Matter for Discussion: Access to Care

Members can view a recording of the debate here.

Trans, non-binary and gender diverse individuals face unequal access to care and treatment across the UK. This can result in traumatic experiences for individuals.

There is little research on the size of this population (Government Equalities Office, 2018), but groups such as Stonewall have underlined the prevalence of discriminatory attitudes. These can limit people’s confidence in accessing health care services, which in turn, can cause delay in accessing gender identity services in many parts of the UK.

The bureaucracy, cost and invasiveness of obtaining a gender recognition certificate are further obstacles to health care. In addition, disinformation surrounding trans issues (Baska, 2022) can add to the negative experiences reported by some trans people.

In 2018, the UK Government ran a consultation on the Gender Recognition Act, which explored the lived experiences of LGBTQ+ people across many areas, including health care. Large numbers of respondents reported difficulty accessing health services, especially gender identity clinics. Many had experienced unprofessional behaviour from health care staff and some felt their specific needs were ignored. While the UK Government has since committed to making changes to the process of gender recognition (Mermaids, 2022), more recently, in April 2022, the government failed to ensure that trans people were protected by the ban on conversion therapy practices (Nicholles, 2022).

In 2017, the Welsh Government established an adult gender identity service to enable transgender people to access care closer to home. In October 2021, the Welsh Government consulted in the LGBTQ+ Action Plan for Wales and RCN Wales responded robustly, firstly welcoming the commitment to improved access to health care for transgender, gender non-binary and gender diverse individuals, but calling for a specified timetable for the implementing of the actions set out.

In Northern Ireland, the remit of the regional Gender Identity Pathway Review Group was established. Proposals for a new service model will identify staff training needs as part of a plan to put in place resilient and sustainable services.

In Scotland, the Charter of Patient Rights and Responsibilities requires health boards to take patients’ needs into account and prohibits the exclusion of access to treatment based on factors that include gender reassignment. In 2020, NHS Greater Glasgow and Clyde and NHS Lothian published a health needs assessment for people who are LGBTQ+. And in March 2022, a bill introduced in the Scottish Parliament aimed to reform the Gender Recognition Act to improve the process for any trans person wishing to change their ‘legal sex’ on their birth certificate (Scottish Trans, 2022).

Trans identities are intricately bound up with health care services, both in terms of achieving gender recognition and in the way nursing and other staff communicate with patients. It is vital that health care professionals understand their regulatory accountability when providing services to trans, non-binary and gender diverse individuals and the challenges they face when accessing care and treatment.

As professionals we have an ethical duty to ensure patients feel safe in approaching us regarding their health care needs.

Reading lists for each agenda item can be found here.

References

Baska M (2022) Trans people ‘ridiculed and hurt’ as UK government fails to reform gender laws, parliament hears, Pink News, Feb. 22, Available at: www.pinknews.co.uk/2022/02/22/gender-recognition-act-gra-debate-commons  (Accessed 20 April 2022)

Each Other (2022) Reviewing our rights as 2022 gets started: sexual orientation and gender identity  Available at: https://eachother.org.uk/reviewing-our-rights-as-2022-gets-started-sexual-orientation-and-gender-identity (Accessed 20 April 2022) 

Government Equalities Office (2018) Trans People in the UK Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721642/GEO-LGBT-factsheet.pdf (Accessed 20 April 2022)

Government Equalities Office (2020) Government responds to Gender Recognition Act consultation Available at: www.gov.uk/government/news/government-responds-to-gender-recognition-act-consultation (Accessed 20 April 2022)

Mermaids (2022) Gender Recognition Act reform: what happens now?  Available at: https://mermaidsuk.org.uk/news/gender-recognition-act-reform-what-happens-now 
(Accessed 20 April 2022)

Nicholles B (2022) We must not leave trans people behind: why changes to the ‘conversion therapy’ ban should concern us all, Gay Times 1st April, Available at: www.gaytimes.co.uk/originals/we-must-not-leave-trans-people-behind-why-changes-to-the-conversion-therapy-ban-should-concern-us-all

Scottish Parliament (2022) Gender Recognition Reform (Scotland) Bill  Available at: www.parliament.scot/bills-and-laws/bills/gender-recognition-reform-scotland-bill (Accessed 20 April 2022)

Scottish Trans (2022) Reforming the Gender Recognition Act. Available at: www.scottishtrans.org/our-work/gender-recognition-act-reform-2022/ (Accessed 20 April 2022)