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."

Yes. The guidance - and all similar guidance - assumes that the trauma is all in one direction: the trans person is traumatised by being misgendered (aka correctly sexed), but no account is taken of the stress it causes the other person in the interaction to have to lie and to pretend to disbelieve the evidence of their own eyes.

I accept that transpeople may be distressed by being correctly identified as their birth sex. I have no desire to distress them where it has no impact on me. But in any interaction with a trans person, it is me who is bearing a psychological cost, by having to collude in a lie.

If it's an unimportant transaction - a receptionist, booking me in for a clinic, or someone serving me in the canteen, then that is a psychological cost it may be reasonable for me to bear (though it would still be totally unacceptable to correct someone with dementia). However, in any relationship requiring deep trust, which includes all clinical encounters, I should not have to lie. It's corrosive to the relationship between both parties because the trans person also knows I am lying.

India Willoughby for example often shares the opinion that following extensive surgery they are no longer a transwoman but female.

Willoughby quite intentionally walks extra distances to use spaces reserved for women who can only access single sex spaces, disregarding additional inclusive provision.

It is ridiculous at this point to still expect women to believe there will be any sense of respect or care for women regarding this, or that it will not be exploited. The tone of it alone betrays the prejudice against women who do not fit their perceptions around the male in front of them and the male's wishes in the moment.

Let me use an example to hopefully clarify. When you ring your surgery at present you can ask for a female doctor. You can still do this - just explicitly state biologically female and the organisation now has a clear duty to provide you one.

But the guidance says that this isn't likely to be honoured unless it's an intimate exam or to mitigate potential psychological impact (e.g. abuse survivors):

"This provision allows for patients to request a healthcare, community mental health or care worker to have a particular protected characteristic in situations wherein this is necessary to deliver reasonable standards of care. Examples of this could be genital examinations or provision of intimate care, where a patient may request a staff member of the same sex.

"A patient can also request a staff member with or without a particular protected characteristic to mitigate potential psychological impact. An example of this could be a woman requesting a female therapist as she has been the target of sexual violence from a man.

"A patient cannot request a different member of staff where there is no clear clinical benefit." (p60)

The guidance makes it quite clear that requests will be denied unless there is a clear clinical benefit, so if the reason is because of someone's past trauma, the only way for the staff booking the treatment (or about to perform it) to know about that patient's history of trauma (which goes to their eligibility to request a same-sex practitioner in those circumstances) is by the patient disclosing their past trauma there and then.

Because the guidance makes it clear that if the intimate care exemption doesn't apply and the patient doesn't disclose that they are trying to mitigate the potential psychological impact on them (because of their history), then their "simple" request for a biological female is likely to be refused.

Should sick people be burdened and have to put up with play along like toddlers to an adult dressed as Julius Caesar at work outside of the theatre?

This nonsense has to be stopped, people sacked, imprisoned and laws removed, that support this bull💩

If it's an unimportant transaction - a receptionist, booking me in for a clinic, or someone serving me in the canteen, then that is a psychological cost it may be reasonable for me to bear (though it would still be totally unacceptable to correct someone with dementia). However, in any relationship requiring deep trust, which includes all clinical encounters, I should not have to lie. It's corrosive to the relationship between both parties because the trans person also knows I am lying.

This sums it up well for me.

It's the need for deep trust.

I can NEVER have that with a HCP who believes it is ok to force me to participate in a lie against my will or to validate their own identity at the expense of mine that trust has already been broken.

I feel their clinical judgement is off if they can't comprehend how their identity impacts on the well being of others in someway.

Saying that women with trauma / cultural issues should just suck it up is NOT in a patient's interests.

Three women: one middle class and educated, one speaks no English and one is working class and uneducated.

Woman one is able to articulate her point well and gets single sex provision

Woman two can't speak English. Doesn't understand her rights. Can't get single sex as she doesn't know she can. She refuses treatment.

Women three knows the issues but isn't good at English. Her choice of words aren't great. She ends up in a big shouting match and is denied care as she labelled as transphobic.

And therein lies your issues with vulnerabilities. The less vulnerable patients will get different access to single sex provisions compared with others because they can advocate.

The dementia patient who doesn't have an advocate? Doesn't understand what's happening? What happens to her?

Well exactly. I would argue that this is a terrible move on the part of an employer - to knowingly and repeatedly place their famously vulnerable trans employees in situations where the mismatch between their gender expression and biological sex is going to be questioned and discussed for practical reasons day in, day out. It's shit for the patients and it's shit for the trans staff.

It's essentially NHS leadership absolving themselves of all responsibility to apply due thought and care to balancing the complex needs of several different employee and patient groups, and instead chucking us all together in a room and forcing us to fight it out between us.

I feel really sorry for the trans people caught up in all of this, because the NHS's inability to lead on biology and psychology (which should be their bread and butter) and to apply any actual thought to the implications of their guidance as it plays out in the real world is placing trans people on the front line of confronting these issues in contexts where their biological sex actually does matter. Additionally, in promoting this fantasy version of medical care which will encourage trans people to think that their biological sex won't matter and the NHS will make sure of it, the NHS is potentially encouraging trans people to apply for inappropriate medical career areas which isn't going to work out well for any of us when it becomes clear that this guidance makes no sense and isn't actually workable.

the NHS is potentially encouraging trans people to apply for inappropriate medical career areas which isn't going to work out well for any of us

Same goes for IVF, adoption, education etc. The narcissistic nature of the issue abuses vulnerable people and makes them and their allies DARVO perpetrators.

"When I informed the practice to say that I wanted to transition, they gave me applause. They only asked one thing: what shall we tell the patients? I was worried about the reception, so I took the decision to tell them myself."

"Patients who knew me from before were very happy for me. I didn’t receive any hostility. We live in a multi-ethnic society; a lot of our female patients wear long, very modest clothes. After I transitioned they allowed me to examine them. For me that was such a big acceptance. For new patients, either they didn’t know or they didn’t care."

Kamilla Kamaruddin, trans GP, London

https://www.theguardian.com/society/2020/sep/11/meet-the-trans-key-workers-treating-teaching-and-serving-the-uk

I get the impression that what you're all saying is you don't care too much what the guidance says - it's just very important to you that transwomen are called men and they know it.

After I transitioned they allowed me to examine them. For me that was such a big acceptance. For new patients, either they didn’t know or they didn’t care."

If they didn't know, then an intimate examination by this doctor was as much a sexual assault as what happened here:

https://www.theguardian.com/uk-news/2023/jun/08/teenage-girl-georgia-bilham-pretended-to-be-boy-duped-second-girl-sex-court-hears

Oh, you're still here @User613. Any chance of an answer to my questions now?

OK so where is it possible to challenge a dementia patient?

Indeed @ResisterRex What's increasingly considered best practice is to go along with (as far as possible) the dementia person's cognition. There are various things my parent says about herself which are hilarious if you know her well - but we don't try to "challenge" her or correct her. It's pointless, but more importantly, it's cruel and unnecessary.

I can think of maybe one or two situations where "challenge" of a demented person's cognitive understanding might be necessary - some male dementia patients become sexually uninhibited and/or violent, but that's about it really.

Most victims of assault aren't willing (and often aren't able) to discuss their past trauma with random strangers in order to receive medical care that won't trigger a further trauma response.

And as someone who IS willing to disclose (but not discuss - and I absolutely resent having to), multiple times on the same day to different strangers HCPs, and who is as a result usually treated very kindly by most staff staff, weeks later I am still suffering from a trauma response to my last hospital treatment. Previously, when I wasn't able to disclose, I nearly ended up being diagnosed with something completely different because it looked like I was having some kind of fit. I wasn't, I was so terrified that I was shaking so badly I couldn't speak.

Until the number of sexual attacks on women are reduced because offenders are actually prosecuted with proper sentences, there should be a blanket assumption that every woman has been subject to sexual mistreatment of some sort, unless she says otherwise.

But oh no. We've got to pander to an extreme minority, when women who've been sexually assaulted actually outnumber them!

PS I know men are also abused by men and that a further minority of people are sexually abused by women. But until women who've suffered at the hands of men start to be taken seriously, I'll let someone else advocate for them.

So, let me get this right, everyone has to pretend that what is totally obvious about a trans person (their sex) isn't true and should never be asked about their obvious sex or how they identify. But natal women have to disclose their absolute most personal information in order to politely request single sex care? A disclosure which isn't totally obvious and might be extremely psychologically damaging?

And for those people with dementia who have past trauma which means they are distressed in the presence of males, but perhaps can't remember the details so can't actually disclose the past trauma, they can get to fuck?

Talk about making it clear who the second class citizens without basic human rights are.

And for child sex abuse survivors who've never told anyone about their abuse and just can't get the words out, or people who have communication difficulties- they just get refused care and can go away and die?

Until the number of sexual attacks on women are reduced because offenders are actually prosecuted with proper sentences, there should be a blanket assumption that every woman has been subject to sexual mistreatment of some sort, unless she says otherwise.

Yes, this. And it's true and what's more the recent report on sexual assaults IN HOSPITAL shows how true it is.

It's a Traliban manifesto. A tiny minority of trans people (and we know it's mostly men forcing this) are the overlords - one rule for them, women get no basic human rights.

If this was implemented across the NHS, it would be the NHS completely failing to do their job which is to provide the best care possible to patients.

Really? Why would any of us even want to know what gender/transgender situation anyone is in when going for medical treatment? Ffs we just want someone qualified to help us, not know their backgrounds, so why does it have to be made into an issue? Hi my name is ....... no need for I'm non binary do my preferred pronoun is... just a name please and get on with treatment!

Baroness Nicholson has written to Steve Barclay

https://twitter.com/baronessnichol/status/1667207590785286144?s=46&t=WHoOZZ_3Kv5G6-FyQuvE0LQ

Her letter is suitably scathing! It would be good though if he also had sight of the Legal Feminist analysis

Missing the point. No one gives a shit about some narcissist’s « identity ». We do give a shit when we’re told that it matters more than their sex, which we have to ignore or they will snivel.

The point is that if a woman has said she does not want care provided by a man, then how the man identifies or perceives his gender and how he would like to be treated by others is not relevant .

Why would anyone not be deeply suspicious of the motives of someone male who knows the patient has refused consent for this care to be provided by a male, and obviously has reasons for this, and still wants to overturn that consent and do that job, and is prepared to use threats to get to physically handle their patient in a way they know the patient does not want them to ?

Swap male for female, it's equally an issue. What motivates someone to say 'yes, you refuse consent to me, but I want to do it ?

Using other people's bodies for your own agenda is not acceptable, is it?

Why would a HCP worth the name wish to distress and discomfort their patient for their own benefit? Or coerce consent? Or 'challenge' someone who is obviously ill, injured, vulnerable, in need of care, as the price of that care?

We already have a male in the rape crisis service who is getting away with making 'having your grip on biological reality and unwillingness to lie on command challenged' as the price of being permitted services.

There is no way to paint this any more as the fault of women just not being kind enough. There is nothing ok about this. There's nothing even faintly reasonable about this. My body is not a resource for the therapeutic use of males.

It's worrying that the term "female" has been hijacked to mean "male with protected characteristics of gender reassignment", which I think is what the authors meant. Your reading makes much more sense though. No mention of what the women using the showers think and feel about having a male in that space.

That would be because not all women are sufficiently privileged to have no concern about accepting intimate care from male people. And some of them just cannot under any circumstances, and how the male person feels is not in any way relevant. Reasons involved may include disability including but not limited to people with physical disabilities and Autism, culture and faith including orthodox Jewish, orthodox Muslim, Gypsy Roma Traveller, trauma, CSA, DV, DA, PTSD, dementia....

These women need health care too, and equality, including equality of access. Why would a HCP not care about patients from these groups or not have had training to understand their particular needs?

The Equality Act 2010 only places duties on organisations regarding discrimination and not on individuals.

Patients need to consent to treatment unless they don't have capacity and then an assessment would be done along with MDT meetings involving numerous professionals on what would be in their best interests.

Regarding refusing to treat certain patients, if that reason was due to a protected characteristic, it would be discrimination as the staff member is representing an organisation.