• Waiting lists for gender identity clinic services have hit an all-time high 
  • Two providers are reporting average waiting times of more than two years
  • One expert clinician says his service is “four times over subscribed” in terms of what it’s funded to deliver

Providers of gender identity services say they are not adequately funded by NHS England, with thousands of patients being forced to wait more than two years to see a specialist.

Mental health trusts are reporting a huge rise in demand, with some providers’ waiting lists growing to more than 5,000.

NHS England, which commissions the services centrally, said the budget for children’s and adults gender identity services increased to £38m in 2019-20, compared to £34m the previous year.

But it acknowledged the current service model is unlikely to address “sustainability challenges” and said it will be piloting new delivery models. It also launched a national procurement for both surgical and non-surgical adult gender dysphoria services in April.

NHSE does not collect waiting time statistics, but four of the six providers in England shared their data with HSJ.

The country’s largest provider of transgender services is Tavistock and Portman Foundation Trust. It serves London and the south east and said its waiting list for a first appointment, currently at 5,717, “is at an all-time high”.

The trust told HSJ it has seen an “unprecedented rise in referrals” to its adult gender identity clinic in the last year and is currently seeing patients referred in August 2017 for their first appointment. This suggests its average waiting times have again increased since 2018-19, when it was 57 weeks.

In its most recent board papers, for July, the trust reported that 7.2 per cent of cases had met the national 18-week referral to treatment standard, against the national target of 92 per cent. This was the only trust to report referral to treatment data.

Leeds and York Partnership FT, which has a waiting list of 1,712, said patients are currently waiting around 30 months for a first appointment. It said the issues stem from a shortage of professionals trained to deliver the services, and funding levels for the service.

The trust said it is only funded to support 27 referrals per month but receives more than 100.

Nottinghamshire Healthcare FT also said its average waiting time is now in excess of two and a half years. At the start of August it had 2,033 patients on its waiting list.

Sheffield Health and Social Care FT said its average waiting time had reduced slightly, from 49 weeks in 2017-18 to 46 weeks in 2018-19. Its current waiting list is significantly shorter, at 749.

Devon Partnership Trust claimed it could not supply the data, while Northamptonshire Healthcare FT did not respond.

Dr Hercules Eli Joubert, lead clinician and consultant psychologist for Leeds and York Partnership FT, said: “The way these services have been set up and therefore continue to be funded reflect a time when there was a lesser demand for them.

“We are about four times oversubscribed in terms of what we are funded for and the referrals we receive. I don’t think NHS England is unaware of this and to my knowledge are doing everything they can to try and address it, but we have to also be realistic that this is not the only kind of service that is in need and there is only so much money that can go around.

“On the other hand people don’t need permission from us to live in their preferred gender. There is opportunity for them to start their social gender transitioning before they’re seen by us. But yes, it is very difficult for patients we are aware of it, it is also difficult and frustrating to us as a clinical team that we are not able to see our patients sooner.”

He added the rising demand for gender identity services has been recognised as an international trend, although there is no clear reason for the sudden increase.

An NHS England spokesman said: “Demand for gender identity services continues to rise as more people feel able to come forward for support and treatment, and we’ve increased investment to respond to the rising demand for these services, with staff working hard to reduce waiting times for patients.”

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities. Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The Summit is free to attend for senior NHS and public sector figures – register your interest here for this free to attend forum on our website: https://mentalhealth.hsj.co.uk/register-2019