NHS England has shelved proposals to change how it commissions gender reassignment surgery following clinicians’ concerns
The national commissioning body in April proposed adopting Scottish guidelines on how long a patient should spend gaining “real life experience” living as their desired gender before being allowed surgery.
But clinicians working in the field said the Scottish system − in which a year must be spent living as the opposite sex − imposed an excessively short timescale. Previous English guidelines set a two year wait before surgery.
Clinicians warned that shortening this period could see a rise in the number of people regretting having the irreversible surgery.
NHS England took responsibility for commissioning gender reassignment services in April among the £12bn in specialist services it directly commissions. It had already begun consultation on lowering the minimum period. However, a spokeswoman said an interim policy had now been developed.
“Following the volume of feedback the consultation received, NHS England did not proceed with the specification developed last year for gender reassignment services,” she said.
“Plans have been put in place to further consult with stakeholders to support the short, medium and long term development of services.”
She added: “This interim policy is for 2013-14 and will be implemented. The interim protocol allows for individualised care planning based on clinical assessment and diagnosis.
“Using the available guidance, it allows for the care pathway to facilitate an appropriate period of living within the identified gender role that in most cases will be from 12 to 24 months, but can be longer if required. It maintains the safeguards of ensuring medical recommendation for surgery to the same standard (two opinions) as last year and recommended in guidance.”
Papers published last month by West London Mental Health Trust, which runs a gender identity clinic, revealed its clinicians’ concerns about the proposals.
Executive director of specialist services Sarah Rushton said: “This proposal has met with strong disagreement from the major gender identity clinics in England including our own.”
She said the objections included a fear that “shortening the real life experience to one year from two… would increase significantly the number of people who wish to revert to their original gender role but have had irreversible gender surgery”.
A spokeswoman for the Royal College of Psychiatrists said its new gender identity standards of care, to be published later this summer, would “list the usual minimum time [of “real life experience” prior to surgery] as 12 months, in line with the World Professional Association for Transgender Health guidelines”.