I've been hearing several verified accounts from around the country where Primary Care Trusts have been issuing policy letters to Gender Identity Clinics, restricting referrals for patients with Gender Identity Issues.
So far as I can see, the PCTs concerned aren't singling out gender identity referrals alone. Generally there are whole categories of treatments which have been lumped into the same boat.
One glance at those lists will reveal, however, that the other treatments subject to cutbacks are generally those which would be considered as 'elective' and generally low priority.
This tendency to lump gender identity patients in with people seeking (say) tattoo removal suggests a certain mindset on the part of the managers concerned.
This is a topic I've sought to act on before. In September 2009 I was successful in getting the Chief Executive of the NHS, Sir David Nicholson, to issue explicit guidance on the topic -- as reported on this blog.
I've also written more generally about the discipline which PCT commissioning managers must follow when changing any policies like this. Again, you can read that here on the blog and here for a more specifically NHS audience.
What the Government says
Baroness Gould, a Labour Peer who is taking over from Dr Lynne Jones as chair of the Parliamentary Forum on Gender Identity has sought to obtain some reassurances from the Government on this matter. Her written Parliamentary Question and the corresponding answer by Earl Howe, Parliamentary Secretary of State for Health, can be seen below.
As you'll see, the Government says more or less what I've explained in more detail here. Consequently the first avenue for challenging any policy change by PCTs affecting access to gender identity treatments should be to demand to see the Equality Impact Assessment (and to check that it was carried out before the policy change was introduced).
Do PCTs still have to do equality impact assessments?
Note that, after the new Public Sector Equality Duty comes into effect in April you may encounter managers who try to argue that they no longer have to carry out Equality Impact Assessments. This is misleading.
It is true that the new legislation changes the emphasis and terminology from "assessing" to "analysing" and that organisations will no longer have to publish all the paperwork; however they are still required to be able to justify a decision on the basis of having analysed its' effects and ensured that they are complying with the general duty to :
- Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act; and
- Advance equality of opportunity between people who share a protected characteristic and those who do not; and
- Foster good relations between people who share a protected characteristic and those who do not.
This is what the Equality and Human Rights Commission say in their non-statutory guidance on the new duty:
"Under previous duties you were required to set out how you would assess the impact of policies and practices on race, disability and gender equality, including gender reassignment. The requirement to set out how you will assess no longer applies, but under the new equality duty you are required to analyse the effect of your policies and practices and how they further the equality aims, and to publish the results of that analysis and the information you used."
So, the position is clear enough. Make sure you demand to see that the PCT has thought about what it is doing.
Parliamentary Question and Answer
Question Number: 5883
Date of Answer: 24.01.2011
Column References: 724 c109WA
Member Tabling Question: Gould of Potternewton, Baroness Topic: Health: Spending Cuts
Question: To ask Her Majesty’s Government what guidance is being given to primary care trusts to ensure that the cuts to services are not being targeted in a discriminatory manner; and what steps they are taking to ensure that the cuts do not discriminate against gender re-assignment cases; and whether they will ensure that their financial policies are equitable and have been subject to equality impact assessments.
Member Answering Question: Howe, Earl
Answer: Primary care trusts, as with other National Health Service organisations and public bodies, must fulfil their statutory responsibilities under the Equality Act 2010, including assessing the impact of their decisions. Guidance is available from a number of sources including the Equality and Human Rights Commission and NHS employers with whom the department is working to support the NHS to implement the Equality Act. The NHS chief executive wrote to all NHS organisations in September 2010 reminding them that compliance with both the spirit and letter of the Act is essential during transition. The NHS Operating Framework 2011-12 also reminds NHS organisations to ensure that all decisions are taken with due regard to the public sector equality duty to ensure that decisions are fair, transparent, accountable, evidence-based and consider the needs and rights of staff and patients across all the equality characteristics.