There is no excuse for NHS services not even attempting to follow up. By analogy, NHS and other Public Sector (and voluntary) Services that issue assistive technology devices and "aids to daily living" often want to audit "technology abandonment" rates and reasons in order to improve services.
The issue with GIDS being a children-only service is not insurmountable. Follow-up could be part of a research project that extended the age range. I was gobsmacked that GIDS being a children-only service was given with a straight face as a reason for extended follow-up not being part of the existing research design.
There might be a technical problem with an NHS service including planned follow-up at intervals greater than 6 months. I do not know the current situation but at one time, to do with contracts and costings as part of the "NHS internal market", lack of patient contact for a six month period triggered automatic administrative discharge of the patient from the service, ie. a new referral would be needed to get the patient back into the system and start a new "episode of care".
In practice, if that problem exists it can easily be circumvented by setting the computer system to spit out a standard letter or text just before the six month mark with a reminder along the lines of, "Hope all is going well, we are still here for you if you need us, here is how to get back in touch."
Going back to the assistive technology analogy, there is a wealth of research showing that patients who are having problems or who have "abandoned" technology do NOT typically get back in touch with provider services.
There are many reasons, eg.
- forgotten how to make contact,
- thinking that the service will not be interested,
- thinking that they are not eligible for further care post-discharge,
- feelings of failure,
- fear that they will be dealt with unsympathetically and "blamed" for rejecting the technology
- fear that they will be pressured into "trying again" with technology that they do not get along with or find unhelpful overall
- fear that they will thought of as having "abused the system" if they no longer need the technology
and the
BIG one
- not wanting to be a "bother" to busy people and taking their time away from other patients.
The only way to ensure that patients get further help if it is needed is for services to contact patients at regular, if infrequent, intervals, eg. once a year. In the old steam-driven days, best-practice was to send out a letter enclosing a stamped addressed envelope with a simple ticky-box form to return. Protocols would vary if the form was not returned within a set period.
This system is infinitely cheaper and easier to implement now that patients can be contacted by text and email so it could be done more frequently at little extra cost. GDPR compliance needs to be considered but is not a barrier.
Ultimate responsibility for failure to implement Follow Up arrangements lies not with NHS provider services but with NHS Specialist Commissioning.
It really pisses me off that Commissioners are pumping money into piloting an adult "Trans Health Service" in Manchester, the Service Specification reading more like an Advocacy and Community Support Hub, ie. rather than funding a legitimate and much needed NHS clinical follow-up system for adults and especially for children exiting GIDS for adult services.
The Specialist Commissioners have, of course, been "captured" by the trans advocacy lobby. The Detrans Advocacy Network desperately needs to push to get in there at that level, eg. an MP asking a question in Parliament - are Commissioners are aware of DAN, explaining DAN, demanding that they are invited to be involved and to submit a report, asking for a report back to Parliament on plans to commission research and services for detransitioners, etc. ( I have already mentioned this to Charlie and, I think, @DJLippy ).
There is NO EXCUSE for the continuing failure of NHS Specialist Commissioners to pay no regard whatsoever to the need to audit the outcomes of NHS treatment and ensure that treatments are evidence-based.
There is NO EXCUSE for their failure to acknowledge and act on the now widely publicised fact that a significant number of young people are detransitioning after being prescribed cross-sex hormones and in some cases life-changing surgery.
There is NO EXCUSE for their failure to attend to the views of child psychologists and psychiatrists that the age range for "children's services" should be extended to 25, ie. to coincide with the growing consensus that that is when adolescence ends.
There is NO EXCUSE for Commissioners pumping money into piloting new adult services that bear little relation to NHS clinical services when there is evidence that existing NHS services are causing avoidable damage to patients.
There is NO EXCUSE for expecting detransitioners to bear the financial costs of detransition when the NHS is obliged under statute to ensure that treatments do not result in extra costs for patients.
There is NO EXCUSE for not including the cost of supporting detransitioners in their commissioning plans and contracting appropriate NHS services to provide these.
There is NO EXCUSE for continuing to support the fallacy that anything other than "affirmation" of "trans identities" amounts to "Conversion Therapy".
There is NO EXCUSE for NHS Specialist Commissioners allowing services to continue operating without an effective follow-up system.