The next battle

[HelenaWaiting]

No gender-affirming treatment on the NHS. My father died waiting for surgery, the NHS is on its knees and taxpayers' money is going on non-essential treatment.

100%.

They can start by not spending millions of pounds on repeating a highly unethical puberty blocking study on children when there is already data available from the previous experiments.

I do think there is a serious conversation to be had about this (i. e. I'm not trying to be provocative). We have a group, for the first time in history, whose demand for rights constitutes the removal or dilution of the rights of another vulnerable group, and not only are they getting an unwarranted amount of support and leeway (for some pretty out-there behaviour in some cases), they are also receiving access to an unwarranted amount of taxpayer funding.

Which they frame as 'healthcare' -making it sound like anyone who disagrees is anti them seeing the GP for their gammy foot, or indigestion, or similar.

I'm so sorry for your loss Helena 💐
I totally agree with you.
Trans reddit uk is an eye opener for what some people expect the NHS to dole out for free.

You might consider it non- essential but how do you define essential?
Would you also put a stop to IVF?
Reconstructive surgery after breast cancer treatment?
Hip replacement for very elderly patients?
Slippery slope if you decide the NHS is strictly for life-saving treatments only.

Preventing private unisex/universal toilets being the norm. They shouldn’t because of document T but it’s what people are taking about. Document T I think is good on this (except they forget to specify info on door gaps).

I think the NHS should only be providing treatment which has been shown to be the best course of action for a diagnosed medical condition. Other, more usual mental health interventions should be assessed before determining that drastic hormonal and surgical intervention is warranted. First, do no harm!

i also think the NHS could save a huge amount of money by following the law on single sex provision and not get involved in long-winded legal cases where they try to defend the indefensible (that goes for the OU as well)

I think there needs to be an enquiry into how stonewall law took hold in all layers of government, without foundation or scrutiny.

I think David Cameron once said something about lobbying being the next big political scandal. It seems it is a major problem with organisations and individuals getting privileged access to the people in power, while others are completely shut out.

It's such a complex issue. Cass started the conversation about the lack of evidence for the experimental drugs and surgery being used on children and young people. Hannah Barnes's book "Time to Think" was an education about the ability of powerful well funded lobby groups wanting to persuade children that a sex change was desirable being able to influence healthcare for children. Exposing their tactics of operating behind closed doors and successfully intimidating/ threatening anyone who challenged their distorted views about children.

The NHS has been a dysfunctional nightmare for many years - the extreme levels of multi tiered management, well paid DEI staff enabled to push their own ideologies and the lack of accountability for decision making has allowed so many bad faith actors to influence policy. The allegedly independent regulator the CQC has been taking orders from Stonewall for years as a Stonewall champion.

So many things have contributed to where we are now but I am hopeful that the SC will make it impossible for extreme transactivism to continue to thrive unchallenged in the NHS and for women to start getting our language, identity and spaces back.

It's a point that needs considering. You're right, the Nhs isn't just for life saving treatment only.

However, it has to make decisions about spending every day. It's not a bottomless pit of money. Costs and benefits need to be carefully examined with decisions made that really in the most benefit for the greatest number of people. Does any research exist on the cost: benefit of gender affirming surgery?

I think it would make sense to consider gender reassignment as part of mental health services as a whole.

I think the NHS should only be providing treatment which has been shown to be the best course of action for a diagnosed medical condition.

If you compare the way 'gender affirmation' has been treated to other childhood issues it is glaringly obvious something is up. I have a young relative with pectus excavatum. NHS treatment used to be the Nass procedure - except the NHS has withdrawn this as they didn't have enough data to support it on a cost/benefit. It's a brutal procedure of inserting metal bars behind the ribs, in front of the heart and lungs - to treat a mainly cosmetic issue. They are possibly recruiting into a trial at some hospitals but current NHS treatment seems to be watch and wait if you can still breathe.

Really good point. The difference in the way gender is treated compared to virtually every other issue is staggering.

I'm sorry for your loss,.OP.

It's becoming clear that the NHS needs a huge move towards treating mental health issues.

IVF on the NHS is severely limited based on cost. The other examples you quoted are the result of severe illness/infirmity. Those examples versus amputating perfectly healthy breasts? I think I know which side of the fence the majority of the public would sit. When you're threatening violence to a group of people (because they had the good fortune to be born with the bits you want), many of whom are funding your treatment - well, there's a saying about biting the hand that feeds.

Maybe we could save money for the NHS by getting rid of the highly qualified medical professionals who currently decide what the NHS should fund and let Mumsnet do the job for free!

I would prefer a evidence based approach rather than an approach based on people on a forum not thinking being trans is real.

Maybe transitioning is the right thing for some people and maybe it isn't. I don't know the answer to whether or not it is and you don't either.

I had a thread a while ago about feeling conflicted about where I stand on this and this type of thing is why. I can't get behind wanting to ban medical intervention that many people have had and feel is has improved their lives.

I think it would make sense to consider gender reassignment as part of mental health services as a whole.

I would agree with this statement. It could be an option alongside other treatments rather than an outright ban.

Would more accurate comparators include:
breast reduction surgery - not available at all in some areas, high bar in others.
sterilisation of younger women who have very seriously considered why it would benefit them

Unless there is a clear diagnosis with an evidence based course of action to relieve symptoms, the NHSshould have no part in it. Gender dysphoria (DSM5)is a diagnosis- the treatments may need further evidence (whether psychotherapeutic or in some extreme cases, transition) but i can see a rationale forassessment and treatment of distress. Gender incongruence (ICD11) is deemed non-pathological. Without distress (dysphoria), there is just identity. People are welcome to have identities, but any interventions should be deemed cosmetic and outside the NHS remit.

I shouldn't have said a 'rationale' for treating distress. That sounds more cllous than i intended. I mean that distress should certainly be addressed by the NHS and treated in an evidence based manner. Identity, by its very nature, cannot be 'treated'.

@GCornotGCthatisthequestion- of course treatments should be evidence based. Currently they aren’t, that’s a lot of the problem. Appropriate treatment for the broad range of ‘gender identity’ issues could cost more rather than less - especially in the case of youngsters who can’t now be shoved on puberty blockers.

I don't think young people should be allowed to make permanent changes to their body or have their development stunted but gender affirming care covers a lot more than puberty blockers for teenagers.

The op states it should all be banned.

Is gender 'affirmation' in itself evidence based? Again the difference between 'affirming' an identity and treating distress caused by dysphoria. The latter seems appropriate, the former is not healthcare.

There are lots of interventions that the NHS could perform that would 'improve people's lives'. Like removing lipomas, annoying skin tags, breast enhancement... but it doesn't. Why is gender identity an exception? I actually agree with you that transition may be the ultimate evidence-based outcome in a tiny minority of cases. But only after all conservative treatment has failed and only I supported by evidence that it will help in some meaningful, measurable way.

I feel like gender affirming healthcare a very broad term that covers a lot of interventions which wlll all have varying degree of an evidence base.

Thinking something "Seems appropriate" or declaring something "not healthcare" is not a scientific evidence based position.

I don't think everything we do now necessarily has a strong evidence base but that doesn't mean that the right answer is to abruptly stop everything.