Archive for March, 2012
There have been a couple more answers from Leeds GIC in response to Freedom of Information requests. The first is the “Information for Referrers” leaflet (PDF Link) which details what steps GPs should take before passing someone on to the service. We already suspected the most interesting part of this, specifically: “The GP would need to provide an up to date physical examination report…In addition to the physical examination an examination of the sexual characteristics would be highly desirable.“. I struggle to see how a physical examination of “sexual characteristics” at this stage can be justified, particularly when by a GP who is not going to have the experience to do this sensitively. The only time I had any form of physical examinations were by the surgeon and electrologist, which despite being rather necessary was still, in the case of the surgeon’s visit, rather upsetting.
Most likely the main effect of this is just going to end up being unnecessarily upsetting people trying to access the service. Luckily, I’ve heard of several people that have refused the physical exam and they’ve still been able to get a referral, so this aspect appears not always to be adhered to. It’s inclusion in the referrers leaflet means people that don’t need it or want it may still end up having it however, because they feel bullied into it to access essential medical care.
One sensible aspect is getting the GP to carry out the blood tests before referral. This would hopefully cut down on delays at the GIC due to needing to go away and come back for a test, although I do not know if this is routine practice at other GICs too.
Slightly worrying is the assertion that this is a “a time-limited Pathway of Care for the maximum of three-year duration“. [sic] Having not heard of anyone being discharged from the clinic after three years while still mid-transition, I assume this is not actually enforced.
The other response was asking who had been involved in an FoI response and some rather inaccurate content on their web site, which has since been updated. In it, they start getting defensive about their policies, something I have not seen before in an FoI response. Here’s what they said:
Specifically, our Care Pathway follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun to ensure that, possibly irreversible hormone treatment is not undertaken without there being a completely coordinated comprehensive care approach which has the ability to meet the changing needs of our service users flexibly and safely. This is paramount to a positive outcome.
Interestingly, they are explicitly rejecting the latest version of the WPATH Standards of Care with this response and reinforcing their view that hormones should only be prescribed after going “full time”. I have no idea if Leeds doctors have ever actually tried anything like talking to their patients, but going full-time is far more irreversible than hormones. Just because it’s social and not chemical/biological does not lessen it’s impact if you are treating the person as a whole.
I have not seen any studies of this, but I also suspect that those going full time before hormones are hugely more at risk of social impacts such as job loss and violence due to not “passing”.
A few weeks ago, an article appeared in New Statesman highlighting how the Met Police buried a critical 2005 report by Brian Paddick into their handling of rape cases. Having asked for a copy of the report, you will probably not be surprised to learn the Met have conveniently lost it. Here’s their reply:
Searches have been made within Sapphire Command, (who are responsible for investigating rape and other serious sexual offences), Territorial Policing Headquarters, Records Management, MPS Press Office and the National Police Library.
The requested document has not been traced.
If truthful, not only have they buried the document so that the public can’t see it, but they’ve buried it so deep that even Sapphire Command don’t have it. Given those are the folks who currently investigate rape and might be best in a position to implement the original recommendation to adopt a “consistent, victim-centered approach”, that’s worrying.
I don’t know who found this first – it was all over twitter yesterday. It seems Urban Outfitters have joined the ranks of retailers using casual transphobia in their products with this greetings card, described by them as “charming”. (Update at 1130, 19th March: The card appears to have been pulled. The link now shows just that the product has “sold out”.)
In case it gets pulled down – I hope it does – here’s the text:
Jack and Jill,
Went up the hill,
So Jack could see Jill’s fanny,
But Jack got a shock,
And an eyeful of cock,
Because Jill was a closet tranny.
Their twitter account, @uoeurope has had a large number of (Polite so far, I’m pleased to say) messages asking for an explanation. No response as yet.
Yvette Cooper, shadow Secretary of state for the Home Office and shadow minister for Women and Equalities made a bit of a faux pas yesterday. She wrote an opinion piece for Pink News – which I agree with the ideas behind, even if I’m suspicious of the motives – calling on the government to introduce more marriage equality by allowing same-sex religious marriage.
Unfortunately, it seems she’s not that well-informed on LGBT issues and neither are whichever Labour HQ staff proofread the piece. Badly informed enough not to know what the T in LGBT stands for in fact.
Here’s what one paragraph near the end initially included…
We know there are other prejudices many who are lesbian, gay, bisexual or transvestite still face from homophobic bullying in school, to discrimination at work.
The line was rapidly corrected to say “transgender”, with Pink News blaming the error on a “typo in the original copy”. But this is Labour’s second error in a week, the first Ken’s London mayoral manifesto making errors on healthcare comissioning.
I do not regard this development as a good thing. Effective government requires effective opposition and it’s harder to push a topic when the opposition are floundering.
The equal marriage consultation is finally out – you can find details on the Home Office web site. For information on how to respond, it’s worth reading About Time. You’ll find much on there that’s Trans-related, as Sarah Brown and myself contributed heavily, but I shall try to get my own draft response up in 24 hours or so for people to look at too.
Thiree points I’d like to make about responses: First is do please respond. I’ll no doubt be posting repeatedly on the topic so you’ll not likely forget and it’s running for 12 weeks, but volume of responses helps as much as having reasoned responses.
Secondly, I note the online form is very “tick-box” in nature. There’s much nuance that’s can’t be put across with an tick-box response so if you have the time, writing in would be better. I’m quite happy for people to copy-and-paste my responses when I’ve drafted them, or just write in saying “What she said!”.
Thirdly, some things appear to have been ruled out by the press releases. This is why it’s important to respond: Many of them are in the consultation anyway and we need to show there is a genuine public demand for these things. Responses from members of organised religions that support equal religious marriage will be particularly useful!
Ken Livingstone, mayoral candidate for London, has just developed some policies for the Trans community as part of his manifesto.
Now, I like Ken. If I lived in London he’d probably get my number 2 preference behind Brian Paddick. After all, when the alternative is Boris, I probably don’t need to say much more.
But it’s pretty clear he has absolutely no clue on what issues face the Trans community. Here’s the very first entry:
Most importantly, it will try to mitigate the worst effects of the government’s disastrous NHS privatization. Local commissioning makes the postcode lottery much worse, hitting trans people hard.
This is flat-out wrong. At best it’s misinformed, at worst it’s blatant scaremongering.
The Health and Social Care Bill actually nationalises commissioning policy for Trans healthcare. Given the awful attitude of many doctors, this is viewed by the vast majority of Trans campaigners involved in healthcare as a good thing. It will end our constant game of wack-a-mole with PCTs implementing policy that is often as not unlawful.
I doubt that anyone outside of the Tory party thinks every line of the bill is great but for the Trans community, the shift in commissioning policy is a positive thing.
The rest of what’s quoted is pretty weak: Sorting out housing and employment discrimination, improving diversity training. The generic hand-waving sort of thing you expect from any politician interested in equalities in a sort of passing manner. Nothing specific beyond a mention of the Trans Day of Remembrance.
I do hope that the final version is a little more robust on issues:
- Specific consideration of the situation that lead to Toiletgate in 2008 beyond just “training” would be nice.
- Backing the Equal Marriage Campaign. (Not just the watered-down Gay Marriage version)
- And ensuring that London, as an employer and service provided, doesn’t use some of the get-out clauses in the Equality Act 2010, something we’ve done in Cambridge.
I’m pretty livid at Ken for this, because it’s appropriating a marginalised group’s issues, a group I’m a member of, to push a partisan point. In doing so, he’s screwing over that group. Labour tried the same with a ploy to keep ID card just for Trans people after the election and we killed that one dead too, with the help of Julian Huppert MP.
The Liberal Conspiracy piece ends:
The experience has shown me that Ken Livingstone is genuine about being the most trans-supportive politician this country has ever seen.
Genuine? Perhaps, I’ll give him the benefit of the doubt on that. Maybe he’s just been hoodwinked by some partisan element within the Labour party. And I’ll similarly assume that Natacha, the author of the document, has never met Lynne Featherstone, the current Minister for Equalities, and is thus unaware of the work that’s being done there.
But still clueless, and thus not much help.
I am somewhat baffled by recent assertions that objecting to people saying “trans men and women” is somehow erasing the identities of non-binary folk. The logic, as best I can figure out, seems to be that if you dare to mention that some people do not fit on the binary then it weakens your own identity by association. Or perhaps you are entirely one extreme of the wibbly wobbly blob that is sex and gender and gender roles and identity… but you’re feeling a little uncertain, perched out there on the edge.
If you have insecurities about your identity, please don’t push them on the rest of us. Yes, I prefer female pronouns. But on a weekend I spend my time, as one person put it, up to my eyeballs in mud. If I get Sir’d occasionally running around a training area instead of Ma’amed as an honest mistake, so be it. I may occasionally get angst about it, but I don’t use that to beat others up with.
Gender is complicated, as Sarah Brown points out and over-simplication does not help our cause.
There are plenty of other terms to use. “Trans folk”, “Trans people”, “Trans community”. Personal objections to how one particular phrase sounds does not suddenly give one the right to trample over others by using a problematic phrase. The onus must remain to find an alternate phrase yourself, otherwise we give free license to bigots to use whatever terms they like because they can’t find one they don’t object to.
Yes, as members and activists within a community we’re expected to abide by a higher standard than the mainstream, because people look to us to set an example.
There are parallels with another problem within the LGBT community – and yes, it’s still a problem – that of bisexual erasure. Sex and the City actress Cynthia Nixon recently caused a fuss by saying that for her, “sexuality is a choice”.
Rightly, she was criticised. What she seems to really mean is that she is bisexual, but she portrayed her position as flipping between two binary states rather than existing somewhere in the complex n-dimensional space of attraction and romanticism.
Lets not fall into Cynthia’s trap when it comes to gender. I’m a Kinsey 5 when it comes to sexuality, and I guess on the same zero-to-six scale applied as male-to-female, my gender identity and presentation is somewhere around a four or five, but with a pretty narrow window I’m able to operate within. Dresses and Barbies at the six end of the scale make me uncomfortable, although not as bad as the catastrophically dysphoria-inducing concept of being any closer to the male end. I’d say a perfectly androgynous three is my hard limit.
Yet even that is a simplification.
It’s a rainbow flag for a reason. Lets keep it that way, with all its colours.
Barker, who I’ve written about previously, was today given a 30 month sentence for two counts of sexual assault and one of fraud.
After a brief panic that being transgender and not totally out while kissing someone has been made illegal via case law, it seems likely that this case is being misreported. It’s the usual suspects, such as the Daily Mail and the Mirror.
Going back to the original reporting, this Metro story from the original hearing states that Barker was initially arrested for sexual assault before it was realised they were in fact (presumed) female – i.e. the original arrest had nothing to do with any cross-dressing/transgender aspect.
What has not been reported is the nature of the “specimen offenses” of sexual assault that Barker entered a guilty plea to. However, Barker lied and claimed to be 16 when they are 19, which may be relevant. Their other girls involved are reported to all have been 15/16 and the slightly more balanced Press Association report states there was “sexual touching” involved.
It’s also important to note that the guilty plea for fraud is to do with a false claim for compensation after a made-up physical assault.
Following some excellent work by Emma Brownbill, copies of meeting minutes from the North’s “Gender Governance Group” (G3) have been uncovered. Formed in 2005, this was initially a forum for gender practitioners from the North of England to discuss their experiences but lately has taken a slightly more sinister turn. It seems the group is concerned about the more progressive approach taken by Charing Cross becoming the UK standard and wants to have input into the forthcoming Royal College of Psychiatrists’ Standards of Care and UK-wide NHS commissioning guidelines to ensure they can carry on as they are. (The UK-wide NHS commissioning guidelines may now not happen: it depends on the NHS Reform Bill passing)
Yes, you read that right: they’re worried about Charing Cross being more liberal.
Edit 2: I’ve been advised I should add a trigger warning to this post: Some folk are finding this upsetting.
One could possibly forgive the group, which at the time consisted of just Sheffield, Leeds, Leicester and York, for not having heard of a “genderless patient” in 2005. After all, back then not many gender-neutral folk would have had the courage to be completely open with the NHS. One surgeon suggested this could be “Scoptic syndrome“, which I’ve never heard of, but may be a typo.
But the group hasn’t improved. Here is one quote from the minutes in 2009 that’s quite revealing regarding the attitude of some doctors towards their patients – the doctor works at Leicester GIC.
[A doctor] spoke to the group about the issue of unintentionally creating “she-men”: patients who have breasts and are on hormones but don’t have final surgery as they don’t want to go any further. These patients continue to live full time as female but with male genitalia. Many of the services present at the meeting had examples of this happening
Further comments also in 2009 show that the clinicians were “wary” of folk requesting just an orchiectomy, despite a surgeon present stating this wasn’t anything new and there were few follow-up issues from this treatment.
Glasgow had similar issues in 2010, referring to a “highly intellectualised” patient who it appears also identifies as gender-neutral, but is repeatedly misgendered as “he” throughout the meeting. Clinicians did not seem to know how to handle this situation due to a lack of an “evidence-base” (as if any of their other work relies on one!) Luckily (for the patient, not for the GIC!) they apparently know their rights and how they can be treated. It seems the patient may also have had to resort to legal threats, as there is a note that the Equality Bill (as it then was) “only mentions FtM/MtF“.
Think you have legal rights?
So is it just those people that don’t fit the nice stereotype and wear frilly dresses or excessively manly outfits to their meetings that they’re uncomfortable with? Sadly not. It seems they are not keen on any of their patients having legal rights at all. One of the rights gained under the Gender Recognition Act allowed people to have complete separation of their old records and details from their new ones, so you can’t be “outed” to medical staff. (After one bad incident, my details are withheld from the central NHS database, the “spine”)
Following a discussion in March 2009, it appears most of the members would discharge patients that actually tried to insist on this, as they were quite keen on their “right not to give care“. There was no discussion about finding an accommodation. Legal rights, or NHS treatment: a simple choice.
Similar applies if you ask for your notes not to be transferred. Given the approach of some doctors I can quite understand patients not wanting unknown material to be handed over effectively scuppering their chances of getting treatment. This is a no-no for many doctors. If you won’t let them see your previous psychiatric notes, they won’t treat you.
It’s probably no surprise to learn that the Department of Health wrote to lead clinicians at the clinics in 2009 reminding them of their legal responsibilities, although the Equality Act was dismissed in 2010 as not applying to the clinics because they work in mental health. (In Scotland and some other countries, gender services are not necessarily lead by mental health)
Even a Gender Recognition Certificate won’t help you. Also in 2010 a trans man (Who has a GRC and has been transitioned for a couple of decades) tried to push for bottom surgery without a second opinion, but they refused. The implication from the minutes is that either he had already had a negative second opinion or that if he did it would be refused as the Gender Clinic regarded his presentation as “chaotic“.
Presumably any non-trans individuals who want genital surgery because of an accident would also be refused if the doctors thought they were acting a little camp?
Based on the above, one might suspect the clinics have a few unhappy patients. Despite this, it was reported in April 2010 that the results of a user survey had “astounded” researchers due to the differences between the NHS and Independent Sectors.
Other organisations aren’t happy either
Other organisations have their concerns about some of the clinics too, and this has not made the members of the G3 group happy. There was grumbling about the Equality and Human Rights Commissions’ report into trans healthcare, with it being claimed “the document could lead to confusion to service users“. Similarly, Leeds were getting “harassing emails” which they found “not very pleasant” because a Department of Health leaflet “doesn’t reflect what they do“. I would guess the DoH leaflet probably states what they should be doing however.
Charing Cross do not appear to be too pleased either, as surgeons who work closely with them refused to accept referrals from Northern GIC clinicians until May 2010 and insisted on having a Charing Cross based doctor performing the second referral. The members of G3 felt that surgeons in London “did not appear to have knowledge of the credibility of services in the UK“. Given one quite vocal member of the group refers to his patients as “she-men“, I’m not entirely convinced they have as much credibility as they would like to think.
Going for a power grab
So, what are the next steps for the G3 members? The national Standards of Care may be published soon, so they keep saying, and the NHS Reform Bill could be more pressing as it would centralise policy. Once that happens, “in commissioning there can’t be any differences any more“.
One would hope that they would aim to work towards the new WPATH Standards of Care, but instead they are clearly wanting to stop things heading in that direction and force the more restrictive RCPsych/UK Standards of Care on everyone. They refused to let a private doctor join the group in 2007, unless he signed up to the new but still draft UK SoC.
It’s not surprising they want to stop others moving forward with care because as of 2008 at least one GIC, Northampton, were “not keen” on the old WPATH Standards of Care. That’s the previous version by the way, as the new one is even more progressive so they presumably hate that even more.
The approach favoured by some members want the group to take “clear clinical governance” and heavier involvement in national commissioning and the UK SoC, which they feel may be applicable not just to the NHS but also the private sector. If they do this, they hope the standards and guidelines will be “flexible enough for all teams to work with” as their current “concern is if they talk to Charing Cross to agree and commission then things will be modelled around Charing Cross.”
But you can forget any actual trans folk or the private doctors having significant input into this process as these quotes illustrate:
When National Standard agreed there would be a one day event and we felt at that stage there was a need for a national body and that is should be for professionals only instead of users and carers
D also made the team aware that the largest independent provider in London, Charing Cross won’t talk to this person. so is there any problem in excluding the independent sector? K said the national standards of care is written for the independent sector and the NHS. A thinks the private sector is a bit of a complication at this stage
This approach would let them carry on with their current practices, such as Nottingham restarting people from square one even if they’ve been private before. (That was 2008, although they did insist they won’t take people off HRT)
For trans men, many doctors – although this is apparently a controversial point within the group – want the ability to impose a 12 month wait and two opinions before allowing top surgery (something that might be required for a trans man to pass at all) despite the WPATH SoC only mandating one opinion.
Leeds and Nottingham are currently requiring “evidence of physical examinations” from GPs for even a referral, even though this isn’t in the WPATH guidelines anywhere at all. Just the pre-surgical exam can be traumatic enough for transfolk when it’s with experienced nurses and surgeons, without an inexperienced GP having to go looking down there too.
I’ll close with this October 2011 quote:
Leeds have struggled recently with GIRES putting pressure on them regarding hormones and real life experience. Leeds clarified that they have two stages of RLE, the stage before hormone and assessment 6 months, RLE 2 years before surgery
This is the kind of regime that they’re fighting to preserve.