Agenda item - Trans Health Services

Report of the Executive Director, Governance, People & Resources (copy attached)

8.1       This item was presented by Lola Banjoko (Executive Managing Director, Brighton & Hove, NHS Sussex); Helen Davies (Clinical Director, Trans Healthcare); Nicky Cambridge (Head of Equality, Diversity & Inclusion); and Hugo Luck (Director, Primary Care). Before handing over to the presenters, the Chair reminded the committee that this report had been requested by Cllrs Clare and Powell, who had written to the April 2022 HOSC. The Chair also noted that the commissioning of Trans healthcare services is complex, with specialist services and services for children and young people currently commissioned at a regional or national level by NHS England. In order to make scrutiny manageable, the Chair had decided to take two reports on Trans Health: the first, at this committee meeting, to focus on locally commissioned services for adults; and the second, to follow at the October 2022 meeting, to focus on NHSE-commissioned services for young people and for adults.

8.2       Lola Banjoko told members that the Trans community experiences significant inequalities, which have been made worse by Covid. These include problems accessing services, receiving treatment, and experiencing discrimination. A Trans Healthcare Improvement Board has been established with representation from primary care, public health, NHSE, University Hospitals Sussex, LGBT Switchboard and the Clare Project. The Board has objectives to reduce health inequalities, to improve comms & engagement, to improve staff training, and to foster better integration between services.

8.3       Hugo Luck informed the committee of the launch of a locally commissioned service (LCS) for Trans people, which would include hormone therapy and an annual review of physical, mental and sexual health. 54 GP practices across Sussex have already signed-up to this service (11 of them in Brighton & Hove). This is a good rate of take-up, and it may be that some practices will take on LCS functions for neighbouring practices.

8.4       Helen Davies explained to members that NHSE runs seven Gender Identity Clinics (GIC) across England. There are very long waits following referral to these clinics, with a 240% increase in GIC referrals over the past five years. A GIC for Sussex is currently under tender. As this is a live process, only very limited information about the service can be shared publicly. Ms Davies added that Brighton & Hove has traditionally had a large Trans population. In recent years there has also been an expansion in the population of Trans people living in East Sussex. Commissioners are committed to working with the Trans community across Sussex in terms of designing and delivering services.

8.5       Nicky Cambridge told members that the NHS has a long history of working with LBG and Trans organisations across the city. Commissioners fund and support organisations for Trans people and have involved community representatives in the planning of new services.

8.6       Ms Davies acknowledged that there were challenges: Trans people experience really significant health inequalities; there is a pressing need to reduce waiting times; and also to improve data on Trans people and their needs (the inclusion of Trans questions in the 2021 census should help). Ms Banjoko added that the next steps include: opening the Sussex GIC; establishing a baseline dataset of Trans needs; strengthening links with local universities; and developing services that feel integrated from a patient perspective.

8.7       In response to a question from the Chair on the typical patient journey, Ms Davies told members that most people’s destination is not surgery; it is key that there are good local services in primary care and timely referral into the GIC, with appropriate support to help patients manage waiting times.

8.8       In response to a question from Cllr John on timelines for the new services, Ms Banjoko offered to provide more information on the GIC at the October 2022 HOSC meeting. Mr Luck added that the offer of training for GPs will be assessed at six months. There is no real expectation or requirement that all GPs will undertake the training as 100% adherence is very rare, and only some GPs in a practice will typically undertake training. Practices offering the LCS will need to show that they have an effective offer to their Trans patients, particularly in terms of annual reviews.

8.9       Responding to a query from Cllr John on engagement and data, Ms Cambridge told the committee that there is lots of engagement happening now, and that it is absolutely vital to the success of services that the community feels engaged. There has been good involvement in and feedback on the LCS model. In terms of data, detailed information from the 2021 census will be published in the autumn and this will give us the first real data on the size of the Sussex Trans population. Ms Banjoko added that public health teams would be analysing the census data and using it to update their JSNAs.

8.10    In response to a question from Cllr Evans on Trans people and cancer, Ms Davies told members that the issue here was primarily around ensuring that people received the screening appropriate to their previous identities. There is a risk that people will be missed in screening calls.

8.11    In answer to a query from Cllr Evans about staff training, Ms Davies responded that it is important that all staff understand that transphobic attitudes are unacceptable. However, different types of staff require different levels of training in Trans health issues, so there is no one-size-fits-all programme.

8.12    Cllr Grimshaw asked what was expected from the census date. Ms Banjoko replied that combining the census data with existing information from JSNA, the ONS etc. will enable a richer understanding of the scale of need. However, specialist capacity will remain limited, so work may need to focus on how best to support specialist services.

8.13    The Chair asked about the what the commissioning philosophy is for Trans health, given the potential for the NHS to medicalise services when people may have a greater need for support. Mr Luck acknowledged this risk, and told members that the basic philosophy is that Trans people should have the same healthcare experience as everyone else.

8.14    Geoffrey Bowden told the committee that Healthwatch had worked with LGBT Switchboard on survey work with the Trans community. It was clear from this that there are still big challenges in terms of communication and engagement. However, it is good to see that the original scrutiny panel report is still relevant and that its recommendations are still being taken forward. The Chair agreed that it had been a long journey, but that there is clearly lots of positivity.

8.15    The Chair thanked all the presenters for their input and said she was looking forward to the report on NHSE commissioned services at the October HOSC meeting.

8.16    RESOLVED – that the report be noted.