Looking Back on 2004 - A Year of Landmark Events

I’m starting 2010 by featuring a film that I made over five years ago, in October 2004.

The film “A Year of Landmark Events” came about because I had been invited to speak at an LGBT event in Brighton and couldn’t make it. However, the DVD that I produced then became a useful educational tool at the time.

It’s worth remembering that there was no You Tube or Vimeo in those days, so the only way I could distribute the film was by the laborious process of making DVD copies on my computer and sending them out by post. In the end I distributed around 150 copies in that way.

The experience of making this resource also shaped the way that I went on to use audio and video media. I could see how media like these could be so effective, and yet I also judged in those days that the world wasn’t quite ready for mass video .. which is why I then moved into producing Podcasts. In early 2005 I purchased a portable digital recorder and talked Tracy Dean (Press for Change's web mistress) into building a Podcast platform to distribute the material. The PFC AV Page remained the home for everything I produced until I moved on from PFC in November 2007.

The film was made barely three months after the Gender Recognition Act had been passed by Parliament, and more than six months before the Gender Recognition Panel would begin processing applications for legal recognition.

After the GRA - October 2004 from Plain Sense Ltd on Vimeo.

It was a time when we were still reflecting on what had just taken place, but also starting to define what needed to happen next, so it’s interesting to look at this again five years on. Sadly the priorities I identified five years ago remain the major challenges for social change today, although undoubtable progress has been made in each area.

A Statement of Support for the Liverpool Homophobic Hate Crime Vigil

On Monday 26th October this year a large gang of youths surrounded and attacked a 22 year old gay man, James Parkes, as he left a bar in Liverpool City Centre. He was left with serious head injuries.

The attack is being treated by Police as a homophobic hate crime and some arrests have already been made.

This was not the first attack of its' kind. Recently another gay man was beaten to death in Trafalgar Square London. Going back further there have been many other such atrocities, including the murder in Liverpool of Michael Causer last year.

Liverpool's Lesbian and Gay community is holding a vigil in the city on Sunday November 1st as the nation increasingly wakes up to the reality of homophobic violence.

In my official capacity as Chair of the North West Region's Equality and Diversity Group I agreed with my associates that I would make this statement of support to the organisers of the vigil.

A statement of support from the Chair of the North West Equality and Diversity Group, Christine Burns MBE, on the occasion of the vigil against homophobia in Liverpool, Sunday 1st November

The North West Equality and Diversity Group (NWEDG) – a network of more than a hundred public private and third sector organisations from all parts of North West England – deplores the senseless and hate motivated attack on James Parkes last Monday, 26th October.

The North West's public agencies have a strong record of promoting the equality and safety of all our 6.9 million citizens, and recognising the value that their immense diversity brings to the character and success of our region.

That includes the estimated 612,000 people who are Lesbian, Gay, Bisexual or Trans.

Regional Equality and Diversity Strategy

As Chair of NWEDG, and as a lesbian woman with an open and proud trans history of my own, I am doubly glad (and conscious) of the commitment I see all the time from my colleagues in the Regional Leaders Board (4NW); the Regional Development Agency (NWDA); Government Office North West (GONW); our strategic health authority NHS North West; and the Equality and Human Rights Commission.

That public commitment is reflected in the Regional Equality and Diversity Strategy, which clearly identifies the goal of reducing all hate crime as one of our three key priorities for strategic action.

No place for hate

Hate crimes – whether against ethnic minorities, disabled people or those who are gay lesbian bisexual or transgender – are the extreme expression of senseless intolerance and discrimination.

These heinous acts can have no place in a modern, plural society – a. society which is fast becoming even more diverse.

There will be more old people, more short term economic migration, more ethnic minorities and mixed marriages, and more openness and confidence about people's sexuality and gender identity.

It's not always that the population itself is changing. It's that people like myself can now be open and honest about who we are and share our experiences of life with our friends, neighbours and colleagues.

We say to those who are uncomfortable with these shifts "get over it!"

In fact I would go further and say that as a region we must embrace and capitalise on our diversity.

There is considerable evidence that if we are positive about diversity and at the same time move towards greater equality, then the North West – its communities and individuals – will be more prosperous and have a better quality of life.

The causes

But we also need to understand why hate crimes still exist.

It's 40 years since homosexuality was decriminalised. Many centuries have passed since England first became a multicultural country – a country of Romans, Angles, Normans, freed slaves and protestant refugees. And all that was even before the industrial revolution!

Hate crime and discrimination begins – like all intolerance – with fear of difference and our own insecurities.

That fear is fanned by ignorance and frequently, but not always, poverty.

It gains strength from a culture where bullying is all too common, and where the majority are sometimes too ready to sit on their hands and stay silent.

Not isolated cases

This week's attack on James Parkes is unfortunately just one of many. I'm conscious that this same weekend there will be another vigil taking place in London because of the recent murder of Ian Baynham. In Liverpool we also remember the murder of Michael Causer. And, later this coming month, there will be vigils all around the country (and the world) marking the annual Transgender Day of Remembrance.

The attacks on James (and Michael) are perhaps most poignant because they happened in our own back yard – in a region where we like to think we have a particular grasp of tolerance and welcoming difference.

The public shock should mark a turning point here in the North West - away from being silent on this issue and towards "equality activism".

Schools have a duty

Schools have a major role in ending the bullying culture and educating children and young people about difference. That must include teaching our children about all types of difference – LGBT included.

The excuse offered by the notorious Section 28 is no longer there. Teachers have a duty to no longer ignore homophobic attitudes, but to deal with them.

Promoting a positive message

The annual celebr8 (don't discrimin8) initiative, which is now in its third year, promotes positive messages about equality and diversity.

Just this week, in fact, we've agreed to support 12 community projects promoting community cohesion, respect and understanding.

That includes one in merseyside. And our second major annual Equality and Diversity conference is to be held this year in Liverpool, on November 11th.

It's not impossible

It's easy, on occasions like this week, to feel helpless and disempowered by the sheer horror of events. The idea that a gang of youths could pour such hate upon a young man like James is beyond comprehension for many of us.

Some might therefore wonder whether the kinds of strategic actions I've talked about can ever bring about the required change of attitudes and behaviour.

As someone who has campaigned in the past for changes that were once considered impossible, I believe that we can change our society to bring an end to senseless hate crime.

But the change starts when we recognise that it's not someone else's job. We all have a part to play. So let's all collectively send a message to the bigots, the bullies, the racists, the homophobes. We say "No to hate crimes in the northwest"

Christine Burns MBE
Chair, North West Equality and Diversity Group
29th October, 2009

Just a change of name...

For some reason or other the simple act of changing a trans person's name and title on medical records seems to be a subject that puts some GP practices and hospital records clerks into an awful tizzy.

This recent example is typical of the kind of question I'm often asked. In this case a gender clinic was being asked for guidance by the patient's GP practice:

We have a patient who is presently registered and was born as female. They have undergone a legal name change of forename to something more masculine. In the letter that you have sent to the practice you refer to the patient as male. You are assessing the suitability for cross-sex hormone therapy; I assume this indicates the patient has not had surgery.

In order for our practise to have this patient registered as male the Family Health Services Authority re-register the patient with a new NHS number and disregard the previous document as archived.

Could you please tell me at what point this patient should be registered as male?

This kind of question is covered in the Department of Health's guide, "Trans: A Practical Guide for the NHS". A common problem is that officials sometimes assume that they ought not to make any changes until the patient obtains a Gender Recognition Certificate. In a footnote on page 30 it says,

"Note that the purpose of a GRC is merely to facilitate the creation of a new entry in the register of births, from which a new birth certificate can be issued. The GRC as a document has no other legal standing. It is not appropriate to operate a policy of requiring sight of a GRC in order to change an individual's name in patient or employee records. A statutory declaration or deed poll is the most that should be required for changes of name and title, just as for anyone else, and regardless of the individual's state of transition."

In case that's not enough, the guide then touches on the topic again and again. There are passages about medical records on page 43, on record keeping on page 55 and a best practice fact box on page 35.

Yet still these questions are asked. For these reasons I thought it would be worthwhile to feature the rest of my answer to the above query. Essentially it comes in two parts:

Firstly, the appropriate time for changing records is when the patient commences living permanently in the new gender role. It is not appropriate to insist that they have had any particular endocrine or surgical treatment – or to insist they have a GRC.

Changing name and title is no big deal. Tens of thousands of such changes are accommodated every year when women marry, so the mechanisms already exist.

The most important day to day change for a trans person is that the records contain the appropriate form of title (Mr, Miss, Mrs, Ms) and the name they have taken. UK law does not require any specific process for that. You and I can change our names at any time just by telling everyone that henceforth we will be known as 'x'.

It's not technically necessary to have a piece of paper (deep poll, statutory declaration or marriage certificate), but banks and other agencies prefer something to put on file, so trans people are recommended to complete a statutory declaration of their name change. As this is a legal document, NHS Trusts should take account of it. To refuse to change records on this basis would be unlawful discrimination.

The second consideration is how records work for the purposes of sex-specific screening (e.g. inviting women over 50 for breast screening or people with prostate glands for checks). The Trans Guide again explains very clearly (top of p43) that screening should be on the basis of physiological need. Thus, depending on the way their systems work, GP practices and hospitals must make appropriate arrangements.

I'm not familiar with the precise operating details of these systems, but if it's possible to make a distinction between title (Mr / Miss / Mrs etc) and sex, there is a decision to make over whether the sex indicator should be changed or not.

A balance needs to be struck between calling the patient for the right kinds of screening and fulfilling the requirements of the Gender Recognition Act when they have a GRC. (i.e. A flag that says a trans man is female could be visible to people who should not see it and the practice would break the law in terms of unauthorised disclosure of protected information).

The best way in my view is to change the flag (as it should be) to reflect the transitioned gender and simply make alternative arrangements to screen the patient. E.g. diary events could be set up on the patient's personal record.

This is preferable in any case as a trans man would need to be seen for gynaecological examinations in a setting which preserves his privacy and dignity. I.e. You wouldn't just let the computer send him along to sit in a clinic full of women.

The same goes for a trans woman needing BOTH prostate exams and breast exams but not gynaecological tests.

Issuing a new NHS number is OK – and some trans people specifically request this. I'm not clear whether there's a gender indicator buried in the number or not. Conflicting answers have been given on this.

However, issuing a new NHS number is separate to the question of whether the patient's medical record should be replaced. Clearly that would not be in the interests of the patient.

The best thing, however, is not to try and make these decisions on a blanket policy basis but to sit down with the patient and discuss the options and the implications so they can decide what's best for them in an imperfect system.

For instance, if one option would mean that doctors couldn't access their previous medical history then patients may well decide that that isn't in their interests.

Remember that all people want is an appropriate sense of privacy, protection from disclosures that could make them vulnerable in their wrong hands, and respect for their dignity.

Dear Sir or Madam – The New Edition

Dear Sir or Madam; ISBN 978-0-9562734-0-6; £13.99; Published by Mark Rees; Order enquiries markrees (at) waitrose.com

Just under eighteen years ago, on Thursday 27^th February 1992, the organisation called Press for Change came into existence in a tea shop.

The tea shop is gone now. There is no blue plaque.

Instead, on the site, stands Portcullis House – the imposing steel, concrete and glass building full of committee rooms and the offices for many MPs.

There is no official history of Press for Change (PFC). The tiny organisation was too busy making history to fuss too much about writing it down.

Obscurity to success

In the ten years between 1995 and 2005, in particular, the campaign went from obscurity to a point where its' primary mission had been achieved. It had seen a succession of ground breaking legal cases alter the way in which transsexual people were viewed.

Employment discrimination was outlawed. It became unlawful to operate any kind of systematic bar to NHS treatment for gender Dysphoria. Hundreds of people obtained practical legal advice. A process was created for transsexual people to obtain birth certificates supporting their lived reality. They could marry someone of the opposite gender or have a civil partnership with a same sex partner. Later on, in 2008, discrimination in the provision of goods facilities and services was also outlawed.

It's a remarkable achievement for a few volunteers working in their bedrooms, and of course I'm proud of the small part I played in that, along with others.

Some of the solutions weren't perfect, but that's politics. A job still exists for people to build on those achievements – particularly to rectify the inequities and embed true change in the country's institutions and hearts. I hope another generation will work on that and forgive us for not fixing everything perfectly at the first attempt.

Maybe, one day too, someone will write about the amazing things that went on inside that tiny little organisation with such grand ambitions. In the meantime the organisation's online web archives stand as a record of the events, day by day.

The man who started it

Whatever anyone finally writes about the PFC phenomenon though, we must never forget the story of the man who – more than any other – caused the events which led to it being founded.

Mark Rees is an incredibly polite and self-effacing man considering his achievements. He's really not the kind of character you'd expect to take his country to the European Court of Rights and make the kind of history which would start a movement.

And quiet mens' achievements can so easily be missed and forgotten when history comes to be written. This is why I'm so keen for people to know Mark's story

First edition

Mark published the first edition of his autobiography, "Dear Sir or Madam" in 1996, just as PFC's campaigning in the UK was beginning to pay off.

Sir Alex (now Lord) Carlile QC described it at the time as "A brave and honest plea for justice .. a story of suffering and success". The New Law journal described it as "Not only moving but required reading for anyone legally and medically concerned". It is a remarkable book.

The first edition, promoted by Cassell, told the personal story of Mark's own life from birth in December 1942, through childhood, going to sea, transitioning to male in 1971, taking his case to Europe in the 1980's and making the vital connections that gave birth to a campaign in the early 90's.

All the way through this very personal account, it's clear that Mark was never in doubt about his gender – and neither was anyone who met him.

But the first edition went to press at a time when the legal and social status quo remained implacably unaltered. The book recorded the genesis of Press for Change but, for Mark, the prognosis in late 1995 remained really rather bleak and daunting.

Cassell finally ceased publication of Dear Sir or Madam in 2003 and, oddly, I never got to read it because I was always too busy.

Rewriting the end

Shortly after Cassell deleted Mark's book, Parliament passed the Gender Recognition Act in July 2004. Thousands of people's lives changed as a result.

With bitter irony, however, Mark was in a unique position which meant he couldn't benefit without losing his small state pension.

Eventually, when he was old enough for his pension to be unaffected, Mark thought again about applying for the legal recognition he had sought all along – the quest that laid the historical foundations for eventual success.

Again, with cruel irony, the delay meant that Mark could no longer use the simplified application procedure for legal recognition. He would have to go through the full process. He explains the complexities of all this in an interview I recorded with him back in 2007 and rebroadcast in 2008.

A little administrative matter

Mark describes it as "a little administrative matter" and pays touching credit to the little part I had in finally overcoming the obstacles for him to receive his very own Gender Recognition Certificate and new birth certificate in 2008, thus bringing his story to a new and rather more satisfying place after 66 years.

So it was entirely fitting that Mark should decide to update his autobiography to include the amazing things that had happened in 13 years since the last, and his own altogether happier ending.

Cassell, the original publisher, thought that by now the life story of a trans man wasn't interesting enough to publish themselves. Fortunately, these days, people can publish their own books quite easily though ... which is what Mark has done.

So if you're at all interested in the history of how Press for Change came to be formed, or what it's like to live through nearly seven decades of life as a trans man, this is your book.

Order from the man himself

You'll need to order the book from the man himself. You can email him at markrees (at) waitrose.com. At 67 you'll need to be prepared to deal in old technology. Mark relies on a computer at the local library and old style ways of commerce like cheques and snail mail. In return, however, I'm sure he'll agree to inscribe your book personally. It's a delightfully olde-worlde process.

And if you'd like to help him then I'm sure he'd be happy to discuss how you can buy a handful of copies to sell on to friends.

Above all though, do make sure you read it. Mark has a lovely style of telling his personal story. He describes terrible obstacles but is never bitter. For, in truth, he really has always been a gentleman.

Guidance on Gender Identity Treatment from the NHS Chief Executive

As explained in the previous Blog post, the issue of how some NHS Primary Care Trusts (PCTs) address the need for gender identity services has been an issue for many years. In fact, it is ten years ago this month that the Court of Appeal upheld a key case brought by four Lancashire trans women against their local NHS.

The case, "A.D.& G vs North West Lancashire Health Authority" established important case law. The appeal judges agreed with an earlier High Court ruling that

• Gender Reassignment treatment was an appropriate treatment for clinicians to consider recommending;
  
• that therefore the NHS had to fund this like any other legitimate treatment; and that
  
• it was unlawful for Health Service managers to operate any kind of policy that amounts to a blanket ban.
  

Managers have the right to set expenditure priorities, but patient needs must always be considered on their individual merits and the law must be obeyed.

The previous Blog explains how this has still not happened in some cases, and the way that I've pursued this as an issue, in conjunction with Dr Lynne Jones MP (Chair of the Parliamentary Forum on Gender Identity) and the Equality and Human Rights Commission.

Last week the Secretary of State for Health responded to a written Parliamentary Question from Lynne on the continuing post code lottery that patients face, depending on where they live. This was part of an all round strategy to encourage an official line to be taken.

Yesterday, I also received a long and detailed letter from one of the Department of Health's civil servants responsible for Equality matters. I don't propose to reproduce the whole letter, but he says:

...As you know, PCTs are autonomous bodies, responsible for ensuring their own compliance with all relevant legislation, including equality and human rights legislation. They are performance-managed by SHAs, and this performance management role includes PCTs' equality and human rights compliance. It is not therefore the role of DH to intervene in the day to day management of PCTs. DH is fully committed to the equality agenda, however, and takes steps to disseminate knowledge and helpful material to NHS bodies where appropriate, encouraging them to promote equality beyond solely the strict requirements of the law. Our series of equality guides to the NHS are a good example of this, not least "Trans - a practical guide to the NHS" which does, of course, include information and suggestions on commissioning, explaining how the needs of trans people should be taken into account.

We do not accept that DH is required to take any further action at this stage in order to comply with our statutory obligations. We are however always keen to promote the equality agenda, and take stakeholders' concerns seriously. We note the serious concerns that you, and the Parliamentary Forum have raised about the availability of gender identity services in particular areas. Consequently, David Nicholson, NHS Chief Executive, has agreed that the Department should write out to all NHS Chief Executives and their teams, via the weekly NHS Leadership Team bulletin this week, to reiterate the importance of this issue. It will be issued this Thursday 24 September and will consist of the following:

Gender Identity Services

Concerns have been raised over the difficulty that some people experiencing gender dysphoria are encountering in obtaining gender reassignment treatment, with the allegation that some PCTS are effectively operating "blanket bans" on funding such treatment. Please be aware that any such blanket approach is unlawful. Each case must be considered individually, according to clinical need and local prioritisation. Further guidance is available on the DH website and in the Specialised Service Definition (No. 22 - Mental Health Services).

Links:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089941

http://www.specialisedcommissioning.nhs.uk/index.php/key-documents/nationally-commissioned-specialised-services/?dl_page=2

Action: NHS chief executives should ensure that they are not operating "blanket bans" in relation to gender reassignment treatment.

Personally I am sceptical that this action is all that is required. I don't think it's a magic wand. PCTs who are causing concern have a rather more sophisticated approach than simply saying, "We don't provide this". Therefore some could continue to claim they are complying with the law anyway.

The usual approach by such PCTs is to have a policy that ranks assessment and support for gender identity issues as low priority, funded by exception, and to operate Exceptional Case review procedures in a manner which simply fail to admit any case as being such an exception.

This kind of smoke and mirrors has therefore had to be approached by patients being prepared to take their PCT to court. Such PCTs then settle at the last moment, ensuring that there is no resultant case law which could fetter their approach to the next patient in line. This is why the situation has persisted for a full ten years since it was supposedly outlawed.

For these reasons I've written back to the Department of Health and, whilst welcoming this advance, I've recommended a series of actions that they could and should be taking, through the Strategic Health Authorities, as a way of reinforcing the spirit as well as the letter of David Nicholson's message. SHA's are responsible for performance managing PCTs, as DH themselves point out.

In the first instance, however, we all need to see what happens as a result of David Nicholson's direct policy statement. Chief Executives of NHS Trusts know that he's not a man to trifle with.

And maybe this will be the nudge that was required, prompting a more honest and equitable approach. If it isn't however, then I'm ready for the next step .. and the Equality and Human Rights Commission are watching closely too.

Parliamentary Answer on access to Gender Identity Services

During the summer months there has been quite a lot of behind the scenes activity going on regarding the inconsistent levels of NHS provision for people with gender identity issues.

I had already been working for some time this year with the specialist commissioning group in Yorkshire and Humberside region. That work has led to commissioners for that region developing what we believe to be the best policy and service specification to date.

By coordinating consultation with representatives of the Gender Trust, Press for Change and Charing Cross Gender Identity Clinic, and by carefully educating the commissioning team, we've arrived at something that, whilst not perfect, represents a significant advance on any previous policy.

The policy and service specification has now been approved by the full regional Specialist Commissioning Group (SCG) and is expected to be ratified by Yorkshire and Humberside's 14 Primary Care Trusts (PCTs) in October. That will mean that treatment and funding policy in the Yorkshire and Humberside Region will be consistent.

With a best practice approach to refer to, I've also been having a similar kind of discussions with the commissioner responsible for the same policies in the North West – although that work still has some way to go. The goal is to gradually infuse better practice, one region at a time.

Ten Years

Yet this also takes place against a setting where we know that many PCTs are still operating policies that amount to a blanket ban on treatments. This is ten years after the Court of Appeal upheld an earlier high court decision (A.D.&G vs NW Lancs Health Authority) which said such behaviour was unlawful.

The PCTs that do this are never so obvious as to say that they are banning treatment of course. No. What they do is to set policies which say they'll not routinely fund treatments, but that people can apply for special consideration under the Trust's "Exceptional Cases" procedure.

Such PCTs can seldom define what would constitute an exceptional requirement though, and in practice some have never made such an exception. When challenged on this by patients prepared to take legal action, they will deny the intent behind their behaviour all the way to the steps of the court and then miraculously make an exception.

There are several well-documented cases around the country where this kind of thing has been happening and, if anything, it seems to have got worse in some areas over the last year or two. For instance, Nottingham Teaching PCT had a policy of this kind, which I criticised to their faces in a conference in the City last year organised by the Department of Health's Equality and Human Rights Group.

Other parts of the East Midlands region had policies which funded assessment and treatment of gender identity issues to varying degrees. However recent changes, meant to centralise policy making on so-called "Specialist Services" at regional level, led to a consolidation exercise in each of the ten English Strategic Health Authority regions.

And in East Midlands, rather than levelling services up to the best, they decided they would level down "to be fair". The plan was to adopt the restrictive Nottingham policy for the whole of the rest of the region.

The situation became so bad that one Nottingham patient embarked on a hunger strike, vowing that she was prepared to die to draw attention to what was going on. Fortunately, after a week, she called off the action, telling the BBC "I've been assured that they will fund and support me". Health services should not have to work in this way for anyone.

Departmental Blind Spot

I've been associated with the Department of Health's Equality and Human Rights team for several years now (since 2006), and I and my colleagues have never missed any opportunity to draw attention to these problems and urge the Department to deal with them.

In September 2008 I was formally appointed as an Advisor on LGBT health issues and felt, by then, that there was sufficient documented evidence (in press reports alone) to move beyond the need to measure and prove the problem. Instead, I advised the Department's equality team to address clear and unambiguous challenges:

1. To address the issue of poor commissioning policies in England and promote a best practice approach with adequate funding and choice to address all the documented issues of delays and obstructions
   
2. To address the issues of General Practitioner knowledge and behaviours (as highlighted by the "Engendered Penalties" report in 2007)
   

During the past year I've then pursued these two targets at every available opportunity, being careful to ensure that additional objectives were not allowed to creep in and dilute attention. (Given the opportunity, officials will always put their efforts into the easiest task and use that the deflect attention from harder topics).

However, as the first year of the Department of Health's LGBT Advisory Group drew towards a close, it was apparent that nothing whatsoever had been achieved on either of these objectives. Worse, we seemed to be going backwards, when Ten Downing Street issued a very poorly informed response to a petition about similar problems in Oxfordshire.

Readers of this Blog will know that I wrote immediately to my associates in the Department of Health pointing out the issues with the Number Ten response and demanding action.

Red Card

Shortly after these events I had another meeting of the LGBT Advisory Group, in which my patience and diplomacy simply ran out. Politicians would say that a "full and frank exchange of views" took place.

Following this I also briefed contacts in the Equality and Human Rights Commission (EHRC), who are already undertaking a very detailed investigation of other issues, continuing work begun by the former Commission for Racial Equality.

The issue is that whilst PCTs are autonomous and the Department cannot order them how to apportion their budgets, Ministers do have an absolute responsibility to ensure NHS Trusts don't break the law or violate the principles of the NHS. By now, the officials at DH were conceding that they knew this was what was happening in the case of gender identity patients in some parts of the country.

The issue is made worse by the fact that I had also put forward a suggestion that the Department could address the policy issue very easily by offering to publish the "Guidelines for Commissioners" produced by the Parliamentary Forum on Gender Identity.

This was meant to hand the officials a solution on a plate ... a lifeline which the Equality and Human Rights team at DH seemed quite enthusiastic to seize. However, in our frank exchange of views (above) it had emerged that the Mental Health team in DH, who have policy responsibility for Gender Identity services, was only prepared to "welcome" the guidelines. They were categorically opposed to publishing this clear guidance under an NHS or Department of Health logo.

At the same time as briefing EHRC I also agreed the text of a Parliamentary Written Question with Lynne Jones MP, which she agreed to submit. As Parliament was in recess for the summer, this has only just been answered. However, it has also now been the prompt for the Department to assure me in person that a letter will be going to the Chief Executives of all English PCTs later this week, on this very issue.

When the letter has been sent and I have a copy I will Blog it here. I'll also cover the formal response to the issues I've raised personally with the Department. In the meantime, however, here is the Parliamentary Question and its' answer.

Note that these kinds of answers are usually couched in very careful words like this one, so the value isn't in the words but the fact that the issue has been forced up to the most senior levels, involving Ministers and the Chief Executive of the NHS, David Nicholson.

16 Sep 2009 : Column 2238W—continued

Gender Identity Disorder

Lynne Jones: To ask the Secretary of State for Health what steps he is taking to ensure that all primary care trusts provide accessible, timely and high quality gender identity services. [291225]

Mr. Mike O'Brien: The Department is committed to the delivery of high quality national health service gender identity services. Primary care trust commissioning of gender identity services remains a matter for local prioritisation, with access to services determined by clinical need and local decision-making.

The Department is in the process of writing out to all NHS chief executives and their teams, via the weekly NHS leadership team bulletin the week, to reiterate this commitment to high quality gender identity services and the importance of considering such cases individually, according to clinical need.

Manchester Pride takes a cue from Lily Allen

The final weekend in August saw Manchester, one of Britain’s most LGBT-friendly cities, hosting its annual three day Pride celebration. In this reply to a similar French video, the revellers deliver a one-fingered salute to homophobia based on Lily Allen’s “F**k You!”. Shame the homophobes never seem to have so much fun in their lives.

Congratulations to the crew at LGF and BellyFlop TV on this amazing video.