Trans Safety Network has been informed that the Chalmers GIC in Scotland has paused surgical referrals for under 25s, and for gender surgery conducted in England (vaginoplasty, masculinising top surgery, and phalloplasty/metiodoplasty). The East Lothian Health and Social Care Partnership, which includes the Chalmers GIC, have stated in a letter to the MP of an affected patient that the pause in referrals for under 25s is a result of the Cass review. The Cass review did not review any evidence relating to surgical referrals in adults, or indeed any evidence relating to medical transition in over 18s.
In the letter, seen by TSN, NHS Lothian states that Referrals were paused from 2nd May 2024 and for those aged 25 and over will restart from 17th October 2024. There have been no public statements on this significant delay, despite the significant impact this will have on patients, many of whom have already waited years to be seen. For those aged 25 and over, the delay in referral will be approximately six months, but for those aged 18-24, referrals will not occur until a review of the referral process has been completed. NHS Lothian “hope to begin this piece of work shortly” but “do not yet have a timescale for this work”. For those under 25, this means that there is no available information on when it will be possible to join surgical waiting lists.
NHS Lothian states in the letter that this indefinite delay has been implemented as a direct result of the Cass review:
“In Scotland, the DCMO report, Cass Review - Implications for Scotland recommended that ‘Services in Scotland should review current transfer arrangements to ensure continuity of care and support over this potentially vulnerable period’. We understand that the reference to 17–25-year-olds was intended to refer to people up to their 25th birthday, i.e. up to the age of 24 years. In considering the wider implications of this recommendation and the Cass Review, NHS Lothian decided to review the service for those aged under 25 years at Lothian GIC. This process will assess the need for additional considerations and/or a different service design to provide the required continuity of care and support for those aged 18-24 years within adult gender services in Lothian. At the same time, the referral process will be reviewed in the light of the newly published NHS Scotland Gender Identity Healthcare Protocol and Gender Identity Healthcare Standards, published on 3rd September 2024, to establish what further developments and changes may be required to the existing assessment and referral process.”
It is unclear how an indefinite delay in surgical referral ensures “continuity of care and support” for under 25s, and NHS Lothian acknowledges that they are “aware of the potential impact of this pause on the mental health of patients awaiting assessment and referral for gender affirming surgery.” Despite this, patients were not provided with detailed information about the pause until the 13th of September, more than four months after referrals were paused.
Trans Safety Network are deeply concerned about the Chalmers GIC’s lack of transparency with patients around this decision. NHS Lothian states “The clinical team have responded to queries from individual patients and from 13th September have been provided with detailed information about the pause to share with those attending the clinic. Those contacting the clinic have been referred to a clinician for discussion and direct support.” This seems to indicate that affected patients are not being informed or provided with support unless they inquire about why their surgical referral is taking longer than expected or are attending an appointment. Prior to the 13th of September they were apparently not even provided with detailed information.
The Chalmers GIC patient who shared these documents with TSN had to go via their MSP to obtain any information about why their referral was taking so long, and had difficulty getting through to the GIC on the phone. When they did get through, they had difficulty accessing the support NHS Lothian claims is available.
“I have been trying to talk to a clinician about this and have yet to do so, I was always told no one was immediately available and someone would phone me back.”
TSN contacted NHS Lothian for comment on the reasons for halting referrals while the review is ongoing, whether impact assessments were conducted, and whether there is a timescale for the review. They sent us the following comment:
“Earlier this year NHS Lothian paused referrals for gender-affirming surgery undertaken outside Scotland. This was to enable a review of our assessment and referral processes to ensure they were supported by good clinical governance and to enhance patient safety.
“From the 17 October 2024, referrals for gender-affirming surgery for people aged 25 and over restarted, with surgical assessments at the Chalmers GIC recommencing from 18 November 2024.
“Patients were provided with information on the pause during clinic appointments, but we apologise to anyone affected by the delay in assessment and referral.”
NHS Lothian have declined to explain the decision to pause referrals during the review, rather than continuing current practice and making any alterations after the review is completed. This will disadvantage NHS Lothian patients in comparison to patients at other GICS, as they will be further down already long surgical waiting lists.
Trans Safety Network are extremely concerned by this development, which restricts care for under 25s indefinitely, with no clear evidentiary basis for the decision. We are further concerned that this has been done without clear public communication with current patients and those on the waiting list. NHS Lothian’s failure to define a timescale for the review leaves trans people, many of whom will have already spent years on NHS waiting lists, in limbo with no information about when they will be able to join surgical waiting lists.
We understand that this news is likely to be distressing for those affected, please contact one of the organisations listed below if you are struggling.
Mindline trans + (Friday evenings only)