Greater Manchester Trans Health Service

[MoleSmokes]

This is something that the investigative journalists could do with looking into sharpish, to present a fuller picture of the issue with the NHS falling for Gender Identity Ideology and plans to pump funding into "Trans Services" for adults across the UK - the Manchester pilot starts Sept 2019.

This is an update on my first post on this subject, in the thread "'Prominant' campaigning role of Tara Hewitt: NHS, TELI, Social work, universities etc"
(Post #92 Tue 09-Apr-19 12:45:20)

There are several documents that need to be cross-referenced to follow the audit trail, which leads via NHS National Specialist Commissioning back to our old friends in the Parliamentary Women's and Equality Committee and its various Consultations, Reports and Recommendations over the last few years.

However, I think that these are the most recent, relevant documents.

March 8th 2019
Report to Greater Manchester Health Care Board
"Greater Manchester Trans Health Service"

www.gmhsc.org.uk/wp-content/uploads/2019/03/07-Greater-Manchester-Trans-Health-Service.pdf

Greater Manchester Health and Care Board
08 March 2019
Greater Manchester Trans Health Service
Sarah Price, Executive Lead for Population Health and Commissioning
Paul Martin, Chief Executive, LGBT Foundation

SUMMARY OF REPORT:
In the face of the ongoing challenges which the trans and non-binary population face within Greater Manchester in accessing advice, support and specialist services, GM has been exploring an alternative model to respond to these needs. GM has now been identified by NHS England as an early adopter pilot to test a Primary Care-led Trans Health Service for Greater Manchester which will commence in September over a two-year period. The development of the service has been truly co-designed with the VCSE, those with lived experience and primary and secondary care clinicians. The outputs of which have informed the NHS England Service Specification.

KEY MESSAGES:

 Currently, there is no local Gender Dysphoria Service provision for this group of patients in the North West with GM residents accessing services from one of seven Gender Dysphoria Clinics, (GDC). Most GM patients access the Leeds, Sheffield and London clinics.

 Current provision does not meet the needs and expectations of patients with long waiting times to access NHS England Gender Dysphoria Clinics, (GDCs) with waiting lists of circa two years.

 GM has been listening to the local trans and non-binary population to understand the challenges and explore how we could improve their experience, including outcomes, both physical and mental health and wellbeing.

 There is also a lack of advice and guidance for clinicians and health care professionals which often results in patients being referred to GDCs inappropriately.

 NHS England are exploring alternative models to increase clinical capacity therefore reducing waiting times and improving the patient experience and were keen to engage with GM in respect of our work to date. The GM architecture also lends itself to implementing a GM wide offer.

 GM has been identified by NHS England to be an early adopter site to test an alternative model for a Trans Health service which will commence in September 2019.

 GM established a collaborative process to develop an innovative primary care model for GM transgender development. The ground swell of engagement and support from potential service users should not be underestimated and this approach has been met with overwhelming support.

PURPOSE OF REPORT:

This paper aims to provide an update to the Health and Care Board of the development of a GM Trans Health Service. It sets out some of the challenges which the trans and non-binary population face and the approach of co-design with key stakeholders to inform the service specification. The Health and Care Board are requested to support the progress to date and the approach of co-design with the VCSE and those with lived experience and other key stakeholders.

RECOMMENDATIONS:

The Greater Manchester Health & Care Board is asked to:

 Support the development of the Trans Health Service in Greater Manchester.

 Note the progress of the development of a GM Trans Health Service.

 Note the approach of co-design with key stakeholders, particularly the VCSE sector and those with lived experience.

CONTACT OFFICERS:

Sara Roscoe – Associate Director of Transition and Development, GM Health and Care Commissioning
[email protected]

Nov 2018:
GM Trans Health Service Community Survey Report by lgbt.foundation

www.gmhsc.org.uk/wp-content/uploads/2019/03/07a-GM-Trans-Health-Service-Appendix.pdf

Tell me what you think looks odd about this extract from the survey report??

Demographics of respondents

The survey elicited 145 valid responses from trans and non-binary people living in GM who would like to access a THS in GM.
The majority of respondents (66%) were living in Manchester, while Rochdale and Oldham had the lowest number of respondents (2%) per borough.

Most respondents were aged between 14 and 34, while fewest respondents were aged 65 or over.

46% of respondents were women, 26% were men and 23% were non-binary. 5% described themselves in another way, including trans masculine and intersex.

11% of respondents were lesbian, 5% were gay, 38% were bisexual, 9% were heterosexual and 38% described their sexual orientation in another way. The most common responses within this category were queer, asexual, and pansexual.

89% of respondents were white, and 11% were Black, Asian, or Minority Ethnic (BAME). Notably, no respondents were from Black African or Black British African backgrounds.

A significant majority of respondents (61%) were disabled compared to 39% of non-disabled respondents.

This suggests that accessibility and inclusion of disabled trans and non-binary people is a key consideration for the service and that there is potential for the majority of those using the service to be disabled and/or living with long term conditions and mental health conditions. Prior research into the UK trans population has suggested a higher prevalence of disability1.

Unemployment was high among respondents; 26% were unemployed, 51% were in full or part time employment, 22% were in full or part time education, and 4% were retired. These findings correlate with existing evidence regarding employment in trans and non-binary communities 2,3.

A significant number of respondents had caring responsibilities (17%) while 9% were parents.

None of the respondents told us they were living with HIV, however 9% of respondents disclosed that they did not know their HIV status and 40% chose to skip the question.

----

This bit:

46% of respondents were women, 26% were men and 23% were non-binary. 5% described themselves in another way, including trans masculine and intersex.

11% of respondents were lesbian, 5% were gay, 38% were bisexual, 9% were heterosexual and 38% described their sexual orientation in another way. The most common responses within this category were queer, asexual, and pansexual.

Do you hear what I hear?
Transwomen are women!
Transwomen are women!
Transwomen are women!
Transwomen are women!

I might be wrong but nowhere does the report define what it means by "women". If I am right, then "Self-ID" is embedded in the consultation, the report and the plan.

Some things that concern me:

1) This would appear NOT to be a service primarily for people who have gender dysphoria, ie. a medical condition which is properly of interest to the NHS.

Instead, it would appear to be catering primarily for people with an ideological identity as "trans" and adult males whose "identification" as women might be more likely due to Autogynephilia than Gender Dysphoria.

I have found another document that states an expected 900 referrals in the first year to Manchester, with levels rising as time goes on. This put me in mind of the BAGIS (British Assoc of Gender Identity Specialists) submission to the Governerment "Trans Equality Report" (?) mentioning that NHS services were overwhelmed with referrals from the Prison Service. Will link when I find it again.

Another Ref:
www.bmj.com/content/362/bmj.k3371/rr-0
Letter in Response to "Trans health needs more and better services: increasing capacity, expertise, and integration"

"Research is needed to explore the interplays between gender dysphoria, mental health problems, autism spectrum disorders, sexual orientation and unpalatable roles in our highly gendered society.(4) More understanding is required into the complex interactions between autogynephilia (a male’s propensity to be sexually aroused by the thought of himself as a female) (5), sexuality and sexual preference, male to hyper-sexualized female transgenderism, and hormonal or surgical treatment. Good Medical Practice requires doctors both to discuss uncertainties about the effects of treatments (6) and also to work with trans communities to create new knowledge together. "

2) If this is NOT a service primarily for people with gender dysphoria, this contrasts starkly with parents having to fight in the courts for services for children with disabilities, with NHS and Education passing the buck!

--

Sorry if this is disjointed and incomplete - in a bit of a rush and I thought better to get this info posted asap!

When I have time I will add info in replies with links to other relevant documents I have found.

Thanks - it is very clear and well laid out, but there is a lot to take on board here so may take a while to process...………………………….

Important to bear in mind that there are a number of prominant TRAs with history of links, involvement & influence in Greater Manchester including Tara Hewitt, Jess Bradley, Stephen Whittle, Christine Burns etc

And reports today say that mental health funding for young people is crashing.

Also concerning (and this has come up in other surveys):

A significant majority of respondents (61%) were disabled

I mean, wtf?! Why on earth is no one looking at that frankly scary statistic? Why do so many trans /nb people have disabilities when compared to the population as whole? Why do none of these organisations doing these surveys ever show the slightest curiosity about this?

There were survey respondents under the age of 18 years?

There are protocols, caveats and safeguarding measures that have to be taken into account when carrying out research involving young people.

Has the Trans Health researcher complied with ethical requirements, like these ones:

esrc.ukri.org/funding/guidance-for-applicants/research-ethics/frequently-raised-topics/research-with-children-and-young-people/

from Greater Manchester Trans Health Service
Report by Sarah Price (linked in OP)

2.1.4. The involvement of the voluntary sector in the co-design of the service model has been integral to this process. Local partners including the LGBT Foundation and The Proud Trust have brought a breadth of experience and expertise.

Proud Trust website:
OUR PATRONS
We have dedicated patrons who support our work and help us spread the word about what we do.
(extract)
Christine Burns MBE is an out and proud lesbian trans woman who, although now retired, campaigned for a quarter of a century for the civil rights of trans people and (for the last decade) all diverse communities. She was a leading figure in “Press for Change” for 15 years, developing trans self-awareness, working on the Gender Recognition Act and regularly appeared in the media on the campaign’s behalf. She worked to develop the first ever official guidance about trans health from the Department of Health. She also led for some years on challenging negative reporting in the media. As an independent diversity specialist she chaired the North West Equality and Diversity Group for many years and helped countless organisations develop equality plans, including a five year stint as the Programme Manager for Equality, Inclusion and Human Rights at NHS North West. In retirement she has focussed on writing. Her books “Making Equality Work” (in collaboration with former colleagues) and “Pressing Matters” (on the roots of trans activism in the UK) are both positively reviewed.
Christine says:
“I was delighted to accept the invitation to become a patron of LGBT Youth North West. The work of people in my own generation laid the foundations of the world that young lesbian, gay, bi and trans people inherit as they grow up."

STEPHEN WHITTLE OBE
“LGBT youth still face tremendous barriers, prejudice, fear and unequal treatment. It is crucial that we work together to give this generation of young people the confidence to continue the battle for full rights and recognition (not simply being forced to accept mere tolerance) is crucial if we want liberation for the generations to follow.”

www.theproudtrust.org/about-us/our-patrons/

Stephen Whittle & Christine Burns were key members of Press For Change
2013 Guardian interview about the formation of the organisation & how they successfully lobbied for GRA:
(extract)
"In the 90s, when she was chair of the Women's Supper Club of the local Conservative party association in Cheshire, she quietly joined Press for Change. Even then, the new activists dared not be openly trans. "The thing that held us back in the 1990s campaigning was that fear of being out," admits Burns. Eventually, she came out in 1995; she jokes that she realised she was more embarrassed to be a member of the Conservative party than openly transsexual.

Much of their campaigning remained on the quiet. The passage of the 2004 law to give trans people legal status was "remarkable," says Burns, because "the government was able to pass an entire act in parliament without anyone throwing a fit in the press". In popular culture, the activists became more forthcoming in their attempts to increase popular understanding of trans issues." (continues)

www.theguardian.com/society/2013/jan/22/voices-from-trans-community-prejudice

threads:
www.mumsnet.com/Talk/womens_rights/3375587-Press-for-Change

www.mumsnet.com/Talk/womens_rights/3436955-Stephen-Whittle

www.mumsnet.com/Talk/womens_rights/3398127-Stephen-Whittle-influential-TRA-asserts-We-know-we-have-Labour-behind-this-one-so-will-simply-do-our-best-to-get-them-elected-Corbyn-seems-to-confirm-this-at-Pink-News

Christine Burns' speech at TRA 'We're Still Here Conference' Sept 2018 organised by Jane Fae:
(extract by OP WhentheHarpySings )
5) HOW THE GRA WAS WON

This was a lecture by Christine Burns of Press for Change

CB cited a lot of case law.

One which is relevant to our interests is that of a trans man called Mark Reece (sp?) who wanted to be a vicar and also marry a woman (this was pre female clergy or same sex marriage)

Reece took his care to the ECHR and lost but it brought attention to the case and Alex Carlyle advised Reece.

They recommended tying to find the “lever” to force the Govt to do something. To chip away at laws which are discriminatory.

They are looking for good test cases.

Burns said that the TRAs need to make themselves the legislators friend. Apparently pre GRA 2004 there was an inter-departmental working group set up in Government to look at the issue and produce a report. Press for Change (CB’s org) wrote the report and the government basically just used that (!). This was 2000 - 2001 time- wonder if we can dig this up?

Anyway,, the GRA 2004 was not what the trans rights group wanted as they had to make concessions on things like medical evidence for a GRC." (continues)

www.mumsnet.com/Talk/womens_rights/3398737-We-re-Still-Here-Conference-8th-September-A-report-from-the-inside

Proud Trust involvement with Social Care guidance & Toolkits (with Tara Hewitt & Three Circles Adoption)
www.mumsnet.com/Talk/womens_rights/3324578-Vunerabilities-of-Looked-After-Children-Social-Work-CP-restricted-by-affirmation-requirement-Trans-Youth-in-Care-Toolkit

Christine Burns

This morning, Christine Burns demonstrated an unusual attitude to the Times investigative articles on what is happening at Gender Identity Clinics. She couldn't understand why, with the stuff happening over Brexit, the Times had published four anti-trans articles.

The responses told Ms Burns exactly why they were important and why the content ought to concern her. She deleted the tweet. Presumably, she had reflected that the tweet would not look good for someone in her role.

I found her open and complete disregard for children shocking. Others did too and I hope that screenshots will be made available to decision-makers.

I found her open and complete disregard for children shocking. Others did too and I hope that screenshots will be made available to decision-makers.

Stephen Whittle
& acknowledged irresponsibility on Mumsnet with regards use of suicide statistics:
In Guardian interview 17/10/18
SW "warned that many trans people would “become depressed and dejected” if reform was delayed. He said: “I am sure there will be a flurry of attempts and suicides. But in the end we will pull ourselves together and continue the campaigning. We know we have Labour behind this one, so will simply do our best to get them elected.”

following MN discussion of serious concerns for the known impact on vulnerable people, especially children based on Samaritans' guidance SW commented,
I agree. In hindsight I should not have said that - but the Samaritan's guidelines never cross my mind

The next day SW acknowledged the serious issues & requested an edit in The Guardian citing Samaritan's Guidance:

SW "In response to some of the considered comments on here, and after thinking carefully so as not to compound the situation and bring more attention to the remark, , last night I wrote the following email to the Society Editor, the Readers Editor and David Batty of the Guardian.

Dear Sirs
You printed a comment by myself in the article by David Batty...

The comment I made includes an inappropriate reference about the prospect of possible suicides and attempts:

It has been brought to my attention that my response conflicts with the IPSO/Samaritans Guidance on reporting about Suicide, which say at
Point 2:
“there is a risk of imitational behaviour due to ‘over-identification’.
Vulnerable individuals may identify with a person who has died, or with the circumstances in which a person took their own life.
For example, combining references to life circumstances, say a debt problem or job loss, and descriptions of an easy-to-imitate suicide
method in the same report, could put at greater risk people who are vulnerable as a result of financial stress.”
And at point 3:
Over-simplification of the causes or perceived ‘triggers’ for a suicide can be misleading and is unlikely to reflect accurately the complexity
of suicide.
For example, avoid the suggestion that a single incident, such as loss of a job, relationship breakdown or bereavement, was the cause.
And at point 5:
“Be careful not to promote the idea that suicide achieves results.”

It is clear in retrospect that my comment was ‘ill thought out’ and completely inappropriate, as it could lead vulnerable and/or young trans people to consider taking their own lives, and clearly nothing could be further from my wishes" (continues)
www.mumsnet.com/Talk/womens_rights/3397010-Guardian-article-on-MPs-concern-with-GRA?pg=7

The Samaritans' Guidance is not stand alone with regards media restrictions, it is founded on well-established Safeguarding good practice

The previous week Helen Belcher (Trans Media Watch) ascribed causative link between suicide and suicide ideation to newspaper coverage with specific mention of the Times journalist Janice Turner:
www.mumsnet.com/Talk/womens_rights/3393577-Janice-Turner-accused-of-causing-trans-suicides

www.mumsnet.com/Talk/womens_rights/3397127-Stephen-Whittle-Press-for-Change-irresponsible-use-of-likely-suicides-follows-Helen-Belchers-Trans-Media-Watch

There seems to be systemic Safeguarding failures/failings within trans right activism, especially with regards the protection of children

They’re trying to move the window of social and clinical acceptability by moving this treatment into primary care leaving the ‘hard cases’ to tertiary care. There was a quote on another thread about that. I’ll try to find it . It is very very worrying because of the precedent it js trying to set.

How the tuck can you have a panel of people consider your application to change your sex on paper for legal reasons (GRC certification process). But only speaks to q Community precticitoner ie nonspecialist doctor to get permanent, risky, life changing medical interventions. This needs proper regulation not pretending these are minor interventions and downgrading the scrutiny. We need a Hoise of commons Select committee enquiry into this and the medical and surgical transing of kids. Sarah Wollaston MP is the chair. Honestly I think the NHS is too far gone to row back- we need Parliament to scrutinise this indoendently before we can sort this out and protect vulnerable children and adults.

That disability stat is incredible. 61% are disabled. I would like to know how this breaks down and whether if, as I suspect, a large proportion of those people have a diagnosis of autism.

A significant majority of respondents (61%) were disabled
This is really worrying. Did they target people with disabilities?

Also, roughly half the people recorded themselves as women, and a quarter each men and non-binary. In my mind (and I accept I could be wrong) I'm guessing the 'non-binary' are mostly females, and the 'women' are a fairly even split of females and transwomen. That makes it 50/50 female/male.

A significant majority of respondents (61%) were disabled
This is really worrying. Did they target people with disabilities?

These surveys are usually self-selecting & due to social media promoted amongst groups.
The majority of surveys are not robust enough to uncover the answers to potential issues.
Conclusions are drawn very quickly and extrapolated out to make general conclusions. When this is used to form policy, law & inform public spending there needs to be scrutiny.

In my mind (and I accept I could be wrong) I'm guessing the 'non-binary' are mostly females, and the 'women' are a fairly even split of females and transwomen. That makes it 50/50 female/male.

This is a crucial issue.
In order for the NHS to collect meaningful data for appropriate health care it needs to record sex (which is unchanging) & gender identity.
There is no way of knowing the sex of respondants and assumptions/confirmation bias are dangerous when intepreting data to provide a NHS health service.

Males can be non binary & some males who identify as non-binary have been very influential- Jess Bradley (Manchester, NUS Trans officer currently suspended) identifies as non-binary & a woman. Bradley is male. Edward Lord (prominant TRA City of London Corporation, previously FA etc) identifies as non-binary but not a woman. Lord is male. Travis Alabanza (Top Shop changing rooms & Burgerz) identifies as non binary & is male. By way of some balance, prominant media trans couple Fox & Owl now both identify as non-binary having being very public about their 'transitions' so Fox identifies as a non-binary man & is female, Owl identifies as non-binary woman & is male.

A significant majority of respondents (61%) were disabled
This is really worrying. Did they target people with disabilities?

This was also a feature of the Stonewall survey.

NonBinary

I think that the term is a political one rather than a description of a gender/sex.

There were swathes of them in the Young Green Party. Their declaration of being non-binary was more about showing solidarity with transpeople.

It did them no harm and meant that they had a better chance of being catapulted into positions of influence, or to be consulted, or to ask for funding for pet projects and jaunts.

What about the high unemployment rates? If being transgender isn't a mental health issue, clearly transgender people aren't coping well with "normal life". Surely that would be a good focus for resources?

The high unemployment rates would be explained by discrimination against trans people.

The thing is, are they disabled or do they identify as disabled?
"Identify as" meaning "pretend to be".

Itssallgoingtobefine - yes I know that's what the TRAs will say, but at some point someone needs to step back a bit and say - is living your life requiring yourself and everyone around you to deny reality, a good thing? Is it really going to be a better outcome than learning to be comfortable with the body you were born with?

Some funding towards that kind of talking therapy would be very good value.

I find this really ominous. I think it reveals that the powers that be are planning to continue brainwashing increasing masses of people into thinking they are born in the wrong body and believing hormonal poisioning and surgical mutilation will somehow solve all their problems. They need to lots of centres to process victims as efficiently as possible with minimal to no gatekeeping barriers. Literally nightmarish.

With Mary Warnock's death it made me think how this area of medicine has somehow eluded being seen as a bioethics issue, in the same way as IVF, and that an equivalent of the Warnock Report is needed. Maybe the Select Committee report suggested by @Chattylion?

The findings of the Manchester survey raise so many questions that need further investigation.

Lots to read and think about here. Thanks for this.

A significant majority of respondents (61%) were disabled

The EA 2010 and most services define being disabled as "if you have a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities".

This covers mental health conditions too obviously.

Given the MH nature of GD itself (despite attempts to demedicalise it) and that so many other MH conditions are co-morbid/ co-related to being trans/the trans umbrella eg depression/anxiety and personality disorders, as well as autism spectrum disorders, I am not hugely surprised to see this figure.

not hugely surprised

Not surprised at all, I should say

I posted a sort of "companion thread" to this one a few days ago on NHS Specialist Commissioning of Gender Identity Services with a link back to this thread. I can't see it but I haven't had a PM from Mumsnet that it was deleted. (Can't imagine why it would be anyway as all the info is in the public domain.)

Maybe it didn't "send" properly? I think (I hope!) I kept a copy off-line so I can try again.

It's not in the list of threads "I'm on" or "Watching".

Can't see it either.

Sometimes you get a deletion message in "I'm on", sometimes there is just a " . " and sometimes nothing at all. No idea how it works .