For those not following on Twitter, a Transcript of Helen Belcher’s oral evidence to the Leveson Inquiry yesterday on behalf of Trans Media Watch is now online (PDF Link) and worth a read. Her evidence begins on page 10 of the PDF, page 37 in Leveson’s own numbering, and there is also a plain text version available.

The written submission is also available (PDF Link) but Helen’s responses to the oral questions make a more accessible and quick-to-read summary of the situation.

Edited to add: Trans Media Watch noted that only part of the written submission is available. Large amounts of harrowing first hand evidence submitted has to remain confidential.

On Friday, myself and a number of other Trans activists had a productive meeting with the General Medical Council (GMC) in London, on professional standards and continuing professional development. The GMC are running a consultation which nominally finished Friday, although we were told that responses sent after then may still be read so there is still time to get your views in.

Staff we spoke with certainly seem receptive and switched on to the extent that once Sarah started quoting the Equality Act at them from her written copy, one staff member was able to join in and finish the quote from memory. The difficulty for us and the GMC is taking the discussions and situations we were having, working within the remit of the GMC to turning them in to more generic guidelines for doctors. (The GMC can only regulate individual doctors, so has no influence on NHS funding decisions for example.)

Much of the meeting was taken up with Trans folk telling their “War Stories” and I think the GMC staff were surprised at how cynical we were as a community as well as the widespread nature of problems and their general severity. One particular story had a GMC staff member put her head in her hands and exclaim “Jesus!”

Some scenarios had been prepared as discussion points of which two recounted fairly typical NHS experiences that will be familiar to any Trans activist: GPs refusing to have anything to do with Trans patients due to moral objections; NHS Gender Identity Clinics (GICs) refusing to prescribe hormones due to lack of what they perceive as adequate documentation; Doctors (And GICs!) old-naming patients. The GMC were keen to point out that these were most definitely not what they would regard as good medical practice!

Of the first of those examples, a GP refusing to even refer a patient based on the doctor’s religious belief, there was much discussion. The GMC guidance on this is unclear, but suggests a doctor can refuse to treat in certain circumstances but instead refer the patient to another GP who can help, which is pretty routine in the case of contraception. However, that guidance is from 2008 and pre-dates the Equality Act 2010 and it was pointed out that the GMC would expect the doctor to refer. However, an activist quoted a doctor working at a Gender Identity Clinic who had never seen a GP refuse treatment on ethical/religious grounds and transfer a patient to another doctor to handle. Instead, they just prevaricate and find other excuses not to handle the issue.

It was also pointed out that you can’t completely divorce medical care from moral judgements, because things can get very fraught when you’re talking about end of life care and abortion – it’s simply not realistic to expect all doctors to react in exactly the same way in these cases – but Gender Identity is one area it seems clear that the GMC do not expect doctors to be exercising any sort of ethical or religious opt out when it comes to simple referrals.

This one case is a pretty good example of the troubles of activism. Whilst it would nice to rush in and say we should prosecute a doctor that refuses to treat on religious grounds and says so, if they’re transferring you to another doctor then they are in doing better than many GPs currently do. Thus, any guidelines the GMC produce as well as needing to be generic should make sure that they don’t push GPs more towards prevarication without explicitly saying why, which is not in the best interests of the patient even if it defends the doctor from a possible legal challenge.

Another interesting point, and this is something I do tend to run up against reasonably frequently, was that our experiences in some areas are not that much different from other marginalised groups who require access to medical treatment. Several examples were cited by attendees of people being forced to see a psychiatrist or gender specialist for clearly routine gynaecological or similar treatment and the GMC has had heard similar stories from the disabled community. (E.g. In the case of someone with Down Syndrome who presents with a broken limb, the doctor will see the Down Syndrome as something to worry about, even if it’s entirely irrelevant)

Sometimes, it feels as if we have more in common with the disabled community than we do with the rest of the LGB community.

The other major area for discussion was how to handle Continuous Professional Development, (CPD) which is quite a new area for the GMC as only being a recent and still developing requirement for doctors. At the moment, a doctor can practice for 40 or 50 years after finishing their training with no further updates required, so the GMC are looking to require regular recertification of some sort for doctors (as an IT professional I have to do this every 2 years!) However, there is some difficulty in identifying what the nature of any other activity should be as the GMC is limited in how much specific direction can be given. Peer discussions and conferences are clearly a good idea, but how do you ensure that it is appropriate content? For example, the recent and controversial Royal College of Psychiatrists conference that was cancelled would have counted for that organisation’s CPD, but is not something most people would have regarded as promoting best practice. Outside of the Trans arena and more generic, how do you stop doctors attending conferences on “talking cures” or homoeopathy as part of their CPD.

Mainly, it seems we simply need to be making doctors aware that GID exists and is something that the NHS handles because many GPs don’t know about this. If they know that and have some vague idea where to start searching for details on how to refer, things should improve. Doctors also need to not diagnose things they’re not competent in, as I have seen letters to patients from non-GIC psychiatrists saying “I don’t think you have GID” or “you might have it, but it’s not serious enough that I’m going to refer you”. All they should be doing is checking the patient isn’t in need of other mental health services (GICs do not have the resources to handle routine psychiatric issues or suicidal patents, for example) before referring, not blocking referrals based on their own untrained diagnosis.

In terms of all the above, the ball is now in the GMC’s court with respect to producing the next set of GMC guidelines. It won’t contain anything Trans-specific (It’s too small a document for that) but now they’re aware of the kind of problems we face, they can hopefully find some appropriate wording to push doctors in the right direction.

Finally, there was some discussion on Fitness-to-Practice and complaints in general, even though that was not the topic of the meeting. It seems that PALS and other NHS complaint routes have different standards than the GMC and it may, in some cases, be more appropriate to complain to the GMC directly in the first instance rather than PALS when it is an issue of transphobic actions by doctors or general clinical care. This is something we (as a community) can hopefully produce some how-and-who-to-complain-to advice on in future, but it also does not necessarily need to be a patient or fellow doctor that raises issues with the GMC for investigation, which raises some interesting possibilities for the community to act rather than having to rely on patients early in transition – who will fear reprisals from doctors.

I have not seen last night’s episode – I’ll watch it tonight – but I understand that there was a scene in My Transsexual Summer that some people have expressed surprise at where Drew is refused employment in a Bridalwear shop on account of being a Transwoman.

Unfortunately, this is not only permitted under the Equality Act (EA2010), it’s one area where Trans folk had rights stripped away as a result of the new legislation. Prior to the EA2010, if someone had a Gender Recognition Certificate (GRC) then they could not – except for a tightly defined set of circumstances involving intimate searches and the like – be discriminated against. This came from the Gender Recognition Act 2004 (GRA2004) amendments to the Sex Discrimination Act 1975. The explanatory notes from the GRA2004 say:

If, for example, the nature of the job requires a woman, it is open to the employer to show that it is reasonable to treat a male to female transsexual person as being unsuitable for that job. The amendments made by Schedule 6 mean that these exceptions will not be available once a person has been recognised in the acquired gender

I don’t know if Drew has a GRC or not, but it’s now irrelevant. The EA2010 removed this rule regarding having a GRC, such that it’s just as legal to discriminate against someone just because you think they might be Trans. (They do not actually have to be Trans, you just have to have “reasonable grounds” to believe they might not be cisgendered)

To add insult to injury, there’s a “passing clause” in the guidelines issued by the Equalities and Human Rights Commission. If you’re “visually and for all practical purposes indistinguishable from a non-transseuxal person of that gender” then it’s much harder, almost impossible, to justify discrimination.

Paradoxically, every other protected characteristic allows you to employ a person with that characteristic – you can insist someone is from a certain ethnic background for example, if you can show that it’s needed to do the job. It’s reversed for Gender Reassignment in that you can insist someone is cisgendered, (Not Transgendered) such as in this case. You can not however insist that someone is Transgendered, no matter how relevant that is to the job as that would be unlawful discrimination.

There’s possibly some room for debate on if being cisgendered might be a “Genuine Occupational Qualification” in this case. It’s arguable that it’s not, but as Sarah put it, “I wouldn’t want to take that one on as a test case”. There’s a strong possibility you’d be having to stuff people into tight-fitting wedding dresses and wield the tape measure, so it’s a step up from just the “changing room problem”.

For more background, I’ve tagged earlier posts that relate to the EA2010. Particularly relevant are “Some Equality Act Clarifications and Good, Bad and Ugly, both from October 2010.

Featured on Liberal Democrat Voice(Edited at 1345: I’m told it was Drew that encountered this, not Donna as I originally stated)

Last night was the launch of Trans Media Watch’s Memorandum of Understanding with Channel 4, which for anyone used to Trans events would have seemed a little unusual, hosted as it was at Channel 4’s HQ in their James-Bond-esque underground bar and cinema. I do feel a little inadequate trying to explain the mood of the room and significance of the event as it really would need the eloquence of someone such as Laurie Penny to do it justice.

This was a novel event to be at because in recent years, when it comes to big LGBT events, I’m more used to standing outside waving a banner than being inside in the warmth with wine and canapés. But Trans Media Watch achieved something truly remarkable with this MoU, aimed to end transphobia in the media and promote more accurate, positive images of transgender people as a whole. As anyone who has been involved in Trans campaigning will know, we can be a very fractious and transient community so it’s good to finally have a cause that I believe everyone can rally behind.

We had several speeches not just from TMW, C4 and the BBC but also from a Government Minister (Yes, a Government Minister turned up and gave a speech about Trans issues at a Trans event organised by Trans folk! How cool is that?) and Channel 4 showed a few clips from “4thought”, a series of short vox pops that include trans folk and I understand will be going out during prime time some time soon.

It was good to finally meet up with many people I know from Trans campaigning that I have either not have the chance to meet or I have not seen for some time. As well as many people from Channel 4 and TransMediaWatch, we had Lynne Featherstone MP (LibDem, Minister for Equalities who gave a speech); Dru Marland and Richard Beard (Becoming Drusilla); Victoria Aitkin (Jason Costello, Hollyoaks); Juliet Jacques (Writes about her transition for the Guardian); David Allen Green (Lawyer, Journalist and Orwell Prize Judge, also gave a speech); Christine Burns MBE (“Just Plain Sense” podcast and co-founder of Press For Change); Dr Stuart Lorimer and Dr Leighton Seal (Charing Cross GIC); Roz Kaveney (Journalist, Author and ex-vice-chair of Liberty); Terry and Bernard Reed OBE (GIRES); Dr Richard Curtis (Transhealth); Dr Evan Harris (President of the LGBT LibDems); representatives from the Government Equalities Office and Scottish Governments; at least one person from the BBC (Who I understand will also be signing the MoU, if they haven’t already) and video clips from Caroline Lucas MP (Greens) and Julie Hesmondhalgh. (Hayley Cropper, Coronation Street). Apologies to anyone who was there who I’ve missed. There were enough people about that I’m sure I’ve neglected to mention someone significant!

And finally, two quotes from the event:
There is no good reason why, just because a Trans person is caught up in a story, it becomes newsworthy” – David Allen Green
This is game changing” – Everyone

Featured on Liberal Democrat VoiceI hope that these events will stop being unusual and the next time we all meet, it’s inside in the warm and not outside waiving banners.

And now we move on to the meat of the discussion from the Government Equalities Office Transgender Workshop. Although as I previously discussed, the meeting was held under the Chatham House Rule, the nature of the meeting means that there would also not be much to say about government policy or likely changes anyway, even if I could. This is because it was a chance for us to let them know our views rather than the other way round. Indeed, even if nothing else I think the meeting was very productive just because it did bring so many people together who would not otherwise have had a chance to meet up.

What I think is most useful for me to do is list topics that came up in the various discussions I was present in. Although we split up into smaller groups for some workshops so issues may have been raised I was unaware of, this should give people an idea what campaigners currently regard as hot topics.

  • NHS treatment is, as ever, high on the agenda. As people may be aware, Primary Care Trusts are being abolished in favour of GP consortia. Despite concerns about localism being bad (See below) I sensed a hope amongst some that the change in structure will be an opportunity for campaigners to secure a change in current practice, given it can hardly get any worse than the de facto blanket ban in operation in some areas.
  • The Gender Recognition Act, in several ways:
    • Marriage-related issues are more of a concern than I’d realised, particularly amongst those who have been fully transitioned for some time. Many refuse to get their marriage annulled just to obtain a GRC and having seen Sarah and Sylvia go through this, I know it can be an unpleasant and problematic procedure that does not work the way that was originally intended. Although it seems the usefulness of a GRC is being diminished, it is still key in one area for some people: Pensions. If you are retiring around now or are already past retirement age, your gender affects your pension age. (An anomaly removed for those of us who are younger) For Trans women, this means you might not be getting a state pension unless you agree to divorce! We already know there is little hope of any parliamentary time in the next couple of years to fix the divorce/annulment requirement or any other Trans issues requiring a major change in the law but I would hope that the Trans community can gain sufficient input into any possible marriage equality bills to fix this at the same time.
    • Misuse of Gender Recognition Certificates. One unintended consequence of issuing GRCs is that some organisations would ask for them inappropriately. (Including Police Officers, eg. the Pride London Toiletgate affair in 2008) The idea was floated to only issue new Birth Certificates (i.e. stop issuing paper GRCs) unless someone either requests them specifically or there isn’t a new Birth Certificate to issue. (e.g. for someone born abroad) Hopefully organisations and individuals won’t ask for a document that the majority of people do not posses! This may be achievable without changes required in law, although the consequences would need to be thought out carefully.
    • It concerns me that there is still some confusion even amongst some activists about how the GRC system works. I heard people who thought that you had to be post-operative to get a GRC or that a GRC was required to get a correctly-gendered passport, which is untrue. (The latter probably caused by some apparently badly worded advice on some web sites which is supposed to indicate just that it is one form of acceptable ID)
  • The last of the big three was Localism – i.e. the push by central government for more power to local communities. There were concerns that in more conservative communities, this could be detrimental to power minorities without appropriate safeguards. (Cambridge is pretty friendly to otherwise marginalised individuals and I’m not hugely familiar with the proposals so I have no strong opinions on this myself)

Between them, I think those three topics probably dominated conversation. In no particular order, other ideas and concerns included:

  • Media representation of Trans people. I think pretty much everyone agreed that the Daily Mail and friends were basically a problem we’re unlikely to fix any time soon. However, I did find out there is apparently a ban on showing Trans issues (Possibly just Trans children) before the watershed on BBC and Channel 4 as it’s seen as “sexual” content. Other countries have documentaries on gender variance aimed at children but they do not get shown in this country because of this. (I was already vaguely aware of the Hollyoaks storyline but I do not know how it fits in with this ruling.)
  • Education was discussed, both at school (Trying to get more Trans input into the curriculum, although localism probably means we’re moving away from setting curriculum centrally) and as adults. (E.g. ensuring medical courses have some content on Trans topics)
  • Alongside the idea to stop routinely issuing the paper GRC, a general feeling that use of gender markers or gender-related titles on official documentation needs to be justified. (For example, the passport service probably need to keep including it to keep in line with international standards, but there is no reason for the DVLA to include it on driving licences) There is some need to monitor gender for equalities purposes, but this restricts questions about gender so equalities monitoring forms which are usually held only as generalised and anonymous data.
  • There is mixed feeling about the Equalities Act 2010 and although we recognise that it is not likely to be changed any time soon, some sort of monitoring of use of exceptions was considered a good idea.

I should stress at this point that effectively what we did was a brainstorming session: Do not expect to see all of the above in the plan when it comes out next year. Some ideas may be impractical once studied further but we were not going to get into the detail of every possible idea in the time available to us. As I understand it, the intention is to release the actual plan some time next year after further, more widespread and public, consultation. I would hope that such a plan can include more aspirational goals such as eventually updating the Equalities Act 2010 but I am not clear if such things are within its scope. What we’re more likely to see, in my opinion, is “quick wins” by changing existing civil service policy or monitoring procedures. Being Civil Service, there was a general requirement that any changes required a measurable outcome. I’m not sure how this would work in terms of more quality-of-life changes such as sorting out the requirement to divorce to get a full GRC, but I guess there are established solutions to such issues.

Featured on Liberal Democrat VoiceAnd finally, there was discussion about consultation processes themselves and general communication with the community. One concept that came up briefly was the idea of “Consultation Fatigue” and this is certainly a danger as it can be quite draining to repeatedly get asked the same questions by the EHRC, the GEO etc. At the very least, it’s prone to promote frustration about too much talk and little action when it is largely a volunteer community doing the work and not people as part of their full time jobs. Another issue was the pressure for grass-roots organisations that revolve around email lists, forums and blogs to formalise into “proper” charities before groups, particularly the likes of NHS Specialist Commissioning Groups, will talk to them. Sadly, becoming a formal charity takes a significant amount of time away from actual activism and I don’t think the Trans community has the resources to sustain more than a very small number of such groups.

Featured on Liberal Democrat Voice“Will transsexuals destroy women’s sport?” is the second largest headline on the front of today’s Spectator Magazine – the largest, predictably, being in relation to the Comprehensive Spending Review. It’s not exactly a positive headline, for a start using “Transsexual” as a noun. For those unfamiliar with the territory don’t do it as it implies it is very othering – man, woman or transsexual? It also contributes to the erasure of trans-male identities in this case as the implication in the headline is that only Trans women exist.

Still, “Sure, if all the women athletes transition to become male, that could damage women’s sport” springs to mind as a humorous response to the front-page headline.

There is a copy of the copy of the Article online, but I fear you will need a paper version or subscription iPad/iPhone version to see the article in the context the editors unfortunately intended. It does improve a little on the contents as the article is billed as “Transsexuals on the track – A new divide in women’s sport”… well, it’s not new, really. Any slightly more positive spin on that page is undone by the photo of a female shot-putter with the caption “Gender games” under it. A shot-putter? Please.

Once we get free from the clutches of the magazine’s editors though, the article by Luke Coppen isn’t that bad. It’s jumping off point is the recent news about Lana Lawless, a Trans woman golfer, who has had to sue a US Golf Association over their Women-born-Women policy. It’s not too bad an article, starting off by listing the concerns of others – “enjoying the physical advantages of men” and then going on to deconstruct them.  It doesn a pretty good job of covering most of the well known (Within Trans circles) problems that the International Olympic Committee have had in trying to figure out who they should allow to compete… and the problem that as in this case, if a Trans woman does succeed, it’s clearly because she was “born male”, not actually because she’s a good athlete.

It’s shame this generally positive attitude is spoilt by one particular phrase in the last paragraph: “As long as there is a male-female division in sports, there will be people stealing across the border.” I’m not “stealing” across anyone’s border, thank you very much. And if anyone did try, I think they would be in for a rude awaking given that the penalty for transitioning when one shouldn’t is similar to not doing so when you need to – depression and suicidal thoughts.

There’s a reason for this post, other than just generally getting annoyed at the headline on the front page. Coppen’s article points out recent research shows that any advantage Trans Women have over cis-gendered wimen is lost after around a year on HRT. This is broady in line with current International Olympic Committee guideline that stipulates a 2 year gap between transition and competing in your aquired gender.

So, we return to our old friend, the Equality Act. Sadly, the sort of nonsense that’s happened in the US with this case could happen here too and it’s entirely possible someone in Lana’s position would lose the case because the act just makes vague references to “fairness” and “safety”. (If it’s not safe for someone to compete, regardless of gender, then you’re doing it wrong)

But if a random author of a magazine article can figure out that there’s no advantage to Trans Women (Where are the Trans Men?), why couldn’t the authors of the act figure out how to express it in terms that didn’t give anyone an excuse to discriminate indefinitely and justify it.