New adult gender dysphoria health service to be piloted in London in 2020

The Chelsea and Westminster Hospital NHS Foundation Trust has been selected to run a 3-year pilot that will evaluate the delivery of specialised gender dysphoria services for adults (over 17) in a non-specialist setting.

The new service will be based at 56 Dean Street, an award-winning NHS HIV and sexual health clinic in Soho, Central London. The development of the pilot is part of NHS England’s ambitious programme of work to increase clinical capacity in the national gender dysphoria service, and by doing so improve access and address waiting times.

People using the service will see a team of multi-skilled professionals that will include established expertise in gender dysphoria healthcare. The service will deliver a range of interventions such as assessment, diagnosis, hormone therapy, voice therapy and referral for surgery and signposting to other holistic services.

During the pilot phase, access to the service will initially be given to people who were registered as patients of the Trust’s HIV/GUM service at 1 January 2020, and priority will be given to patients who are on a waiting list at an established Gender Dysphoria Clinic.

The service will work to an adaptation of NHS England’s national service specification for non-surgical services, which states that access to the NHS pathway of care will be dependent on a clinical diagnosis of gender dysphoria.

The service expects to see the first patients in spring 2020. Further details will be available soon around the arrangements for identifying eligible patients.

Over time, the aim is for people with gender dysphoria to be able to access specialist expertise in other local health settings around the country. In support of this, NHS England will also establish further pilots during 2020. This includes a service rooted in primary care in Greater Manchester, the model for which has been developed as an outcome of stakeholder feedback gathered there in 2018 and 2019. Further pilots around the country are also being explored.

Different constellations and shining stars: lesbian parents’ voices on accessing healthcare for their adopted children.

As part of LBT Womens Health Week, Lucy Kelsall-Knight from the University of Birmingham School of Nursing will be delivering a lunchtime seminar about her research:

The past few decades have seen significant changes in family demographics. It is now more common for parents to be lesbians and in 2019, 1 in 7 children in England were adopted by same-sex parents. Adopted children have an increased incidence of additional healthcare needs, and therefore dental and medical appointments, in comparison to children who remain with their biological parents. This study focused, through the use of narrative inquiry, on the voices of lesbian parents with regards to accessing healthcare for their adopted children.

The research showed that there was an undercurrent of discriminatory practice, shown by various healthcare professionals within the NHS in England, and a lack of understanding of the adoption process, knowledge surrounding the child’s history, and legal stance with regards to parental responsibility.

Date: Monday 9th March

Time: 12-1:30pm

Venue: Murray Learning Centre, room UG10 (University of Birmingham campus)

Organiser: University of Birmingham Rainbow Network

 

All welcome and light refreshments will be provided.

GLA event for LBT Women’s Health Week 2020

The Mayor of London, Sadiq Khan, is hosting an event targeted at LGBTQ+ women as part of International Women’s Week and LBT Women’s Health Week. The event takes place between 10.00am and 1.00pm on Tuesday 10 March 2020, at City Hall.

The aim of the event is to raise awareness about LGBTQ+ women’s health inequalities, to make it easier for service providers to empower service users, hear from agencies that support LGBTQ+ women, and to raise awareness from the audience who may have never considered the health issues outside of a heterosexist paradigm.

The Mayor is aware that LGBTQ+ women’s voices often go unheard, and he is keen to hear directly from a wide range of women about their experiences and the barriers they still experience.

Attendees will have the opportunity to hear about the Mayor’s approach to health equality, and from a range of speakers including Professor Catherine Meads, Professor of Health, Anglia Ruskin University, Vicky Hobart, Head of Health at the Greater London Authority, and interact with a panel of health professionals, chaired by Dr Ronx Ikharia.

If you would like to attend this important event please contact Kiran Moritz at kiran.moritz@london.gov.uk

The event is free of charge and a light lunch will be served in a safe space where photography will be optional. Capacity is limited to 80 people. When capacity is reached you may be placed on a standby list. Please tell Kiran if you have any access or dietary requirements.

Call for evidence: Weight Management for People with Severe Mental Illness

The Mental Health Consortium (Association of Mental Health Providers, Centre for Mental Health, and Rethink Mental Illness) with Health and Wellbeing Alliance partners Men’s Health Forum, the National LGB&T Partnership and Race Equality Foundation, have been commissioned to investigate weight management for people severely affected by mental illness.

The project, which is funded by the VCSE Health and Wellbeing Alliance, will report on current and emerging positive practice, and it will make recommendations about interventions and ways of working that show promise in reducing the physical health inequalities faced by people with severe mental illness, such as preventable conditions like cardiovascular, respiratory and some cancer by way of example. (By severe mental illness, we mean psychological problems that are often severe enough to seriously limit someone’s ability to work and to do day-to-day activities. Diagnoses include, but are not limited to, enduring psychotic disorders, personality disorders, eating disorders, mood disorders and anxiety disorders).

We are now seeking evidence from people and organisations who are willing to share their knowledge, experience and understanding. We are interested in all kinds of work in this area, especially:

  1. first person accounts about weight management from people with experience of living and working with this issue; and first-person account from people with severe mental illness on their weight management
  2. strategies and interventions that have been put into practice, with or without success.

All submissions will be gratefully received and will help to inform this project’s recommendations.

Key areas of interest

  • What strategies and interventions have been tried already?

We would like to hear about any weight management schemes that have been developed for people with severe mental illness, especially those that have been put into practice. What was the thinking behind them? What difficulties did they run into, if any? What were the outcomes? To what extent did the perspective of people with lived experience influence this scheme?

  • What experiences have people with severe and enduring mental illness had with weight management interventions?

We would like to hear about what people with severe mental illness want from weight management schemes. Have they experienced any particularly good or bad interventions? Do they have additional needs that aren’t being met by mainstream services? What have they, or would they, find most helpful?

  • What additional barriers do people with severe and enduring mental illness encounter with managing their weight?

We would like to hear about challenges faced by people on account of their mental health when it comes to weight management. How do severe and enduring mental illnesses affect someone’s ability to manage their weight? Do people with severe and enduring mental illness experience additional problems accessing and adhering to the services?

How to send us evidence

We welcome evidence in a range of formats. Written submissions should be no more than 3,000 words in total and can be accompanied by supporting documents, web links or videos. The deadline for submission is 16 December 2019

Please send evidence to submissions@centreformentalhealth.org.uk

Please ensure you give us your name, organisation (if relevant) and contact details, indicating if you would like us to treat your evidence anonymously.

Any questions?

If you would like to know more about this project, please get in touch with Emma Bailey at emma.bailey@centreformentalhealth.org.uk and/or Dania Hanif at dania@amhp.org.uk

Call for Evidence: Helping People with Severe Mental Illness to Stop Smoking

The Mental Health Consortium (Association of Mental Health Providers, Centre for Mental Health, and Rethink Mental Illness) with Health and Wellbeing Alliance partners Friends, Families and Travellers, Men’s Health Forum, the National LGB&T Partnership and Race Equality Foundation, have been commissioned to investigate how to best support people severely affected by mental illness to stop smoking.

The project, which is funded by the VCSE Health and Wellbeing Alliance, will report on current and emerging positive practice, and it will make recommendations about interventions that show promise in reducing the physical health inequalities faced by people with severe mental illness , such as preventable conditions like cardiovascular, respiratory and some cancer by way of example. (By severe mental illness, we mean psychological problems that are often severe enough to seriously limit someone’s ability to work and to do day-to-day activities. Diagnoses include, but are not limited to, enduring psychotic disorders, personality disorders, eating disorders, mood disorders and anxiety disorders).

We are now seeking evidence from people and organisations from all sectors who are willing to share their knowledge, experience and understanding. We are interested in all kinds of work in this area, especially:

  1. first person accounts about help to stop smoking for people with severe mental illness both from people with experience of SMI and working with this issue; and
  2. strategies and interventions that have been put into practice, with or without success.

All submissions will be gratefully received and will help to inform this project’s recommendations.

Key areas of interest

  • What strategies and interventions have been tried already?

We would like to hear about any schemes for helping people stop smoking that have been developed for people with severe and enduring mental illness, especially those that have been put into practice. These could be based in the community, voluntary sector, local authority or the NHS. What was the thinking behind them? What difficulties did they run into, if any? What were the outcomes?

  • What experiences have people with severe and enduring mental illness had with interventions to help them stop smoking?

We would like to hear about what people with severe mental illness want from schemes for stopping smoking. Have they experienced any particularly good or bad interventions? Do they have additional needs that aren’t being met by mainstream services? What have they, or would they, find most helpful?

  • What additional barriers do people with severe and enduring mental illness encounter when stopping smoking?

We would like to hear about challenges faced by people on account of their mental health when it comes to stopping smoking. How do severe and enduring mental illnesses affect someone’s ability to stop smoking? Do people with severe mental illness experience additional problems accessing and adhering to the services?

How to send us evidence

We welcome evidence in a range of formats. Written submissions should be no more than 3,000 words in total and can be accompanied by any supporting data, documents, web links or videos.

The deadline for submission is 16 December 2019

Please send evidence to submissions@centreformentalhealth.org.uk

Please ensure you give us your name, organisation (if relevant) and contact details, indicating if you would like us to treat your evidence anonymously.

Any questions?

If you would like to know more about this project, please get in touch with Emma Bailey at emma.bailey@centreformentalhealth.org.uk or Dania Hanif at dania@amhp.org.uk

Share your views on the new questions for The National Surveys of Sexual Attitudes and Lifestyles

The National Surveys of Sexual Attitudes and Lifestyles (Natsal) are among the largest surveys on sexual behaviour in the world. The surveys have taken place every 10 years since 1990. NatCen Social Research, University College London, London School of Hygiene and Tropical Medicine and University of Glasgow are currently preparing for the next Natsal survey.

NatCen Social Research, an independent research institute, will be testing some questions which may be used in the next Natsal survey and are looking for respondents to take part in face-to-face interviews.

Who are they looking for?

We are looking to speak to a variety of people who consider themselves to be members of the LGBT+ community.

What is the study about?

The aim of this project is to try out new questions and changes to questions for the next Natsal survey to make sure they are easy to understand and answer. By trying out the questions with a range of different people, such as yourself, we will be able to check that the questions are understood easily and work as intended.

What is involved?

Taking part would involve arranging a suitable time to talk to you about the questions. In the interview you will be asked the questions which have been developed and asked for your thoughts on the questions. The interviews will last about an hour. They will be audio-recorded, with consent. Respondents who take part in a face-to-face interview will receive a £30 high street voucher as a token of our appreciation for participating in the research.

When & where will the interviews take place?

The interviews will take place in London during the day. Interviews will be taking place until the 25th of November.

Will the interview be confidential?

Yes, completely. Any answers you give will be treated in the strictest confidence in accordance with the General Data Protection Regulation (GDPR). Everything you tell us will only be used for the purpose of this research and will not be shared with anyone outside the project research team unless you say it can be. The research will be written up as a report. Your name will not be used in the report. With your permission, the interview will be audio-recorded.

Interested in finding out more?

If you are interested in finding out more about this research and what is involved, please contact Emma Corteen, emma.corteen@natcen.ac.uk

Greater Manchester Trans Health Service Pilot

NHS England has launched a selection process to find a suitable provider, or group of providers, to deliver a pilot healthcare service for trans and non-binary adults (17 and above) in Greater Manchester. The pilot will initially run for up to three years.

As an outcome of a significant programme of work to improve gender dysphoria services, NHS England has concluded that a new delivery model is necessary for England that offers access to specialist care by trained professionals in primary care and other local settings.

NHS England is looking to establish – for evaluation – a multi-disciplinary team based in primary care in Greater Manchester that will deliver NHS services that are currently only available in designated Gender Dysphoria Clinics.

The advantage of this model, if positively evaluated, is the ability to increase clinical capacity to an extent not possible using the current delivery model; more timely and accessible care delivered (initially) in the Greater Manchester area; and a better join-up between the team providing specialist care and the individual’s own GP.

The Greater Manchester Trans Health Service will work to an adaptation of NHS England’s national service specification for gender dysphoria services (that was agreed in 2018 as an outcome of public consultation).

A key feature of the selection process is for bidding organisations to describe a delivery model that has been co-designed with the trans and non-binary communities of Greater Manchester, and which is tailored to meet their particular needs. A common theme heard during consultation was around the need for a more inclusive service, streamlined referral processes and multi professional/multi-sector staffing.

As well as providing a range of support to people, the Trans Health Service will work closely with GP practices and build collaborative relationships with local statutory services and voluntary sector services, so that individuals may be easily referred or sign-posted to other services in Greater Manchester that meet their overall health and social care needs.

NHS England is working collaboratively with the Greater Manchester Health and Social Care Partnership (GMH&SCP), which combines health and local government, on the pilot. GMH&SCP will support NHS England in setting up the service and consider how additional services could be incorporated over time.

The service will initially focus on supporting individuals from Greater Manchester who are on the waiting list for a first appointment at a Gender Dysphoria Clinic.

The invitation to tender for the Trans Health Service is open to health and social care and third sector organisations. More information about requirements of the service for potential bidders is available on the Government Contracts Finder website. The tender process closes on 22 November 2019.

The Trans Health Service is expected to be in place in 2020.

For more information about NHS England’s work on gender dysphoria, please contact england.scengagement@nhs.net.

Call for Evidence: Barriers for marginalised groups to accessing breast screening

Background

In England, breast screening is currently offered at 3-yearly intervals to women aged from 50 up to their 71st birthday. In 2017/18, 2.54 million women aged 50-70 were invited for breast screening of which 70.5% attended. Early diagnosis is key to improving the likelihood of successful treatment of an ageing population. The NHS breast screening programme has been experiencing decreasing uptake over a number of years. Whilst attendance for breast screening is a personal choice, and this must be respected, it should be an informed choice, and the screening service should be aware of, and able to respond to, the barriers that some population groups face in accessing the service.

The Project

In order to effectively reduce the impact of inequalities, The National LGB&T Partnership, in collaboration with Health and Wellbeing Alliance Members Friends, Families and Travellers, Faith Action, Race Equality Foundation, Mental Health Consortia and Win Win Alliance, and supported by Public Health England, are working on a project which will identify reasons why some people are not attending for breast screening. Barriers to screening can include physical and communication barriers as well as cultural and social barriers, and there is a current lack of evidence of the barriers to attendance experienced by groups who experience marginalisation and inequalities.

The project will undertake significant consultation through focus groups with various seldom heard groups to identify whether there are issues affecting the different community groups in relation to breast screening. Practical measures to reduce these barriers and reduce variation in participation will be identified, including through consultation with staff working within breast screening services, and outlined in a national toolkit, for use by these staff to better engage and communicate with the various population groups.

Call for Evidence

To support the development of the project, particularly the questions that will be asked of participants in focus groups, we are asking you to share any research, investigations, projects or information you have conducted or are aware of which relates to barriers to accessing screening and preventative care for marginalised groups. Our priority is to consider access to the breast screening programme, but as we know there is limited evidence in this area, we are extending this call to capture all evidence which may shine a light on the issue. We are interested in the experiences of people covered by all 7 main protected characteristics* (age, disability, gender reassignment/trans status, race/ethnicity, religion or belief, sex/gender, sexual orientation), 5 health inequality areas (Gypsy, Roma, or Traveller communities, vulnerable migrants, homeless people, people in contact with the criminal justice system, sex workers), and mental illness, people without English as a first language, people with caring responsibilities and people with experience of sexual violence and/or trauma.

*at this time, the remaining two protected characteristics: marriage/civil partnership and pregnancy/maternity are not key areas for investigation.

How to contribute

Please send any documents and/or links to: harri.weeks@lgbtconsortium.org.uk by October 25th.

The role of the GP in caring for gender-questioning and transgender patients

The National LGB&T Partnership welcomes that the RCGP have established a position on the role of the GP in caring for gender-questioning and transgender patients and recommendations for ensuring these patients receive equal access to the highest standard of care. We particularly welcome the assertion that “GPs are expected to approach the holistic care of gender-questioning and transgender patients as they do with every patient – openly, respectfully, sensitively and without bias” and the recognition that “The gaps in education, guidance and training for GPs around treating gender dysphoria for both adults and children, and managing broader trans health issues, also needs to be urgently addressed”, particularly the recommendation that “if GPs feel a lack of knowledge or experience about the healthcare needs of trans people, they…address their training needs as part of continuing professional development.” 

However, our support of the position statement is not without its hesitations.

We of course welcome further research which will support the development and extension of positive support for trans people, however we are concerned that there is yet again call for further research when we know that this is used as a stalling mechanism in policy change and that national and international evidence is increasingly widely available, as is community-developed intelligence. The possibility of future innovations should not be used as a reason to ignore or undermine current good practice.

We welcome the progressive position that “people who are uncomfortable or distressed by their biological sex or gender roles and behaviours assigned to them by society, but do not wish to alter their sexual characteristics” deserve appropriate support. We call on NHSE to describe how this support will be provided through a model which restricts provision of care through the NHS England commissioned services (GICs) to those who receive a diagnosis of gender dysphoria.

We contest that GPs are “being pressured into prescribing”, particularly given the numbers of service users who state their GP is refusing to prescribe, even after instruction from a GIC, and also argue that prescribing should not be seen to “fall outside the limits of one’s competence” when detailed clinical guidance on hormone therapy has been available to GPs in the NHS publication Guidance for GPs, other clinicians and health professionals on the care of gender variant people since May 2008.

We have some concern that the statement made in section 28 ii may prevent those GPs who might feel competent prescribing from the point of a patient’s presentation to them from doing so, as they are instructed to “refer patients to a GIC or equivalent if they exhibit signs of gender dysphoria and request treatment”. This is compounded by the fact that the position statement also refers to the GP “taking on the ongoing prescribing of medication for patients and the monitoring of any side effects…after a patient has been discharged from a GIC”. The statement also acknowledges the lack of capacity of GICs, long waits between appointments, and long distances that many patients are required to travel to attend. Many trans people will not be discharged from the GIC until after they have received surgical interventions, which, between the requirements of the service specifications and the capacity-affected long waiting times between appointments is often a number of years after starting hormone treatments. Requiring patients to travel to GICs to obtain prescription, administration and monitoring of their hormone regimens during this time is clearly unreasonable.

We encourage the RCGP and the NHS to further investigate the opportunities and detailed complexities of altering NHS data collection systems with regards to sex, gender and trans status, so as to find a solution which serves patients, practitioners and researchers, as the suggestions outlined in UK Wide Policy Recommendation iii (page 10) do not appear to sufficiently consider the appropriateness of the changes recommended.

We are pleased to see that the statement suggests it is “vital that frontline GPs, patients and the broader trans community are involved in the design and implementation of changes to the current system”, and welcome the RCGP to call on the National LGB&T Partnership, it’s members and colleagues to support them in this work.

#LBTWomensHealth18 – If you’re not counted you don’t count.

Mike Cullen at the LGBT Foundation wrote the following blog post for us about Sexual Orientation and Trans Status Monitoring and Lesbian, Bisexual and Trans Women’s health.

LBT Health Week is a great opportunity to talk about monitoring, which continues to be a key part of the work of the LGBT Partnership and has been for a number of years. For those of us working in the sector we’re very aware of the health inequalities that LBT women experience, such as poor mental health, sexual and reproductive health inequalities and higher rates of cancer. Yet often these inequalities are not addressed by mainstream services and so the needs of our communities go unmet. To put it simply, if we’re not counted we don’t count.

Invisibility within services means that they are unaware of the specific health needs our communities often experience. Monitoring the sexual orientation, trans status and gender identity of service users is the simplest way to start addressing clipboardthat.

It means that an evidence base can be built and as a result targeted preventative work can be done to help reduce these inequalities. We know for example that LB women are less likely to access cervical cancer screenings than their heterosexual counterparts. Monitoring means that when LB women access services health care professionals can ensure they are given the correct information.

Another benefit of monitoring is that it shows you are acknowledging someone’s identity and are seeing them as a whole person. This helps to reduce barriers to accessing services and creates an environment of openness where people are more likely to discuss their health concerns. When services have a fuller picture of who is sat in front of them, they are able to diagnose and treat people faster, as well as signpost to services suited to individual needs. Monitoring alone isn’t going to reduce all of the health inequalities that LBT women experience, but it’s a great first step.

 

 

For further guidance on monitoring please visit lgbt.foundation/monitoring