Gender identity healthcare: evaluation of the impact of Scottish Government funding

Annex I: Evaluation Interview Schedules

Below are the interview schedules for healthcare staff (including process and impact questions), third sector organisations, and service users.

1. Interview Schedule for Healthcare Staff

Introductory Questions

• Could you tell me about the nature of your work and the work of your organisation?
• How long have you been working in your current role?

• I understand that you have received funding from the SG to improve access to, and delivery of, gender identity healthcare services. Could you tell me about the amount you were allocated, what you have spent the funding on, and your main aims in making improvements?

Process Questions

• How has the staff mix changed as a result of the SG funding?
• What do care pathways look like at the moment, and how have they changed as a result of the improvement work?
• What is your process for getting second diagnostic opinions (for instance do you still go to Sandyford for second referrals), and has this changed?
• Has there been any change in support for those currently on waiting lists, such as pre-service support and wrap-around support? And if so, how has it changed as a result of the funding? If this has not happened yet, why not?
• Have there been any changes to the way in which waiting lists are validated and reported?
• Have there been any changes to how waiting lists are clinically triaged?
• How do you manage waiting lists and use this data to inform future service planning? And has this process changed with the SG funding?
• As a result of the funding, has the way in which you engage with patients changed? If so, how?
• How do you engage with people using the service to shape your organisation’s continuous improvement, development and delivery?
• Has the way in which you engage with, and commission, third-sector input changed as a result of the funding?
• Have there been any changes in staff training as a result of the funding?
• Have there been any changes to the way in which you collect and manage data to deliver services and allocate resources?
• Do you measure changes in staff or patient satisfaction, and if so, how are these measured?
• How are the changes you’ve implemented as a result of the funding aligned with the original principles for the allocation of funding?
• How is your service supported within your NHS Board clinical and operational governance structures, systems and frameworks? Has this changed since December 2022, during the funded improvement work, and how?
• Have you developed any new collaborations, networks of support or knowledge exchange with other clinics as a result of the funding?
• Are there any gaps in provision?
• Are there any emergent issues that are influencing your improvement work?

Impact Questions

• Have waiting times changed since December 2022? What impact has this improvement work had on waiting times, if any?
• Have there been any changes in partnership working, between the Gender Identity Clinic and other primary and secondary services in your NHS Board?
• Have there been any changes in partnership working between the Gender Identity Clinic and other services in referring Health Boards?
• Have there been any changes to patient care, as a result of Gender Identity Clinic staff providing advice to other primary and secondary services?
• What are the changes to patient satisfaction and feedback as a result of this improvement work?
• What are the changes to staff satisfaction and feedback as a result of this improvement work?
• Do third sector providers notice any changes in how people talk about their experience of accessing or waiting to access the services as a result of this improvement work and what are these changes?
• Do organisations and individuals making referrals into gender identity clinics report any changes in the feedback on the clinics received from referred individuals?
• What benefits or unintended consequences have arisen from this improvement work, with regard to patient care and staff wellbeing?
• What benefits or unintended consequences have arisen from this improvement work for any related services, such as GPs and CAMHS?
• How have you sought to address health inequalities with the funding, including inequalities resulting from multiple disadvantage and intersectionality?

Concluding Questions

• What do you see as the value of the SG funding, and how successful have you found it?
• Is there anyone else we should talk to or documents we should look at?
• Is there anything you would like to add?

2. Additional/Alternative Questions for Third Party Organisations

• What kind of support are you offering to people seeking gender identity healthcare services?
• Are you currently providing any services in partnership with GICs?
• Have you found the Gender Identity Clinics and other teams/departments within the NHS to be open to partnership working? How would you describe working relationships?
• Do you work with GPs to support patients? If so, how?
• Do you offer any specific support to patients on waiting lists?
• Do you work with any other organisations in providing support/services to people seeking gender identity healthcare?
• How would you like to work with Gender Identity Clinics in the future?
• How would you like gender identity healthcare to be delivered in future?
• What are the greatest obstacles to supporting patients, in your opinion?
• And what are the greatest opportunities to support patients?
• Have you noticed a difference in the services provided to patients with the commencement of SG funding from the end of 2022 onwards?
• Generally speaking, what do you think the improvement funding could be used for?
• Is there anything else you would like to add?
• Is there anyone you recommend that we speak to?

3. Additional/Alternative Questions for Service Users

• Could you describe your journey so far using Gender Identity Services?
• How have you found the experience accessing services?
• Have you received support from any other services?
• Have you felt supported and listened to by healthcare staff?
• Did you feel that there was a good transition of care between the person you first saw (as relevant, i.e. your GP, psychologist?) and the clinic?
• [If relevant] did you feel that there was a good transition of care from the clinic back to your GP?
• Do you feel that staff are trained and knowledgeable about gender identity?
• Have you noticed any change in service since you began your journey? (For instance, the SG provided additional funding from late 2022 onwards)
• What in your experience works well?
• Do you have any suggestions about how to improve the service?
• Is there anything else you would like to add?