NHS Policy Audit - working party -Thread #3

Just seen this thread, and hope the following are useful . . .
West London NHS Trust policy (freely available).

I'd draw your attention to the 'Case Example' on page 14 / 40, and the 'Scenario' on Page 16 / 40.

T7 Trans Policy How to care for the needs of our patients.pdf

@GreenAllOver, re Harman and the PIE scandal. I’ve always been very confused by that, and how anyone, even the most liberal, would think that it was an acceptable stance to take. However, because of another thread on here, I happened to go back and re-read about the German experiment that placed foster children with paedophiles, and there was a certain amount of background explanation for how this came to be seen as ok.

Basically, the take was that, pre-WWII, Germany had such an antiquated view on sex and sexuality, that anything remotely non-vanilla, or not between married couples, or not for procreation purposes, was seen as deviant. And that that repressed attitude was one of the things that led to Naziism (not saying I agree with this thesis, just that it’s what was put forward at the time). Therefore post-WWII, there was a push to the other extreme — everything should now be out in the open and explored and made “normal,” including things that should probably have come under the heading of paraphilia or fetish.

I’m certain that there were bad faith actors working out ways to take advantage of this, but if I squint, and look sideways at it, I can sort of see why some people, who just didn’t want to be on the wrong side of history, might have gone along with things beyond a point where they could (visibly) back out without looking like traitors to the cause.

I don’t, maybe some of the more knowledgeable posters about Labour politics will. The Tom Harris thread has some people who remember a lot of this.

What I do know is her history with Harriet Harman at Liberty (the PIE scandal) and this Guardian article showing her being lobbied in her previous SofS role by Press for Change in 2002.
https://www.theguardian.com/politics/2002/dec/22/gender.immigrationpolicy

So it’s plausible (but note I have no evidence, this is purely supposition) that she was always interested in what she saw as liberal and human rights causes, and Press for Change therefore lobbied her, built up a relationship, and then moved that to focus on health issues when she moved from Trade and Industry to Dept of Health.

PS Apologies for error in previous post, should be Alan Milburn (not Andy).

And we end with an EqIA checklist that ticks the "neutral impact" column for all 9 PCs (in which sex = sex/gender and gender reassignment = transgender)

So taking you back to the introduction for this gem:
"The law and practice in this area may continue to change and so we will continue to review this Guidance regularly to make sure it is kept up to date. It has deliberately been written in a simple format to make the document as accessible as possible. However, its simplicity should not be read as an attempt to minimise the complexity of the subject matter."

Now going to do something else for a while after repeatedly shaking my head very hard to dislodge everything that I've just read.

This is really good @GreenAllOver. Do you know what the deal is with Patricia Hewitt and the switch to dependence on GIRES for policy-writing?

@Cantunseeit:

If the service user has a sex offending history, risk should be managed in the same way as it would be with any other client, irrespective of gender. The vast majority of transgender people are entirely law abiding, with the notable trait that they (understandably) tend to be more private than others. "

Ha HA!

Oh dear. I’m crying. I also have a swamp in Florida that the writer of that piece of speculative fiction might be interested in buying.

another one and still 10 pages to go of this off the scale steaming pile of shit

"12. Using Toilet and Shower Facilities
Toilet and shower facilities are generally private and consequently trans people should be able to use the facility appropriate to their preferred or acquired gender.

If a person holds a Gender Recognition Certificate, or you have reason to suppose they do, then they are legally entitled to use those facilities.

If the service user has a sex offending history, risk should be managed in the same way as it would be with any other client, irrespective of gender. The vast majority of transgender people are entirely law abiding, with the notable trait that they (understandably) tend to be more private than others. "

Ah yes, the transphobia is “gender racism” trope.

My bingo cards are getting worn out here.

I am starting to reach the point where I don’t think that anyone outside of the TQ people who wrote them ever actually read any of these policies.

OMG

"7.1 Supporting Trans people
Often staff are concerned about the possible risks and vulnerabilities that could arise as a consequence of admitting a trans patient on a ward during transition, but these should be assessed in light of the cause of that concern. Patients may, of course, be moved, but not on the basis they are trans and not to an inappropriate setting. Just as a BAME patient would not be moved to an inappropriate ward due to potential racism by other patients, so too should a trans person not be moved from a ward appropriate to their acquired gender due to prejudice of patients or staff."

@KnottyAuty Looking through the timeline, this is how it pans out for each SofS up to 2010:

• Early Blair era SofS’s for Health (Dobson, Milburn, Reid), from what I can see really did preside over an attempt to eliminate mixed sex accommodation.
• Patricia Hewitt presided over the setting up of SOAG (soon SOGIAG) and the first publications in the GIRES series
• Alan Johnson inherited a legacy of work in train (more of the GIRES documents, a joint NHS CE and Stonewall CE letter just after he was appointed) and on his watch the May 2009 CNO letter with the Annex E was published
• Andy Milburn continued what Alan Johnson had started, with Annex B in 2010

I agree completely, but we would need to be aware of all of the policies where this has potentially been injected, even if only one or two lines - maternity care, consent, chaperoning…

Sorry to spam the thread but sharing these glorious examples while I'm finding them (glorious only for the new heights of batshit that they reach)

"4.4 Summary
The Equality Act 2010 prohibits discrimination against someone who is undergoing gender re assignment. People are not required to have undergone or plan to undergo a surgical or other medical procedure to receive protection.

As part of the process, an individual is required to live ‘in role’, they will therefore need to access facilities relating to their acquired gender.

Once an individual is deemed to have successfully transitioned, they can apply for a Gender Recognition Certificate, giving them legal recognition of their acquired gender. An individual does not have to undergo a surgical procedure to apply for a Gender Recognition Certificate. Once an individual has a Gender Recognition Certificate, it is an offence to disclose their previous gender history."

Agree, it is vague and not water-tight but it is a significant shift away from the 2019 guidelines.

I feel we should be campaigning for a centralised SOP that is extremely clear and not open to mis-interpretation. This would also save Trusts much time and money by not having to develop their own.

I'm sure there would be lots of drawbacks to this approach but it would also speed up and de-risk the implementation

When a single room is not available, this will be escalated operationally (to gain relevant support to agree level of risk to all patients requiring a cubicle)

This seems quite a vague statement to me. What risk are we talking about here?

The risk involved in placing a trans-identified patient on the ward of their sex presumably, since the alternative would breach same-sex exemptions.

We should be very wary of vague statements. We've seen what happens when activists start interpreting them.

Saying the quiet parts out loud at Oxford Health NHS Foundation Trust:

"Trans people, who may be male or female of any age, are those people who live all of the time, or part of the time in a way which is not usually associated with the gender which they were assigned at birth. ‘Trans’ is an umbrella term which includes those people who live or wish to live full time in their preferred gender (transsexual people) and those people who live part of the time or on
special occasions for reasons of comfort or sexual pleasure (sometimes called transvestites). Transsexual people sometimes have hormones and surgery to make their bodies more congruent with their internal sense of gender."

On a quick look, some of these links might be helpful, at least in shaping an FOI request that will get a useful answer. This is from 2018:
https://www.cqc.org.uk/publications/major-report/sexual-safety-mental-health-wards

And this from a bit later:
https://www.gov.uk/government/publications/rapid-review-into-data-on-mental-health-inpatient-settings-final-report-and-recommendations/rapid-review-into-data-on-mental-health-inpatient-settings-final-report-and-recommendations

I recall an earlier (possibly annual) series of reports on safety on inpatient mental health wards, but could only find these more general ones, but if you’re interested they might have some useful information:
https://www.cqc.org.uk/publications/monitoring-mental-health-act

Surrey and Sussex Healthcare submitted

Tricky to find any info at all. I think patients could struggle to find the Privacy and Dignity Policy that covers patient accommodation and I couldn't find anything about staff.

This bit looks promising:
Accommodation for transgender people and gender variant children
Single Occupancy/Side rooms may be the preference of the patient or may be the most appropriate option and this will be the standard approach for all transgender patients. The patient will be asked if they are happy with a single occupancy/side room with ensuite facilities..., but this must be done in discussion with the patient ensuring their consent.
If there is a circumstance where the patient does not wish to have a single occupancy/side room or there are any concerns in relation to the requirements of a patient presenting as transgender these should be discussed initially with the patient in a sensitive manner however if there are still concerns or an agreement cannot be reached these should be escalated...
But then the wrecking-ball which is the NHSE guidance
APPENDIX 4 - National Guidance Delivering same-sex accommodation for trans people and gender variant children (NHSE/I 2019)
P30 Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use.
P31 In some instances, parents or those with parental responsibility may have a view that is not consistent with the child’s view. If possible, the child’s preference should prevail even if the child is not Gillick competent.

OK thanks I'll check it

How about Surrey and Sussex Healthcare NHS Trust

Hello I don't think I have submitted Kent & Medway NHS & Social Care yet - if I have, it's in error as am still working on the last few bits

This must feel incredibly frustrating but it isn't as bad as it seems. The consultation isn't 'Britain's Got Talent' or Strictly. There is no weight of opinion involved. The EHRC has invited opinion on its draft guidance to ensure that factual errors and gaps are covered off before the final guidance is presented to the SoS.

Also good advice!

You might be able to take some of this - assuming you want to raise with the Trust that they're risking seeming biassed and potentially falling into error by not consulting with all stakeholders? That's the route I went with my Trust (no reply yet from the EDI lead, who is a transman so very neutral obviously). Alternatively you could try asking the Freedom to Speak Up Guardian to raise it as a concern, if you want to be anonymous, depending on how neutral your FTSUG is

https://www.legalfeminist.org.uk/2025/04/29/where-are-your-values-now/

So if I understand correctly, your trust wants to respond to the EHRC consultation, and they are soliciting responses from their members, via the LGBTQIA+++ network. I presume these responses will not, therefore, be anonymous within the trust? And that you will have no control over how (or even if) they are used? I can see your concern.

To start with, no matter what anyone responds in the consultation, the EHRC cannot in any way shape or form change the SC ruling. The consultation is rather about how to make the SC ruling clear and understandable to service providers. The things that could possibly change as a result of the consultation would be stuff like the wording of examples that are given to illustrate situations and how people should respond to them. I agree with you that your trust is behaving dodgily, but I’m not sure how much damage they can do.

However, you know that you can also, as an individual, respond to the consultation? And that you can say what you have said above - that your trust (which you could name) is soliciting feedback, but rather than asking people to respond as individuals, is collating responses (and potentially editing them, who knows) via a group which appears to have a particular agenda with respect to the consultation. I think if you’re concerned, that might be a way to go. And if you don’t want to respond to the consultation, you could simply email the EHRC, and/or one of the commissioners (Akua Reindorf is one).

Hi, apologies for asking here, but you are the most knowledgeable people I know about this.

I work for a mental health trust.

Re Supreme Court FWS judgment, they've done the usual - ignored women, offered support to LGBTQ+ colleagues.

They say they will respond as a Trust to the EHRC consultation, and they're seeking input/contributions - via the LGBTQ+ networks, asking us to send contributions to the chair of the LGBTQ+ network. No other contacts given.

I assume many women won't feel comfortable sending responses to this guy (LGBTQ+ chair) - he's made his position pretty clear.

I'm not even sure who to ask about this.

I'd like to know how the Trust includes individual contributions in their Trust response, and who decides what their position is going to be.

Has anyone else come across this, or got any suggestions?

Thank you, as always! xx