Lyn Brown

Labour Party Candidate for West Ham

Transgender Equality Debate Speech

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On the 1 December I spoke in the Transgender Equality debate. Speech Below:

Thank you Mr Speaker,

I have listened with interest to the excellent arguments made by Members about how the Gender Recognition Act and the Equality Act ought to be amended to better protect transgender equality rights.  I do hope the Government takes these arguments seriously and that they respond appropriately.  However, I want to use my speech to focus on a different aspect of the excellent report from the Women and Equalities Select Committee: the services provided for transgender people by the NHS.

Trans people experience worse health, both physical and mental, than the general population.  The Equality and Human Rights Commission have found that a higher proportion of transgender people say that their physical health is 'poor or very poor' compared with other LGBT communities and non-LGBT communities.  Levels of poor mental health are also higher in the transgender population, about half of young trans people and a third of trans adults report that they have attempted suicide.  It is therefore imperative that trans people have full access to general medical services.

Trans people also have specific health needs.  Untreated gender dysphoria, which is medically defined as where a person experiences discomfort or distress because of a mismatch between their biological sex and gender identity, can take a real toll on mental health.  Dr John Dean, who is the Chair of the NHS National Clinical Reference Group for Gender Identity Services, has said, and I quote:

“Not treating people, is not a neutral act—it will do harm.”

I could not agree more with Dr Dean.  Some trans people’s health and wellbeing would be greatly improved by gender confirmation treatment through our specialist Gender Identity Clinics.  Trans people have to be able to access those treatments on our NHS if they need them.

Unfortunately the Select Committee Report demonstrated that our NHS is not currently providing a good service for trans people.  In fact, the Select Committee Report found, and I quote:

‘The NHS is letting down trans people.’

One of the first problems identified by the report was discrimination faced by trans people when they tried to access general medical services.  Dr James Barrett, President of the British Association of Gender Identity Specialists, told the committee, and I quote:

‘The casual, sometimes unthinking trans-phobia of primary care, accident and emergency services and inpatient surgical admissions continues to be striking.’

Sadly this discrimination has real consequences.  Terry Reed, of the excellent Gender Identity Research and Education Society, told the Select Committee that trans people were often nervous about accessing services because they were ‘not treated sympathetically or even politely’ by doctors and staff. 

Trans people also have real difficulties accessing Gender Identity Services.  GPs have a legitimate role in acting as gatekeepers to NHS specialists, but I am afraid there is evidence that prejudice and ignorance amongst our GPs is preventing those who experience gender dysphoria from receiving the services they need.  Dr James Barrett, of the British Association of Gender identity Specialists, has said that there is a ‘persistent refusal’ on behalf of some GPs to make referrals to Gender Identity Clinics.  The Beaumont Society have heard of one trans person being told by their GP at their first assessment:  ‘You’ll be taking money away from more deserving cancer patients.’  Completely disgraceful.

If someone experiencing gender dysphoria is referred to a Gender Identity Clinic it can take a long time for them to receive specialist services such as hormone therapy or genital surgery.  The process requires an independent assessment from two separate consultants and typically takes months. Controversially, an additional precondition for genital surgery is that the patient must undergo at least a year of “Real-Life Experience” living “in role” of their affirmed gender.  It’s an enforced pause.

I have read the guidelines that explain the rationale behind this enforced pause.  I understand that the social aspect of changing one’s gender role is challenging, and that clinicians do not want people to take on surgery until they are fully aware of those challenges.  But I think the Government should assess the arguments made by some in the trans community that decisions over whether to go ahead with surgery should be based on an ‘informed consent model.’ Under this model doctors could immediately approve medical interventions if they are satisfied that a patient is fully aware of the implications of their decision.  It is my understanding that this model is already used in parts of the United States, so the Government should be in a position to carefully assess its strengths and weaknesses.

I think it is important that the Government understand that delays in receiving treatment can cause real suffering.  One trans person told the 2012 Trans Mental Health Study, and I quote:

‘Not having had my gender confirming yet has a constant effect on undermining my self-esteem and self-confidence as well as social transition - I hate every day I have to live with ‘boy parts’ and can’t wait to get rid of all recognisable boy bits.’

Another person told the same study, and I quote:

‘Permission for my chest surgery was delayed and I waited double the usual waiting time… This caused me to go into a deep depression. I had panic attacks when I left the house, I lost my job and then found I couldn’t leave the house.’

What these people are describing is real human suffering.  It may be possible that this suffering could be prevented if we improve the speed with which our NHS works for trans people.  Delays should not be any longer than is strictly necessary from a clinical point of view. 

‘Not having had my gender confirming yet has a constant effect on undermining my self-esteem and self-confidence as well as social transition - I hate every day I have to live with ‘boy parts’ and can’t wait to get rid of all recognisable boy bits.’

Another person told the same study, and I quote:

‘Permission for my chest surgery was delayed and I waited double the usual waiting time… This caused me to go into a deep depression. I had panic attacks when I left the house, I lost my job and then found I couldn’t leave the house.’

What these people are describing is real human suffering.  It may be possible that this suffering could be prevented if we improve the speed with which our NHS works for trans people.  Delays should not be any longer than is strictly necessary from a clinical point of view.

Mr Speaker.

As a result of the of problems I have outlined, the Select Committee recommended that the Government conduct a ‘root-and-branch’ review of how NHS services can be improved to better serve trans people and to completely stamp out transphobia in our NHS.

Instead the Government responded by stating that they will look into broadening the terms of reference of NHS England’s existing Task and Finish Group for Gender Identity Services.  I think that when such systematic failure has been identified the Government ought to question the governance arrangements in place, rather than relying upon them even more.  I would then like to finish by inviting the Government to give fresh consideration to a root-and-branch inquiry as part of their commitment to the cause of transgender equality.

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