Cleo Madeleine
Spokesperson at Gendered IntelligenceIn the midst of renewing the NHS constitution, a concerning focus emerges on transgender exclusion rather than inclusion, sparking debates over fundamental rights and healthcare access. Spokesperson from Gendered Intelligence, Cleo Madeleine, examines the implications of proposed changes and advocates for a broader focus on improving healthcare for all, including transgender individuals.
What’s Happening?
The NHS constitution sets out policies and expectations for the health service across the UK. It’s an important document because it makes the case for what the NHS ought to be.
The constitution is renewed every ten years to ensure it stays relevant to the needs of its patients and service users. The last time was in 2015, and so the recent announcement of a consultation into the constitution is timely enough. The focus of the consultation, however, is cause for concern.
Anyone living in the UK is, by now, aware of the challenges facing the NHS. Years of cuts have left doctors stretched thin, hospitals and clinics understaffed and poorly resourced, and wait times steadily growing across the board.
Despite these obvious issues, the consultation – and the reporting around the consultation – is preoccupied with transgender people. Specifically, a proposal has been made to make it easier to exclude transgender people from appropriate gendered facilities in several areas, including wards, mental health facilities, and admissions units.
There are very serious issues facing transgender people in healthcare. Wait times for specialist gender identity services are in excess of five years (the NHS constitution sets out a maximum acceptable wait of eighteen weeks from referral to treatment). Poor understanding and education in clinical settings often leads to trans people being missed for vital healthcare. Only half of all trans men receive appropriate cervical screenings. Health outcomes are also worse, with trans people – in fact, all LGBT+ people – having significantly increased risk of serious mental illness.
None of these are the focus of the consultation, however. Continuing what increasingly seems like a dangerous obsession with the exclusion of transgender people, government ministers have focused on changes to the consultation that undermine existing rights and protections instead of supporting patients and healthcare professionals.
What Does This Mean for the Transgender Community?
These are just proposed changes at the moment – there’s a whole consultation period ahead, and it’s unclear whether NHS policymakers have any appetite to change their longstanding policies on trans patients.
The accommodation policy used by many hospitals and clinics says, in brief, that patients ought to be accommodated in line with their gender wherever possible, unless doing so would cause distress to the patient.
Even if these changes were to go ahead, it’s unclear who it would benefit. There is no evidence that this policy has in any way compromised the care or safety of other patients. In fact, we’ve already seen from ‘bathroom bill’ style laws in the US that policy and legislation that excludes transgender people often ends up hurting the people it is ostensibly designed to protect. Just consider the stories of cisgender lesbians ejected from public toilets because someone thought they didn’t belong there.
Nor would these changes help healthcare professionals. All the doctors I’ve worked with have talked about needing better pay, more resources, more space. No hospital has rooms to spare for accommodating any transgender patients they might happen to have.
In any case, for a long time the Equality Act has outlined both the right trans people have to equal healthcare and the limited situations in which exemptions can be made (providing intimate care is a great example of this!). It’s not clear why the NHS constitution would need to be amended when the law is settled, or, indeed, if these changes would be legal at all.
The answer, I think, is that this isn’t really about the consultation or the NHS constitution. It’s about the message it sends. The implication is that trans people are unwelcome, that healthcare professionals shouldn’t welcome trans people. It suggests that trans people are expected to out themselves if they want to go to hospital, or that trans healthcare professionals are expected to out themselves if they want to go to work. It says that a constitution premised on basic equality should be reworked to specifically exclude a particular group.
According to the government’s own National LGBT Survey, up to a quarter of trans people avoid seeking necessary care because of a previous negative experience or a fear of judgement. These threats of exclusion fuel those fears and drive more trans people away from the healthcare they need and deserve.
What Could the Government be Focusing On?
So much trans-exclusionary rhetoric is couched in terms of improvements to women’s rights or services. If a serious commitment to women’s healthcare underpinned this consultation it could instead focus on areas in sore need of improvement, like fertility and natal care. This wouldn’t just help all women, but also the whole LGBT+ community, who have significantly poorer access to these services.
Alternatively, the government could commit to reducing wait times. Gender identity services have some of the longest waits for treatment in the country, but they’re not alone – wait times for many vital services have been slowly climbing for years. An NHS consultation that recommitted to an eighteen-week target and to supporting those people who are waiting longer would be welcomed by everyone, not least the trans community.
Unfortunately, that isn’t the case right now. There are other positive changes on the roster for the consultation, including addressing health inequity and improving family and patient involvement in healthcare decision-making. These kinds of changes, properly supported, could do some real good. It’s a shame they’re held back by the senseless campaign to exclude transgender people.
To read more on transgender rights, in conversation with Cleo, please click here for an exclusive article that appears in the fifth edition of Chamber’s Journal.