Good Law Project files for judicial review of NHS England

[PurgatoryOfPotholes]

The statement from the GLP website is as follows.

Back in October, we told you we were preparing to issue proceedings against NHS England over its long-standing, lengthy and unlawful delays to meeting trans people’s healthcare needs.

Less than two months later, we are now filing our claim for Judicial Review. In that time, the shape of the case has changed slightly, so we wanted to tell you what’s new.

We’re bringing this claim against the NHS alongside two adult claimants, two child claimants and trans-led grassroots charityGendered Intelligence.The claim now focuses on six key problems with NHS trans healthcare provision. We argue:

1. NHS England has failed, under regulation 45(3) of the 2012 Regulations, to ensure that 92 per cent of trans patients who are referred for medical treatment begin that treatment within 18 weeks of referral.

2. NHS England has failed, under section 3B of the National Health Service Act 2006, to provide services for children needing puberty blockers that they can access before starting puberty.

3. NHS England have failed, under the NHS Constitution, to uphold the rights of adult patients with gender dysphoria to begin treatment within 18 weeks of referral.

4. NHS England has unlawfully discriminated against trans people because waiting times for gender identity services are longer than for the vast majority of other healthcare services.

5. NHS England’s decision to introduce and maintain a ‘Multi-Professional Review Group’ as part of puberty-delaying treatment for trans children is unlawfully directly or indirectly discriminatory. We also think the Service Specification unlawfully requires both the child and their parents to consent to treatment, contrary to the principles established in GillickandAB v CD.

6. NHS England has failed to comply with its public sector equality duty to ensure trans people can access acute services by setting up the Multi-Professional Review Group for trans children and in the arrangements it makes with providers.

Eva Echo, one of the adult claimants in this case, explains the impact of waiting so long for treatment. “I would describe being on the waiting list as torture, and there were times when I felt that I may not even be alive long enough to receive my first appointment. Being on the waiting list was no comfort; I desperately needed help.

“My mental health was worse than it had ever been; coming out had allowed me to recognise my gender dysphoria, but I was left completely alone to manage it. I felt, and still feel, completely let down by the system that I thought was there to save me.”

For too long, the NHS has failed to prioritise trans healthcare. We, alongside many affected individuals, medical professionals, families and campaigners for trans rights, believe the current system is not fit for purpose. The available services simply aren’t meeting the needs of the people they should be helping. Too many trans people have died waiting for the treatment they were entitled to. Many more suffer in ways that are entirely preventable. The bottom line is that trans people have a right to access essential care, just like everyone else.

@Alltheprettyseahorses

Point 2. WTaF?! It's eugenics.

Yes

Let them bring their JR and we can watch them being shot down by the court.

I imagine the delays in treatment will be looked at in regard to the general situation we are in, i.e. the pandemic, and not set against some utopian standard of the GLP's imagination. I have a family member working in the emergency services who says people are waiting over 30 hours to be seen in A&E and there is no effective ambulance service. Plus, there aren't actually that many HCPs currently trained in trans health care - they can't be magicked up just as Covid-19-resistant staff can't be pulled out of a hat either.

The entire system is fallible and fragile.

FFS. There is a pandemic on. People are dying of cancer and other serious diseases. Unfortunately, zealots do not consider others, or the wider picture

I hope it bankrupts them.
At the very least, twisted sense of effing medical priority.
At worst - demanding puberty blockers for pre-pubescent children? Wtaf?
GLP my arse. Lost the plot.
I hope donors leave them in droves

@highame

A very quick scan, and I'm no expert but even I could shoot down those arguments. However, looking at the quality of the legal teams the NHS has put forward recently, anything could happen. It's only been the joiners who've brought clarity and sense to proceedings. Cass review on the horizon?

This is a fundamental challenge to the system so the NHS better get their legal team in order.

If it was to succeed funding and staffing would have to be prioritised over other services.

The NHS can't be run by court challenges there are plenty of times where basic funding issues stops treatment being provided.

Its the usual debate about if I can get a pill which cost 1/2m of the total health spend but it extend my life by 5 years why should I not just go to court and get it.

BAD Law Project. 😠

It really is going to have to be established: is this a health care need? In which case why are public bodies and lobby groups insisting it isn't? Make your mind up.

And is this group more important than all other groups and entitled to special treatment compared to other groups? If so, how has that decision been reached? Because a lot of very vulnerable groups have suffered during the pandemic too.

And again in the claims about risk: no mention of what comorbidities may exist, such as Autism or anorexia which both carry a far higher risk than any other group. (And Autism services are pretty much non existent right now and have been since the pandemic started.)

This is interesting purgatory. Thank you for posting.

I wonder why they are pushing now and not waiting for the Cass review? Maybe with the Australian study stating that multi disciplinary treatment was so important and being jeopardized by children arriving pre-loaded with their demands is becoming well recognised around the world. It certainly fit with the GIDs whistleblowers.

journals.sagepub.com/doi/full/10.1177/26344041211010777

^Published April 22, 2021
Kasia Kozlowska, Georgia McClure et al^

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

Part of the conclusion

Our findings indicate that engagement with families, a trauma-informed model of mental health care, and ongoing discourse pertaining to the effects of unresolved trauma and loss need to be part of all gender dysphoria clinics and the services with which they collaborate. Because of their impact on subjective well-being and the development of the self, specific loss and trauma events present crucial opportunities for both long-term psychotherapy and more immediate, targeted treatments. The move to a more comprehensive, holistic model of care—one that takes into account the individual’s developmental history and the experiences that make up that history—has also been echoed in the work of other clinician-researchers (D’Angelo, 2020a; Entwistle, 2019; Giovanardi et al., 2018; Kozlowska et al., 2021; Williamson, 2019).

@Helleofabore As a rookie, I've not come across that before so will go & study.
Am in the thick of it with dd2, so my focus is to protect her from external influence - particularly her school at the moment as it has transpired.
Thanks!

Presumably a lot depends on the screen of the judicial review and the quality of nhs lawyers. Anyone can challenge that wait time guidelines arent being met after all. Will the review be allowed to consider context ie covid, and comparison to delays in other services, and assess validity of claims such as ‘too many trans people have died’ how many? What of? Any other conditions present? Which can also be compared to the unfortunately serious level of other deaths due to lack of access to timely care. But I hope the public can take a step back from ‘of course trans people need decent healthcare’, a sentiment which applies to everyone, and remember that auntie Janet and Bob next door would be alive today if the nhs could manage providing care within recommended wait times, not to mention my bestie Sarah who is 4 weeks into the two week fast track without being seen.

Screen? Scope

For them to be successful on the PB front, they have to prove all the things that Bell vs Tavi could not. Unless they have compelling evidence since, when all the rest of the world are putting up disclaimers about their use.

And if they have this evidence, have they shared it with Dr Cass?

And if it is sooo compelling, why not then wait for the review to be released and changes enacted from it?

Oh… wait… it will be the same emotive manipulation they have always used. Not evidenced based.

Well I hope that they are forced to define what they want treated very precisely. And that when the lack of precision cannot be explained away with emotive positioning, that this leaves their case with nothing.

I cannot believe this will bring sympathy, rather the opposite when waiting times in many regions for actual life threatening (not suicide threatening) treatments are also too long. And for many disability assessments, and other mental health assessments.

It’s beyond belief they can be this dumb.

But dysphoria is not requirement.

No changes to body required.

Its not a mental.heakth issue

So what exactly are they treating and why?

With schools etc applying the unapproved affirmation model. Then again what's the problem?

And y do kids need blockers?

If they have known since they were 2 then y do they need extra time at 11 to decide?

What's the definition of what they ate treating amd hoping to achieve. I.thought the bodies weren't wrong?

This makes.it all.elective surely?.which means wait like everyone else with non.urgent elective surgeries do or go.private.

They are being treated like everyone else

They are saying 'treatment' in some of those points, not medication. So presumably this also includes talking therapy?

Also how many people could sue the NHS for failing to meet their waiting times? In a pandemic?

And again, what is that going to look like? A man suing the NHS because he wants breast implants or feminising hormones. In a pandemic.

I say go for it.

Does anyone happen to know what breast reduction surgery waiting lists are like? All I know is that a friend recently went private after years going back and forth with the NHS and getting nowhere. Clear medical grounds, not just cosmetic.

@EndoplasmicReticulum

Do donors to the Good Law Project know what their money is being used for? I couldn't work it out from the website. For example if I donated because I supported one of their other cases e.g. climate change, does my money go towards that in particular or just into a big pot that they can then use for this?

When I donated, it was clearly to the “general pot”.

Agree it would be good to see similar for CAMHS too, but it does not mean the current claim is without merit - far from it.

Recommendations from the Paterson enquiry are also very much in favour of multi disciplinary teams in order to stop lone clinicians acting in ways that might harm patients. MDTs should be welcomed as helping to view the patient holistically, rather than seen as a threat.

@Datun

They are saying 'treatment' in some of those points, not medication. So presumably this also includes talking therapy?

Also how many people could sue the NHS for failing to meet their waiting times? In a pandemic?

And again, what is that going to look like? A man suing the NHS because he wants breast implants or feminising hormones. In a pandemic.

I say go for it.

This reminds me of the reaction when someone complained that the mastectomies of women with breast cancer were prioritised over elective mastectomies.

www.mumsnet.com/Talk/am_i_being_unreasonable/3368777-To-think-that-in-the-current-dire-state-of-the-NHS-finances-its-a-no-brainer-that-first-priority-for-mastectomies-goes-to-cancer-patients#prettyPhoto

I thought that part of the reason for proposing self-ID - without requiring referrals from doctors - was that having a trans identity is not deemed by tra to be a medical issue.

The way Maugham has framed this on Twitter has made me confused. He says: “We're pleased to say we have now issued proceedings to tackle the institutional perception that being trans is a sickness to be fixed. Our case raises issues of neglect, of direct discrimination and of clear failures to apply clear law.”

How will this case tackle the institutional perception that being trans is a sickness to be fixed when the entire case is structured around a demand for more healthcare NOW, even though we are in a pandemic, because this healthcare is urgently life saving? The impression I get is that the good law project sees being trans as a dire medical emergency! Er, yes, if your skeleton argument talks about people killing themselves because they can’t get treatment it does make them appear to be sick.

It’s another trans paradox, one I can’t get my head around . Trans is not a mental illness or a medical condition , it’s who we are, an identity , so give us self ID. Oh but it also requires lifelong surgical and drug interventions and is a medical emergency in children. Pick one!

And finally, my essential scans and tests for cancer ( I have a pre malignant condition) have been so delayed by covid I’ve had to go private.. the waiting list is years. Can I get judicial review of this too? Oh wait, I understand that we’re in a pandemic and the nhs is underfunded. Unlike some people.

@WorkingItOutAsIGo

If it’s a medical issue then it should be treated as such in all ways. Medical definitions, in the DSM, medical review needed for GRA etc etc. And actually, pandemic or not, they are right to ask for NHS standards to be upheld.

I assume they are about to do the same for CAHMS referrals as well for example? If not, why not?

This is the thing. Mental health support is woeful, across the board. It needs urgent attention and funding. Anyone suffering from any form of MH issue should be getting help and support.

But being 'trans' isn't a mental health condition, so how on earth is it supported by the NHS?

Someone is going to have to make a decision one way or the other. Either it's a mental health condition or an illness that needs treatment, or its not.

Er, sorry. Hadn't RTFT, I see I just provided another echo of what everyone else said.

Surely Keira Bell and Mrs A should apply to intervene in this case around puberty blockers? I don't trust the NHS to make a decent case given they are pretty in bed with the TRAs anyway.

Given that the NICE review into puberty blockers in children and teens found that the quality of evidence was very low, I would think the Good Law Project is on a sticky wicket.

There isn’t strong evidence supporting any aspect of trans medical treatment, for children or adults.

Are they not just setting the stage for the NHS to be honest about this and refuse to fund it? If they get what they want then decision makers will eventually be faced with a choice between massively increasing the funding for unevidenced treatments to make them timelier, presumably at the expense of other NHS services that actually have an evidence base, and simply scrapping gender services on scientific grounds. Why would they go for the first option? I don’t think public opinion would support it.

How does it work anyway, can cancer patients demand a judicial review for delays in treatment? It would be great if judicial review could somehow force the NHS to be better funded.