Letter to Department of Health regarding Number Ten Petition Response

Earlier this year, a petition on the Number Ten Downing Street web site drew many hundreds of signatures protesting the existing policy on gender Dysphoria treatment by Oxfordshire PCT.

The policy agreed to refer patients for assessment of their gender Dysphoria – a process that would involve social transition and hormone treatment (some of which is irreversible) but which then refused to fund any surgeries which clinicians indicated to be necessary to complete a patient's treatment.

Today Number Ten has responded. You can read their response here.

Apart from the fact that the response really says nothing useful in policy terms (other than the fact that the policy is being reviewed), I was disturbed by the poor description of the patient pathway, and what it could imply to those who are not completely familiar with best practice, and the areas where treatment protocols are in active dispute.

I have written immediately to the senior civil servant who would most likely have been involved in drafting the Number Ten response. And if he wasn't involved in the response then that would raise another question.

Here is an extract from what I have said:

Dear 'B'

I have just been notified by the No.10 epetition system about the Government's response to the issues surrounding the current commissioning policy of Oxfordshire PCT concerning gender reassignment treatment. As you know, the present policy – by amounting to a blanket ban in all but name – is unlawful.

I am writing to you personally as I expect that you should have had some input into the text of the response.

What troubles me is that the reply is factually incorrect in the way that it describes the standard patient pathway.

Firstly, the description blurs the distinction between a referral to a CMHT psychiatrist (to rule out psychiatric illness) and the tertiary referral which normally takes place from there to a gender identity specialist service (which need not necessarily be psychiatrist or psychologist led). In doing this the reply over-emphasises the prominence of psychiatry in treatment and implies that gender identity patients have a mental illness. As you know, the direct reverse is true. The point of the two stage referral is to ensure that people who are mentally ill are treated locally for that mental illness. Gender clinics deal with people who are not mentally ill (or in whom the mental illness is unrelated to gender Dysphoria or simply a result of non-treatment of gender Dysphoria).

Secondly, and far more seriously, the No.10 statement implies compulsion in the organisation of the Real Life Experience (RLE) and that endocrine treatment may not be offered until late in an 18 month process. In the worst of the policies I have come across this is never the intention. There is controversy over whether endocrine treatment should start before or in the first three months of RLE – the Parliamentary Forum regards the latter as unethical and cruel (a potential human rights abuse) – but I have never come across anyone proposing that patients should effectively live in drag for extended periods without endocrine treatment to support the other changes they need to make (such as facial hair removal, which is impossible otherwise).

In a sense this emphasis on the non-surgical aspect of the patient pathway is an irrelevance in any case, however, as the petition was about the cruel and unethical policy of embarking patients on a programme like this and then refusing to fund clinically indicated surgery to complete it. The No.10 makes no reference to the place of surgeries in the patient pathway and therefore fails to answer the very essence of the petition.

'B', I've now been working with you for the better part of four years and so I now expect better from the Department, which I'm sure will have been involved in drafting and agreeing this statement.

Please confirm what you are going to do about this.

Yours etc...