June 22, 2008

A couple of reasons why some trans* people are wary of both the PCTs and politicians: First, Debbie Davies, a transsexual woman in Nottinghamshire, has been denied access to meds and surgery by her local Primary Care Trust (PCT).

Click here for the full story as reported in the local press.

What is worrying is the policy mentioned in the article: in a nutshell, the PCT does not fund the drugs or surgery for patients requiring gender reassignment, but will fund any psychological support required. In other words, they’ll prescribe antidepressants but not hormones. In the light of the proposed changes to the DSM, this seems an entirely natural policy for a PCT to implement: after all, gender dysphoria, or Gender Identity Disorder (GID) as it is called in the DSM, is classified as a mental illness first and foremost.

(Previously I have written about the proposed changes to the DSM in these posts: Mad as hell, Still mad: more on DSM-V/Zucker/Blanchard and Crazy love)

Dr Chris Kenny, Nottinghamshire Primary Teaching Healthcare Trust’s director of public health said:

“This policy is in common with other PCTs in the East Midlands and is soon to be adopted as a formal policy across the region.”


…And in other news, a report in Pink News presents a frightening example of how patchy MPs’ knowledge of gender identity issues is: Mark Pritchard, a Conservative MP who represents The Wrekin, has claimed that gender reassignment is a “matter of choice”.

“Given the number of sex changes, which are increasing in the United Kingdom year on year, the cost to the NHS, which has scarce resources, and the fact that sex changes are a matter of choice, is it not time that we had a debate about the issue?” he asked Harriet Harman, Leader of the House.

Thankfully, Ms Harman – who is also the Secretary of State for Equality – told Mr Pritchard he “misunderstands the situation”.

“It is not a question of choice: if someone needs to have gender reassignment surgery, it is a question of necessity for them.”

It is interesting to note that Mr Pritchard voted against changes to the Human Fertilisation and Embryology Bill designed to stop discrimination against lesbians and single women accessing fertility treatments.


The root of the problem in both these cases is PCTs’ financing arrangements and priorities. The Department of Health’s document NHS funding processes and waiting times for adult service-users: Trans wellbeing and healthcare (click here for a direct link to the PDF download) states openly that funding of treatment is a ‘postcode lottery’.

It adds that “the system of funding is undergoing a major change as special commissioning groups (SCGs) play an expanding role”. However, although “the NHS is legally required to fund treatment”, this funding is only made available “in accordance with reasonable local priorities, which permit wide differences in local funding policies”.

Although the content in itself makes depressing reading (and not only for trans* people who depend on NHS assistance in their transitioning), the whole document is a must-read if only for its comprehensive illustration of how the state appears to act as gatekeeper, not facilitator, in the provision of treatment of gender dysphoria and transsexuality.


©2008 Helen G

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