Telegraph: Patients may be guilty of discrimination if they refuse care of transgender medic, NHS bosses told

[ResisterRex]

A report by the NHS confederation is in today's Telegraph. A good example of how a hierarchy of EDI seems to have been cultivated, with disabled people right at the bottom. Anyone who's had a parent or grandparent with dementia will be upset to read that parts of the NHS want to be able to refuse to provide care to their loved one because their comfort comes last.

www.telegraph.co.uk/news/2023/06/09/nhs-patients-discrimination-transgender-staff/

"Patients may be found guilty of discrimination if they refuse the care of a transgender medicc_, according to new NHS guidance.
Health bosses have been warned that patients have no right to be told a healthcare worker’s assigned sex at birth.
However, transgender health workers can choose not to treat patients if they feel uncomfortable doing so, the report by NHS Confederation says.
The report, published earlier this month in partnership with the LGBT Foundation, says patients can only request care from a same-sex staff memberr_ in limited circumstances, such as if they are having an intimate examination.
It states that when a patient requests an employee administering care to be a woman or a man, “the comfort of the staff member should be prioritised”.
Patients with dementia ‘should be challenged’

The report goes on to say that “the patient has no right to be told that the person treating them is trans or non-binary,” adding: “It would likely be discriminatory for the patient to refuse to be treated or cared for by a trans person, unless clear and evidenced clinical harm may result to the patient.”
Patients with dementia “should still be challenged” if they express discriminatory views about transgender staff, the 97-page guide states, while their relatives “may be removed from the premises” if they do the same.
But a non-binary medic can refuse to treat a patient, with the advice stating they “should not be forced to deliver care if this would cause undue distress or invalidate their lived experience of gender”.
It comes as the NHS published its first equality, diversion and inclusion (EDI) plan, which outlines that organisations are to include “diversity training on gender reassignment and sexual orientation” within mandatory training for healthcare workers."

User 613

This refers specifically to situations where it doesn't matter.

Who decides what matters. Have you ever worked with someone with dementia? It is so difficult for a proud person to be utterly vulnerable. Then telling them that a person they recognise as male is actually female, be they optician, dentist or whatever, is plain cruel.

The lack of understanding of or significance given to other people's vulnerabilities is what makes Stonewall influenced organisations so in humane. It is always all about the men.

Shouldn't spill over into anger?

I'm fucking incandescent, mate. I'm not going to wait for permission to get a bit cross while women are treated like this. Being calm and reflective and patient and detail focused is what has enabled this wretched, insidious political movement to get to the point where the NHS is denying health care to women. On political grounds. To protect the feelings of a particularly special group of men.

Im sat in a doctors waiting room listening to the conversations of various non men. So many non men in here. Absolutely no non women though.

See its a complete bastard. It just doesn't work.

I dont think you have read the guidance either. See my above post - there is only 1 mention of dementia in the 97 page document - it has nothing to do witht the issues you are referring to- it specifically relates to discrimination/harassment- see my above post again.

Patients with dementia should only be challenged on this where possible.

There is a well established legal framework called the mental capacity act which would be relevant in assessing this. This is regularly used to assess patients with dementia capacity to make many decisions.

Yes I have worked with literally hundreds or thousands of people with dementia and agree with your points about vulnerability but they are not relevant to this guidance which still supports all people being able to choose the sex of the person examing or providing physical or personal cares.* *

@EmpressaurusOfCats I'm so sorry about your mother. 💐 for you.

The stuff about “challenging” the views/speech of patients with dementia makes me unspeakably furious.

My elderly parent has early dementia - no short term memory at all. There is a young person in the family who is trans and my fucking SiL is a trans cheerleader (I reckon it’s Munchhausens by proxy). My SiL thinks she has the right to correct my parent when they correctly sex this child. We have had words …

It is downright cruel and utterly ableist as well as ageist to do this to someone struggling with cognitive deficits.

Dementia is cruel enough. Now they’re castigated and fucking “challenged” ?? For speaking the biological truth …

I’m glad my parent doesn’t live in the UK any more.

User613 · Today 14:53

Patients with dementia should only be challenged on this where possible.

That is exactly the sort of thing which ends up with "mission creep," though. Soon enough, you'd have people under the impression that challenging dementia patients was the done thing in all circumstances.

User613 states they have worked with literally thousands of people with dementia.

Are you being free and easy with the definition of 'literally', @User613? And possibly equally free and easy with 'thousands'?

Bugger wrong thread, i clicked the wrong open tab in on my phone and can't see the thread title.

Yes I have worked with literally hundreds or thousands of people with dementia and agree with your points about vulnerability

The you will also know that many confused elderly people are never diagnosed. Indeed my mother's first GP was very resistant to her getting a referral for a diagnosis.

Please tell me why you are so determined that the needs of one group of men takes priority over the needs of a proud and elderly generation.

This!

My parent is still cared for in her own home, but it’s inevitable that she’ll need more care as she heads towards being over 90. She’s very polite and undemanding, but this scenario absolutely would frighten her.

@MissLucyEyelesbarrow Yes eye exams can be considered intimate examinations - anything close or with physical contact can - see gmc guidance - you can request same sex for these.

The GMC considers any situation where a clinician may have to touch or even be close to a patient to be potentially intimate. So, if we are following the GMC , all close contact with patients would be exempt from the Confed guidance. This is precisely one of the reasons why it is unworkable and inconsistent with existing law and NHS standards.

@User613 OK so where is it possible to challenge a dementia patient? What sort of scenario? Obviously you have "hundreds" or "thousands" of experiences to draw on.

It matters not how many times dementia patients are mentioned. Indeed, if they're inconsequential as you seem to be suggesting, why are they there at all?

I also agree with @MissLucyEyelesbarrow about the trauma experienced by victims of child abuse. In particular, the needs of child sexual abuse victims and survivors who may be minors or adults.

How can you say that it "supports all people being able to choose the sex of the person examing or providing physical or personal cares" when it actually says (p60) that they can't?

For employment purposes, guidance from the British
Medical Association supports the view that a trans
person’s assigned sex at birth is irrelevant to their
working life. For this reason, they conclude that a
patient has no right to be told a healthcare worker’s
assigned sex at birth.

Who determines what is considered 'intimate'?

(Clue: it's not women.)

Women weren't consulted in this.

For me it's about trust. Yes an eye examination in a room with someone who insisted I called them female when they were clearly male would be a problem for me.

Why?

Because its a closed space. But not necessarily one deemed that I need a chaperone. And I'm being asked to trust someone who is forcing their views onto me.

I already feel uncomfortable in that situation due to power dynamics - they hold the knowledge and power whilst I the patient don't.

I am being asked to trust someone who is making me participate in a lie. Someone is holding this power over me. In an enclosed space. Getting into my face for an examination.

That's an issue. That's disrespectful. That's removing patient dignity and security. That's removing my power to express my own truth about how this makes me feel threatened.

And I legally have a right to believe gender is not sex.

Ironically, I wouldn't feel the same problem with a man, because I'm not having power held over me in the same way.

It needs putting into the context of TRA threats to women in the current political climate.

"If you don't do what I say, I will ruin you and I will accuse you of transphobia and you will have a black mark on your medical records and no one will treat you ever again."

Why would I want to put myself into a vulnerable position like that? Having no chaperone puts me at risk of power abuse (I stress this doesn't mean being attacked physically in anyway). The way this document is worded and the climate of harassment and intimidation is enough of a concern. The guidance literally says, if you don't behave in the correct manner you risk being blacklisted!!! There's a threat to patients contained with in it! Women should take that seriously given the state of play and examples of harassment/ court cases out there.

I note here that we see some fucking wild definitions of what constitutes transphobia from TRAs and there's no legally explicit definition of it written into that document. So it's not a stretch to suggest that someone making an innocent remark or breathing at the wrong time could lead to accusations.

As others say, then where is the court to give you a fair hearing on that?

I'd be particularly concerned if I'd publicly spoken for women's rights or I was a known for working in certain areas - I'd be an easy situation to abuse.

Safeguarding against abused of power comes in various shapes. If a woman feels vulnerable in any situation where she is alone then that should be enough. 'Intimate' to me could include is any situation where I am alone with a male. My state of undress is irrelevant.

They've just handed a shit load of power to a group who have threatened women who want to uphold their rights. You know women who haven't done the reverse and made threats in response.

It's fucked up.

It risks undermining trust in the entire system - and ironically particularly for every trans practitioner. Allowing the right to single sex, means that it actually protects that trust in the system and institution and works in the favour of trans HCPs.

2.@LonginesPrime yes good point -its covered by the guidance though! See p60 "a patient can request a staff member with or without a protected characteristics to mitigate potential psychological impact.

The guidance also comments "in reality and specifically in health there are likely to ve extremely few circumstances in which... refusing bit to be treated by a trans person would be upheld"

Right, but my point still stands - the patient with a history of male-violence based trauma asks to be treated by a woman, they send a transwoman, and then the patient, who may be acutely aware of the fact society labels women who say trans women are not biological women as horrible bigots, then has to explain to that transwoman that no, they actually meant a different type of woman. Let's face it - most medical care isn't provided by committee and if you need the nurse or doctor who's just come in to examine you to stop immediately, it's then you have to tell them directly to their face before they start.

If the patient is aware of the current climate around gender identity, they may well need to explain that they want a biological woman to treat them but they also might not want to explicitly state to the transwoman that they believe that this transwoman is biologically male and that their beliefs as to the nature of gender is clearly at odds, as the patient may be aware of how upsetting and distressing trans people find it to be told that other people don't share their views on gender.

It's one thing saying to a non-trans male nurse or doctor "actually, can I please have a female examine me as I'm uncomfortable with a male doing it" (although it seems that now they'd have to state the details of their whole rape experience at every appointment to justify that), but to make the same request of a transwoman necessarily requires misgendering them and revealing to them that while they might believe they are female, they are actually not in reality. It doesn't feel like a supportive environment for that transwoman either to deploy them in a position whereby patients are often reminding them that they're a biological male. The fact that the guidance says that most patient requests to not be treated by a biological male will be unsuccessful suggests that even the report writers know that many more patients will be telling that transwoman that they are male even if the ultimate outcome is that this misgendered transwoman still has to treat that patient following the patient's objections.

So it is actually really challenging for a patient with a history of trauma who's also aware of trans issues and trying to be inclusive and respectful to balance their need to not be treated by a biological male with the transwoman's need to be treated as a biological woman.

It's all very well the report writers saying 'this affects hardly anyone' but I believe the numbers of women and girls this specific trauma exemption affects is far higher than they think, and they cannot possibly know the stats on this yet as transwomen haven't routinely been classed as biological women for the purpose of provision of medical services by someone of a specific biological sex before, as sex and gender haven't been regarded as separate characteristics for this purpose previously. Up until now (IME, at least), patients with a trauma history might request a female staff member and everyone would share the understanding that this referred to the biological sex of the practitioner. But now the patient is forced to specify that this is what they mean, and knowingly risk being ostracised or denied the medical treatment they need.

So you think consent is only for the rich?

I have very little interest in the subject of transgender rights on a personal basis beyond generally wishing people well.

I read this thread and was appalled by what posters were saying was being introduced - so I looked up the document to find out more and found it didn't resemble these posts or the daily mail article in the least.

The nhs gets lots wrong in general (across all areas) and I agree with the poster who makes the point about mission creep - particularly- if this is reported inaccurately as it has been - as I expect just like these posters most people won't bother to read the detail.

This scares the hell out of me. I was abused as a child, have CPTSD, and my biggest “trigger” is being vulnerable around someone in a position of power. I have to have a operation soon to remove a fibroid and I’m terrified enough as it is, but the idea I’d also have to play pretend with some guy who doesn’t respect my request for same sex care is just too much.

Patients have no right to be told if the person looking after them is trans or non-binary?

I couldn't give a fig if they are non-binary. And do they really think I won't know if they are trans?

Sigh.

Anyway, the Equality Act applies to the PROVIDER of the services, not the consumer of them.

I can't see comments on the telegraph story.

@OldCrone -yesi read that bit. So you have no right to ask anyone's sex at birth But you can ask for a doctor or nurse of a sex of your choice. That's adequate surely - why would you need to know staff's sex. Just request the sex you wish. It would be a bit odd to be insistent on knowingly sex of staff not treating you!

@LonginesPrime I agree with your point but again I'm not sure you've read the guidance. You can request a biological female - of course you're right that then a mistake could be made and the wrong sex sent.this guidance would support you making a complaint in those circumstances and has defined your rights to someone of the same biological sex. There are many wider problems in the nhs and it wouldn't surprise me if sometimes they make mistakes and send the wrong staff -but that has nothing to do with this guidance- and women will be able to quote this guidance to support their complaint!

@RedToothBrush yes of course women can decide what is intimate! Again the definition allows great flexibility - see this quote from GMC guidance on the topic intimate examinations "include examinations of breasts, genitalia and rectum, but could include any examination where it is necessary to touch or even be close to the patient"

Anyway, the Equality Act applies to the PROVIDER of the services, not the consumer of them.

This is the issue with opposition defiance disordered people - the grass is blue and the sky is green, it's all the opposite is true.

That the thing with someone who is a man who wants you to say he is a woman, he is in hospital as a medic and you in hospital as the patient, yet he is getting his employer to demand that the most vulnerable patients are the service providers to him. Patients are pimped out to service his needs and provide him unpaid care when they get none.

@Naunet don't be scared! The guidance doesn't say that at all - it explicitly says you can request someone of the same biological sex - please do!

This.

It's the one on one situation it creates.

The new guidance increases the risk of confrontation, places women in a situation where it's potentially disclosure or blacklisting and risks giving extra power to trans activists.

The extra power wouldn't be such an issue, if there wasn't this extraordinary lack of oversight and consideration of the current climate where intimidation is being used so readily on social media and through the court system.

The lack of checks and balances and the complete removal of safeguarding it represents IS the problem.

The guidance ITSELF increases risks to patients and ironically doesn't remotely protect trans people.

All the vexatious accusations and the overzealous use of the word transphobia for absolutely nothing have created an environment where people quietly want to distance themselves from even the possibility of drama in order to protect themselves. Not because they are actually transphobic, but more because they want to avoid being accused of transphobia.

It's bonkers.

My own experience of walking on eggshells around my sibling and the moments of 'boom' for nothing are representative of that. I don't want to be in that position again - it's an abusive situation. Especially given my separate issues with power dynamics and HCPs generally to begin with.

How do I even begin to explain that face to face with someone? Why should I? My right to believe in sex not gender is in law. I don't want to discriminate but equally I don't want to put myself into a situation where I feel exposed and vulnerable - and that includes WITH all my clothes on.

Transparency is the way to build public trust, to allow informed decision making.

Women should be able to opt out proactively to avoid situations ever arising where there is a problem/ confrontation. And if it's unavoidable a third party needs to explain this - without the threat of withholding care being held over a patient. Mainly because that's coercive and negates consent (which again puts trans HCPs at MORE not less risk themselves).;