National Gender Identity Healthcare Reference Group minutes: December 2024

Attendees and apologies

• Professor Nicola Steedman, (Co-chair), Deputy Chief Medical Officer, Scottish Government
• Dr Ewan Bell, (Co-chair), Associate Medical Director, NHS Dumfries and Galloway
• Kerry Cairns, Service Manager, Elmwood Geder Identity Clinic, NHS Grampian
• Dr Moira Connolly, Psychiatrist, Interim Clinical co-lead Sandyford Gender Identity Service, NHS Greater Glasgow and Clyde
• Hayley Fairgrieve, Gender Lead Nurse/Advanced Sexual Health Practitioner, Chalmers Gender Identity Clinic, NHS Lothian
• Linsey Galbraith, Principal Information Analyst, Public Health Scotland
• Dr Sean Harper, Consultant Clinical Psychologist, Director of Psychology, NHS Grampian
• Jane Harris, Head of Programme, Postgraduate and Post-registration Education and Continuing Professional Development, NHS Education for Scotland
• Janis Heaney, Associate Director, NHS National Services Scotland
• Dr Amber Keenan, Clinical Lead, NHS Highland
• Jennifer Layden, Health Improvement Scotland
• Rhoda Macleod, Head of Sexual Health, Prison and Police services, Sandyford Gender Identity Clinic, NHS Greater Glasgow and Clyde
• Niamh O’Connor, Deputy Director, Public Health Strategy and Improvement Division, Population Health Directorate, Scottish Government
• David Parker, Senior Educator, NHS Education for Scotland
• Dr Ruth Pearce, Lecturer, University of Glasgow
• Dr Pavan Srireddy, Consultant Adult Psychiatrist, Interim Clinical co-lead Sandyford Gender Identity Service, NHS Greater Glasgow and Clyde
• Dr Fiona Wardell, Standards and Indicators Team Lead, Healthcare Improvement Scotland
• Mairi Watson, Public Health Scotland
• Dr Craig Wheelans, National Medical Advisor, Specialist Healthcare Commissioning, National Networks & National Planning, NHS National Services Scotland
• Lived Experience Coordinator
• Representative, * LGBT Health and Wellbeing
• Representative, * LGBT Youth Scotland
• Representative, Transparentsees
• Scottish Government Secretariat

 

Apologies

• Dr Fiona Clunie, Consultant Psychiatrist/Medical Lead, Chalmers Gender Identity Clinic, NHS Lothian
• Dr Alison Poupart, Interim Consultant Clinical Psychologist, NHS Greater Glasgow and Clyde
• Kimberley MacInnes, Service Manager, Raigmore Gender Identity Clinic, NHS Highland
• Dr Paul Connelly, Clinical Lecturer in Diabetes & Endocrinology, University of Glasgow
• Dr Susan Rooney, Clinical Lead, Sandyford Gender Identity Clinic NHS Greater Glasgow and Clyde
• Representative, Scottish Trans

Items and actions

Welcome & minutes of previous meeting: Paper A (minutes)

Ewan Bell (EB) welcomed attendees to the 21st meeting of the National Gender Identity Healthcare Reference Group (the Group). Apologies were noted.

The Group agreed the minutes of the meeting on 1 October 2024.

EB highlighted that a member of the policy team is moving to another post and the Group thanked them for their work.

The Group was updated that following a pause while the NHS Lothian reviewed their governance processes, the health board has now resumed the appointments and referrals for gender-affirming surgeries for those aged 18 – 24. It was highlighted that UK Government is extending the temporary ban on private and EEA prescribing and supply of puberty blockers for gender dysphoria until the end of year.

 

Policy Update and Risk register

Actions arising from previous meeting were completed, including sharing of the NHS Lothian shared care agreement, which came into effect in November, with the Group.

A number of completed workstreams progressed by the Group were acknowledged and some of the workstreams nearing the completion outlined, including consideration of future funding and on-going work by NHS Education for Scotland. It was highlighted that the final report of the independent evaluation into the impact of Scottish Government funding to NHS for improvement of their gender identity services has been submitted to the Scottish Government. The boards were thanked for supporting the evaluation and next steps before the publication of the report in early 2025 were outlined.

Update on the ongoing and outstanding workstreams was provided, including that Task and Finish group is progressing young people’s commissioning and the update will be provided at a future meeting. The commitment to, and duty for, public involvement in service planning at different phases of this work was acknowledged and that this will continue to be highlighted at  meetings of task and finish group.

Strategic network work was discussed and it was noted that there is still a commitment and need to form such platform. This is a wider piece of on-going work between NSD and SG that spans across specialities, including considerations of role and remits of networks and how they sit nationally.

Updates to the risk register were outlined, including risks now archived, and new risks arising highlighted.

 

PHS Waiting times data

PHS highlighted the first publication of ‘official statistics in development’ of waiting times for first outpatient appointment at gender identity clinics. This publication marks a start of the process in terms of getting to nationally consistent, comparable waiting times data and it was agreed that there is still work to do.

Discussion on the data followed and how it is presented in the publication. Concern regarding comparison on like for like basis between services was raised as they all work differently and cover different areas and number of patients. The Group also asked whether there is sufficient focus on internal waiting lists, whereas patients may have a first appointment but have to wait months or years for next steps, such as hormones or surgeries, which is not currently captured. An issue of internal waiting time ‘wastage’ was highlighted, where by the time a person gets second opinion the first one times out.

PHS agreed comparison is not like for like and are aware of differences, and noted that work continues on getting the balance right in a way that makes the statistics helpful.

 

Next Steps

Next priorities and how these were identified was outlined, including:

Young people, including work progressed by Task and Finish Group, NHS Education for Scotland work and four nation research on puberty blockers.

Adult services, including review and implementation of evaluation findings, future allocations depending on HIS, PHS and evaluation, scoping of surgical provision in medium and long term, consideration of future provision and commissioning of adult services, and reviews and updated of Gender Identity Healthcare Protocol to reflect new and emerging evidence and best practice.

Strategic support, including strategic forum to replace the Group in 2025, continuation of PHS work on waiting times data collection and reporting until it becomes routine, completion of University of Glasgow research projects and consideration of future funding for this purpose to encourage research, implementation of evaluation findings, and future training needs.

The next step includes advice to the Minister regarding future priorities.

The co-Chairs acknowledged that the Group cannot continue with this work indefinitely, but expressed their anxiety that there is still no strategic forum for this area and that while a lot has been achieved there is also still a lot that needs to happen.

The Group mirrored their concern that the work accomplished so far would be lost. The need for a strategic forum and for operations/clinical support to encourage collaboration, learning and sharing of best practice was discussed. The clinicians expressed they feel vulnerable while the work on what future network models is on-going, especially as this area of healthcare is under such intense scrutiny and would welcome clarity on the future of networks. NSD confirmed that a Director Letter is expected early next year in relation to this and it was agreed that policy team will follow up with Chief Operating Officer Directorate about timelines.

The Group also acknowledged the progress so far, including work progressed by HIS, NES and PHS, which was not happening before the Group started work.

The Deputy Director acknowledged the need for continuing the work and highlighted that the work achieved so far should provide the foundations so that the progress us not lost.

 

AOB

Co-chairs proposed that the next meeting is scheduled for February to allow for some of the work to be completed. The Group agreed.

No other business was raised, and the meeting concluded.