SPATH - Scottish government treatment protocol for trans care counter to Cass

[ArabeIIaScott]

This looks highly alarming.

https://twitter.com/CanSG_org/status/1686645272129011712

'FOI response has revealed that Chief Medical Officer@DrGregorSmith
has approved SPATH as Scotland's new treatment protocol. GPs will be able to prescribe hormones, & refer patients for surgery, without psychological assessment. This decision goes against@Hilary_Cass
recommendations'

More on SPATH here:

https://forwomen.scot/16/11/2022/spath/

https://www.whatdotheyknow.com/request/communication_related_to_nhs_sco

Info from For Women Scotland:

'As expected from a treatment protocol heavily based on the discredited WPATH standards of care, there are numerous concerns with SPATH, including the following:
‘Barriers’ to surgery should be removed with surgery seen as a preventative measure rather than to cure distress:

• No psychiatric diagnosis of gender dysphoria, patient assessed only for readiness for the hormone or surgical procedure requested.
• Only one opinion needed to refer patient for surgery except in ‘complex’ cases.
• Counselling or psychotherapy “not a prerequisite” before irreversible surgeries.
• Specialist GPs, rather than gender identity specialists, should be able to refer patients for surgery.
• Senior clinicians or psychiatrists treating a patient’s complex mental health problems barred from involvement in assessing readiness for surgery.
• More surgeries recommended by WPATH may become available on Scottish NHS in future (eg. voice feminisation surgery).
• Patients placed on medical pathways after brief assessment as lower level interventions like voice therapy/wigs are deemed “extremely low risk”.

GPs should be able to prescribe hormones and non-specialists to assess patients:

• Family doctors should be able to sign “shared care agreements” with gender clinics to prescribe drugs as part of an “enhanced service”.
• Backs a pilot project for those “self-sourcing” their own hormones to get priority referrals to clinics, despite admitting this could incentivise use.
• A “safer alternative” should be provided by GPs where patients are self-prescribing.
• A wide variety of health professionals can develop competencies to carry out assessments of readiness for gender affirming healthcare, including doctors working in primary or secondary care (such as GPs with special interest, psychiatrists, sexual health specialists, and endocrinologists), nurse practitioners, psychologists, and allied health professionals (such as occupational therapists).

Services for children to continue with “affirming” approach despite Cass review:

• A long-term approach to treating children will have a “trans affirmative approach” (Cass warned about this).
• Literature to be developed for children, including under 13s, telling them about the “importance of gender affirming care”.
• Opens door to GPs prescribing puberty blockers, saying role of primary care “to deal with treatment following assessment” should be considered, “reducing the need for specialist clinicians”.
• Hormone/puberty blockers continue to be prescribed despite Cass’s early findings of scant evidence for their use, only to be reviewed 12-18 months after SPATH published.
• Fund partnership work with third sector organisations to provide patient support, including group work and befriending. Badged as from the NHS to “provide credibility”.
• No consideration of care for detransitioners.

NHS Scotland should “move away” from “gendered healthcare”:

• Report says “systems within NHS Scotland need to allow for increasing gender identities for patients, specifically including non-binary identities. This should be done as part of a general move away from gendered healthcare.”
• Claims transmen may feel uncomfortable seeking contraception or smear tests when the services “target audience” is incongruent to their gender identity, such as a “women health clinic”.
• “If clinically appropriate, laboratory reference ranges should be decoupled from gender markers and instead be relevant to the individual”.
• Suggestion of “inclusive” signage, forms and leaflets, and appropriate staff training.
• Where CHI number is changed, responsibility placed on the patient to decide when it is appropriate to disclose their sex to “ensure patient safety” or for “determining appropriate care”.'

Recipe for disaster. Please tell me the SNP are on track to be wiped out at the next General Election and Scottish Parliament election.

It is very alarming. I tried to get SIGN to agree to a patient proposal on this back in 2021 and was ignored. I raised my concerns again in 2022 and was brushed off and told the work was already underway.

There’s supposed to be a consultation about it right now, but I never heard anything about it. I’ve written again to ask where the 12 week consultation is.

https://twitter.com/rogdmum/status/1686673511031418880?s=61&t=8CxL28ZCFDq66yuIWhY6_Q

Well, yes, but I'm not convinced Scottish Labour are going to be putting the brakes on this, either.

Thank you.

Hannah Barnes needs to be pursuing this.

I should have linked to this tweet…

https://twitter.com/rogdmum/status/1686667938906963968?s=61&t=8CxL28ZCFDq66yuIWhY6_Q

This is extremely concerning, especially the "any questioning or psych assessment is conversion therapy" tone.

‘Barriers’ to surgery should be removed with surgery seen as a preventative measure rather than to cure distress:

• No psychiatric diagnosis of gender dysphoria, patient assessed only for readiness for the hormone or surgical procedure requested.
• Only one opinion needed to refer patient for surgery except in ‘complex’ cases.
• Counselling or psychotherapy “not a prerequisite” before irreversible surgeries.

Or, to summarise, 'Quick! Chop them up before they change their minds.'

This is so awful. I'm absolutely furious. 😡

I know there's a lot more here but wigs are going to be provided. Wigs aren't provided for alopecia or hair loss due to chemo. Yet again certain special people prioritised

When it all goes wrong...

Family doctors should be able to sign “shared care agreements” with gender clinics to prescribe drugs as part of an “enhanced service”.

...looks like a good way of passing the buck between two parties, with the wrong party being bounced around a Kafkaesque system for many years.

Tragically, yes. This just awful.

Is this a general edict that includes children of all ages?
If it is, it highlights the repeated problem - that of slipping issues relating to children in under the radar with no acknowledgment that children are not mini adults.

Coming from medical professionals that's not only shocking but it's an open safeguarding issue.

Preventative of what? Eh? What is surgery preventing? This isn't removal of a septic digit or cancerous lumps. How can anyone with a smattering of conscience approve of this.

I've just been on a retweeting spree

Scotland

my country. Now just chop em up quick as said up thread

what happened to safeguarding in Scotland

magic words whoosh on you go to a miserable medicilased future

How can anyone with a smattering of conscience approve of this.

There's the issue.

Barriers’ to surgery should be removed with surgery seen as a preventative measure rather than to cure distress:

Prevent what?

Cure distress - if you're not distressed by your condition, why do you need to be treated for it? If you are distressed, but surgery it's not considered curative, why cut?

Yes exactly jelly.

it’s all smoke and mirrors

who is pushing this in scotland and why?

FOI trying to get information out of them.

https://www.gov.scot/publications/foi-202200324041/

What the actual fuck?? Someone has done one hell of a job influencing the Chief Medical Officer of Scotland - who are they? How did they get such POWER? I just don’t know how this is all going to end but I’m fucking glad I’ve managed to usher my children through their early/mid-teens unscathed by this. But seriously what’s going to happen if this government doesn’t pay any heed to the fact it is flying in the face of evidence, public opinion and common sense. It’s like it’s suffering from an institutional case of Pathological Demand Avoidance 😡

NHS Equality and Diversity bods:

https://www.healthscotland.com/equalities/leadcontacts.aspx