Gender identity healthcare - evaluation of the impact of Scottish Government funding: research findings

Evaluation of the Impact of Scottish Government Funding – Gender Identity Healthcare

Main Findings

This is an evaluation of the impact of Scottish Government (SG) improvement funding to NHS Health Boards on access to, and delivery of, gender identity services in Scotland. It was commissioned by the SG as part of the NHS gender identity services: strategic action framework 2022-24 commitment to “have funded service improvements or pilots established via the direction of the Reference Group independently evaluated.” At the time of publication, £3.6 million has been allocated since December 2022 to Health Boards with Gender Identity Clinics (GICs) to improve gender identity services.

The main findings of this evaluation project are as follows:

1. SG improvement funding has enabled GICs to expand their Multidisciplinary Teams (MDTs) by hiring new staff or extending current staff hours to deliver services and see patients. Funding has been used by GICs to improve service delivery processes (validation of waiting lists, improve data processing), improve communications with service users, and strengthen relationships with third sector partners in delivering complementary care to service users.

2. SG improvement funding, in some cases, has also led to the strengthening of GIC relationships with the rest of the Health Board, including key secondary NHS teams, which has improved the delivery of patient care.

3. NHS Health Boards have seen an increase in demand for gender identity services across Scotland since the allocation of the SG improvement funding. Thus, while SG funding has enabled staff at GICs to tackle long waiting lists, the increase in referrals has made it difficult to bring waiting lists down.

4. All of the NHS Boards have cited challenges in using the SG funding effectively, owing to larger structural issues around: difficulties recruiting into the area of gender identity healthcare owing to a dearth of specialists; difficulties in retaining staff when part-time and fixed-term contracts are often used because of short-term funding cycles; the absence (until recently) of shared care agreements between GICs and GPs; challenges in supporting staff development and service delivery due to the lack (until recently) of national standards, training and skills frameworks for gender identity healthcare; and concerns around staff safety and wellbeing owing to significant public attention and media scrutiny.

5. While NHS Boards have experienced these similar challenges, there has also been variation in impacts across GICs in their ability to use the SG funding to improve gender identity services. While some services were able to make strides in improving service delivery and patient outcomes, others were less able to do so during this period. We have surmised that these differences are due to: level of demand for services; culture and leadership; staff capacity and skillset; healthcare approach; governance and partnerships; negative media attention.

6. Best practice learnings include: (at the local clinic level): fostering cohesive teams; getting the staff mix right, appropriate staff grading, staff safety and wellbeing support, continuous improvement, and strong patient communications; (at the Board level): proportionate workloads, sharing responsibility across Boards, consistent care pathways, collaboration with third sector, shared care with GPs and Board support; (at the national level): long-term core funding, clinical governance, staff training, national networks and international policy learning.