Transgender resources in Devon – the challenges and the heartache

Healthwatch Champions ensure they are informed of the latest information on health and care services in Devon, Torbay and Plymouth so they can offer up-to the minute advice and information to clients.

Shirley Weeks, Healthwatch Champion Coordinator sought information regarding Transgender care provision in Devon and is grateful for the following response from Steve Sylvester, Director of Specialised Commissioning and Health & Justice – South West NHS England and NHS Improvement – South West. Despite the challenges there are plans to improve provision.

Your Voice

A client who recently shared a positive experience of their visit to the Laurels Clinic in Exeter, told us of their ‘excruciating’ wait for gender reassignment treatment. An insight in to the impact this has on their day to day life and well-being.   

Listen to their story

(not the actual person’s voice)


Dear Shirley

Enquiry about Transgender care provision in Devon

Firstly, can I apologies for delay in responding back you.

Thank you for contacting us requesting further detail about the services provided at the Laurels. For context, there has been an exponential increase in demand for gender dysphoria services in recent years which has far outstripped planning expectations. Whilst NHS England has increased the funding available for gender dysphoria nationally, the limiting factor is the availability of clinical staff who have the necessary skills and expertise to deliver these services. This has led to all providers of this service experiencing significant difficulties recruiting and has unfortunately resulted in long wait times nationally which are in excess of the 18-week referral-to-treatment standard.

There are currently 7 gender identity clinics in England, with 2 of these in the South of England. The Laurels Gender Identity Clinic has an excellent reputation and has historically had shorter waiting times than clinics in some other parts of the country. However, as NHS England commissions services nationally for the population of England it is not possible to limit access to these services based on residence, and over a number of years there was a significant increase in referrals into the Laurels Gender Identity Clinic from outside its normal catchment, and coupled with significant difficulties in recruiting to key clinical posts this has regrettably resulted in the current long waits for an initial consultation.

Steps we are taking to address the issue

A new national service specification and clinical protocol for gender dysphoria has been developed, which aims to reduce delays by streamlining the treatment pathway. However, this requires a change in the way services are currently delivered before it can be implemented.

There are two points in the gender identity pathway where capacity constraints have caused significant delays: the gender reassignment surgery itself, and the psychological assessment stage which is early in the pathway and which may also involve a consideration of issues around hormone prescribing. Capacity in both the surgical and pre-surgery elements of the pathway is being addressed through two nationally run procurement exercises.

In 2019 NHS England and NHS Improvement concluded the procurement of gender reassignment surgery providers which has resulted in a number of new providers entering the market nationally, and which will create additional capacity for gender reassignment surgeries to be undertaken in the South West. NHS England and NHS Improvement is currently in the process of implementing the outcome of this procurement by finalising contracts with the newly designated providers.

In relation to the pre-surgical element of the pathway, the national procurement process is still ongoing and is due to complete later in 2020. As part of this procurement, NHS England and NHS Improvement is considering formal pilots of new care models which will allow decision-making about referral into surgical service to be made at a much earlier stage within primary care, and these may have the potential to inform more sustainable arrangements for delivery of gender identity services in the future. In the meantime, regrettably, gender identity services remain highly pressured and so NHS England and NHS Improvement South West is considering steps which can be taken locally to ease this pressure and minimise the disruption which delays can cause to patients, including through formalising arrangements for the prescribing of hormones on an interim basis for patients awaiting psychological assessment.

Whilst the national procurement and implementation of the new protocols will improve access, NHS England and NHS Improvement recognises that resolving gender dysphoria capacity issues requires a coordinated approach to expanding the clinical workforce and is currently working with the Royal College of Physicians to develop an accreditation programme for clinical staff who wish to work in Gender Dysphoria medicine and to encourage specialisation in this service.

I trust you will find this account helpful in answering the questions you have.

Yours sincerely

Steve Sylvester

Director of Specialised Commissioning and Health & Justice – South West


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