales and NI are smaller and have freshly minted FOIs from our friend Ermine I believe.

It's unlikely that they're talking to each other so you could take a scattergun approach and ask them all. There'll be people who have asked these questions before so you will add to a pile that they shouldn't be able to ignore. Guess they're waiting for the guidance on how to have single-sex spaces that are single-sex because it's so confusing.

Thanks @Cantunseeit they never fail to to prioritise TiM do they🙄

@KnottyAuty I will get Wales posted up ready to start tomorrow hopefully. I have had a long day [early start] and seen almost nothing of the tribunal but it should be easier tomorrow.

Just submitted Wrightington, Wigan & Leigh NHS Foundation Trust, which included guidance for phone responders in its transgender patient SOP (focussing on how to identify and placate transwomen who have been misgendered because they sound like men on the phone). I haven't come across this before. Unfortunately, the pdf was locked and no C&P possible so had to retype examples in the jotform and this guidance was too long so I've made a note with the page ref.

The staff SOP - whilst delusional and with an interesting view of the law - included the following, which NHS Fife may be wishing they had thought of:

"Where locker or shower facilities are open plan then it is good practice to review this, and, at the least, provide some provision (e.g. curtained spaces) where staff need not be in a state of undress in the presence of others. If it is genuinely impossible to to adapt locker or shower facilities in order to accommodate a pre-operative member of staff in a state of undress then this is one very limited example of an instance where the law permits the employer to make separate arrangements. It is highly unlikely that the employee concerned would object to this pre-operatively..."

... but of course Dr U would very much have objected ...

and I have no words for this:

"...It is also important to appreciate that if anyone is likely to feel vulnerable in the toilet then it will most likely be the trans person - being acutely aware of the incongruity of their anatomy and certainly not wishing to draw any attention to this."

Please may I ask a general question? My trust still has its non-compliant "Gender Identity" etc etc policies on its intranet
(as well as still putting out regular messages about how much they support LGBTQ+ people who are sad after supreme court ruling - nothing about supporting women of course)

Who would be the right person to get in touch with to enquire about their plans for the policy? Would it be HR? Communications? Directors? DEI (lol)?.

Thank you so much for all you're still doing.

Latest snippet from CNTW bulletin:

Do you speak Urdu or Punjabi? We need your help!
We're looking for clinical staff who speak Urdu or Punjabi (or both) and identify as a woman to help plan and deliver a mental health awareness session for a local women's group. This is likely to be a one-off informal session and is an opportunity to promote mental health awareness in communities which may face barriers to accessing mental health support. If you would like to support this activity or are interested in finding out more, please email

@NeedMoreTinfoil Hello seen you some place else recently 😀I am following this thread too and feel guilty i have too much on to contribute, don't worry about it. We can only do what we can do.

I'm so sorry I haven't been around to help recently, two family members going through devastating life changing illness plus nursing the much loved old dog through terminal cancer til we had to say goodbye to him has kept me a bit occupied, to say the least. You lot are doing a terrific job.

@YellowRoom jeez that is egregious to say the very least.

Sorry just trying to catch up and I missed this earlier. As you will see we have reached the end of the English trusts. Wales is next so if you keep an eye on this thread you can volunteer for that.

Evening lovely vipers. I hope we are all enjoying the tribunal. I have now allocated the last trust in the NW and as the update below shows there are just a handful left to actually complete England. I am sure we will get these done over the next few days.

Acute trusts

Blackpool Teaching Hospitals NHS Foundation Trust - teawamutu
Bolton NHS Foundation Trust -teawamutu
Countess of Chester Hospital NHS Foundation Trust - cantunseeit
East Cheshire NHS Trust - cantunseeit
East Lancashire Hospitals NHS Trust - cantunseeit
Lancashire Teaching Hospitals NHS Foundation Trust - mipe
Liverpool University Hospitals NHS Foundation Trust - withsilverbells
Liverpool Women’s NHS Foundation Trust - mipe
Manchester University NHS Foundation Trust - yellowroom
Mid Cheshire Hospitals NHS Foundation Trust - FarriersGirl
Northern Care Alliance NHS Foundation Trust - cantunseeit
Mersey and West Lancashire Teaching Hospitals NHS Trust - yellowroom
Stockport NHS Foundation Trust - Mipe
Tameside and Glossop Integrated Care NHS Foundation Trust - teawamutu
University Hospitals of Morecambe Bay NHS Foundation Trust - LadyElaine
Warrington and Halton Hospitals NHS Foundation Trust - cantunseeit
Wirral University Teaching Hospital NHS Foundation Trust - Mipe
Wrightington, Wigan & Leigh NHS Foundation Trust - cantunseeit

Ambulance trust
North West Ambulance Service NHS Trust - Yellowroom

Community and mental health trusts

Bridgewater Community Healthcare NHS Trust - cantunseeit
Cheshire and Wirral Partnership NHS Foundation Trust - LadyElaine
Greater Manchester Mental Health NHS Foundation Trust - withsilverbells
Lancashire and South Cumbria NHS Foundation Trust -yellowroom
Mersey Care NHS Foundation Trust - FarriersGirl
Pennine Care NHS Foundation Trust - Blackmetallic
Wirral Community NHS Foundation Trust - FarriersGirl

Specialist trusts

Alder Hey Children’s Hospitals NHS Foundation Trust - cantunseeit
Liverpool Heart and Chest NHS Foundation Trust - yellowroom
The Christie NHS Foundation Trust - FarriersGirl
The Clatterbridge Cancer Centre NHS Foundation Trust - Mipe
The Walton Centre NHS Foundation Trust - teawamutu

I have submitted Lancashire and South Cumbria which has secure mental health facilities. The notes section is enormous as there was so much material.

Staff stories
Sally's story - Starting work in the early 2000s came with challenges around the use of the toilets and changing areas. Sally was often faced with conflicting and changing messages and was often stopped from using the female facilities making her feel degraded, unwelcome and denying her social existence. Only when the Gender Recognition Act was introduced in 2004 did this become less difficult.
Jay's story and Guild Lodge (supposedly single-sex secure MH wards). He had already been ostracised by his peers on coming out as lesbian at high school and that had a huge impact on his mental health... He’s exploring areas where he believes further education is needed around LGBTQ+ matters, such as schools

Staff Policy
Providing effective and compassionate support will involve educating oneself with relevant and credible information...
Once Gender Recognition is granted then a trans member of staff who may be carrying out intimate care or observations must be treated as their assigned gender and a GOR cannot be claimed.
There is evidence that sex differentiation of the brain may be inconsistent with other sex characteristics, resulting in individuals dressing and/or behaving in a way which is perceived by others as being outside cultural gender norms.

Patient policy
Where a trans person is visually and for all practical purposes indistinguishable from a nontrans person of that gender, they should normally be treated according to their preferred gender
Arrangements for searches should be made where possible by mutual agreement with the service user and within the guidance... Any search of a service user’s property or clothing should be carried out by a staff member who is the same gender that the service user identifies as. For example, a trans man should be searched by a male member of staff and a trans woman searched by a female member of staff.
...trans people should be able to use the facility appropriate to their preferred gender. If the service user has a sex offending history, risk should be managed as it would with any other service user
It should be noted that Trans people, like cis gendered people, may neglect personal care when they become unwell. This can mean that trans people appear more like their birth assigned gender. This should not be considered as a change of mind in relation to their assigned gender and indeed therapeutic benefit may be gained through assisting trans people with appropriate self-care (for example assisting a trans woman with shaving and hair removal or a trans man with breast binding).
If the transitioning service user has a sexual offending history, would this risk be the same on a male or female ward, and what can you do to manage this risk
Service users who have difficulties accepting trans service users - This may put the service user at risk, so enhanced observation may be necessary, until it is felt that the risk is no longer present. It may be prudent to begin to pro-actively run activities on the ward to discuss trans issues or issues relating to difference generally to help improve awareness and attitudes of service users towards trans people.
Trans people (like everyone else in Britain) can use toilets or changing facilities appropriate to their gender presentation with or without a Gender Recognition Certificate
The “Real Life Experience” will need to be deemed complete, before a recommendation for gender reassignment surgery is made. The experience of living in a new gender role is used to assist in determining whether a service user has demonstrated a satisfactory adjustment to a new gender role in a real life setting. Consequently, it is important that we treat people in accordance with their presenting gender and facilitate their access to facilities that relate to their presenting gender, in order for them to take the next steps in their transitioning journey, if we do not facilitate access we could be subjecting the service user to a disadvantage that is unlawful under the Equality Act 2010.
Case study - ‘Julie’ needs to be admitted as an inpatient. Julie has been living as a woman for ten months, her birth gender was male. Staff consider Julie to be too unwell to have the capacity to determine the gender ward for admission. The staff assume that her presentation is that of a male dressed in women’s clothing. Julie does not have a Gender Recognition Certificate (GRC), she has not changed her birth name by deed poll, and the Rio records state that she is a male. As there has been no gender reassignment surgery, they decide that Julie will have to be admitted to a male ward. INCORRECT...

Nancy Kelley addressed the Trust in 2022 - there's a video on YouTube.

Brilliant Tea! I award you the very last English Trust, The Walton Centre NHS Foundation Trust.

Tameside done, @FarriersGirl - want me to pick up another?

Thank you we are almost there Wrightington Wigan and Leigh NHS Foundation Trust is all yours and the last acute trust.