Mystery surrounds the appointment of a virtually unknown gender clinic specialist to chair a crucial new advisory group in the NHS.
The decision, recently made public on the NHS CB's web site, appears to pass over senior clinicians whose expertise and track record are far better known to patient stakeholders.
I'm keen to hear from anyone who can shed light on this, as the appointment seems strange in the circumstances.
Clinical Reference Groups
The NHS Commissioning Board has been recruiting volunteers to sit on and chair new bodies called Clinical Reference Groups over the last few months.
These new groups are integral to the design and planning of specialised services, which include all NHS-funded Gender Identity treatments.
I explained how specialised commissioning will work in the new NHS structure in a previous article.
The process to populate these groups has been advertised openly, and would have been seen by the clinical leads and staff of all the existing gender clinics in the UK.
Breadth and depth of experience
Several names would come to mind as clinicians with the breadth and depth of experience to either chair or populate such a committee, which will influence the future evolution of how services are commissioned and the protocols by which they work.
Experience of patient diversity is essential, so one school of thought is that you might pick a chair from one of the larger established gender clinics, seeing hundreds of patients a year drawn from a wide national catchment.
There is one particularly obvious candidate from that point of view.
Experience of policy development is essential too, so another school of thought is that you might pick a clinician with a record of leading on the development of best practice guidelines.
For instance, Dr Walter Bouman (Nottingham) and Professor Kevan Wylie (Sheffield) are both clinical leads of substantial established Gender Identity Clinics in England. Both attended a recent conference with me in San Francisco, developing a global consensus among specialist clinicians for revising medical classification. The latter has also chaired an inter-collegiate committee developing UK treatment guidelines.
You would think that clinicians from these three centres would be the leading contenders to go on and chair any committee advising the NHS Commissioning Board.
The NHS Commissioning Board has now announced the appointments of many of the first CRG chairs, however.
And the selection of a chair to lead on gender identity services is a bit of an outlier.
Now, this is a field that I have been working in for over 20 years. I sat on the Parliamentary Forum on Transsexualism for 13 years. I chaired the first working group set up by the Department of Health to develop educational resources. I wrote the Department's official policy guide. I am the UK's external advisor to the World Professional Association for Transgender Health. And I've sat on more committees and spoken at more policy events than I can honestly remember.
And in all that experience I have never encountered the name, let alone the presence, of John Dean.
Some digging reveals that Dr John Dean is the lead clinician for a service called The Laurels in Exeter. The clinic doesn't appear to have a web site of its own; however this site by Gay Youth UK provides some details.
That would be handy, of course, as the Chief Executive for the neighbouring South Devon Healthcare NHS Foundation Trust is none other than Paula Vasco-Knight, the National Lead for Equality at the NHS Commissioning Board.
Since many equality concerns have been raised around the design, conduct and access to gender identity services over the years, the Commissioning Board's head Champion for Equality is almost certainly likely to know the new Chair of the Clinical Reference Group already.
New broom vs competency
There is an argument, of course, that the governance of policy development in this area might need a clean pair of hands, untainted by all the previous history and enmities.
Gender clinicians in the UK really aren't a model of happy families. In particular, politically, they seem to have divided into "Charing Cross and the rest".
The unifying factor for "the rest" is that, even when their case loads are all added together, they are still only a fraction of the size of the Charing Cross behemoth. You can readily appreciate where they might find common purpose.
However, I look at this from the perspective of a lay expert who has watched the painful evolution of policy for many years. I am a critical friend. I have not been sparing in criticism of what was bad. Equally, I've been generous in helping anyone and everyone who wants to do it better.
For that reason, I would feel rather more reassured if one of the existing experienced players were chairing this Clinical Reference Group and the rest were around the table.
Surely depth and breadth of clinical expertise matters? I would be particularly worried if it turns out that any of those experts are excluded (though the panel memberships haven't been published yet).
To me, regardless of how wonderful he might be in his own small clinical fiefdom, the newly appointed Chair of the Clinical Reference Group for gender identity, is a virtual unknown. And that is a matter of concern. It's akin to putting the head of a tiny cottage hospital in Devon at the head of the cardiology CRG.
This is why I'm concerned to understand more about this appointment … the logic for how Dean was chosen … where he claims expertise, given his noted absence from anything I've been involved with all these years … and who he is including (and excluding) from the group he will lead.
In my previous blog about gender identity service commissioning I was cautiously optimistic that the new system could actually improve experiences for English trans patients.
That may still be the case. Dr John Dean could turn out to be an inspired choice for chair, sweeping away the past and acting as a new broom. When an unknown gets appointed over the heads of so many more experienced and networked clinicians, however, you are bound to wonder...