Major Scottish health board’s gender clinic to resume all referrals and assessments

In April, NHS Lothian announced that based on clinical advice, both it and NHS Greater Glasgow had deferred starting new patients on puberty hormone suppressants and gender affirming hormones in mid March.

That response came following the position taken by NHS England ahead of the Cass review, with a decision taken to formally pause treatment, supported by Sir Gregor Smith, the chief medical officer for Scotland.

NHS Lothian said all referrals to surgery and assessment appointments were paused in May so as to allow for “extensive reviews" designed to “enhance patient safety, and ensure adequate support and guidance was in place for everyone, including people with complex needs.

Restrictions for patients aged 25 and over were lifted in October following the completion of the evaluation of clinical governance arrangements. While the pause remained in place for those patients aged 18 to 24, it has also now been lifted after what the health board described as a “successful review of the processes, pathways and clinical governance arrangements”.

The move was ratified at a meeting on November 19. Appointments will resume for those aged 18 to 24 “as soon as they can be arranged”, the health board added in a statement.

The shift in stance has been welcomed, although some groups said questions remained around the health board’s decision to pause referrals and assessment appointments in the first instance.

In a statement, Scottish Trans said it was “really pleased” the pause had been lifted, and stressed the health board had acknowledged the impact it had had on those impacted.

But the organisation added: “We still think that it isn’t very clear why this pause happened. In particular, we’re not sure why it took longer to recommence assessments and referrals for people aged 18 to 24.

“We will be meeting with members of staff from NHS Lothian and East Lothian Health and Social Care Partnership, who manage Chalmers Gender Identity Clinic, this week, after we wrote to them in October trying to understand what was going on.

“We hope this will help us to understand more about what happened, but, more importantly, be reassured that these kinds of interruptions to people’s care will be avoided at all costs in the future.”

Trans activist and journalist India Willoughby also welcomed the decision, writing on X: “Well done Scotland!”

In its letter last month to Dr Tracey Gillies, NHS Lothian’s medical director, Vic Valentine, manager of Scottish Trans, said the health board’s actions had amounted to a “serious interruption” to trans people’s ability to access health care, particularly as its gender clinic provided care to people across four Scottish health board areas.

In a statement, NHS Lothian said the reviews were carried out to ensure that all patients of all ages were supported throughout each step of their journey as they moved between departments, hospitals, other health boards in Scotland and trusts in England.

The health board said it was keen to ensure that “enough information” was available to allow patients to participate fully in decisions about their healthcare, as well as support and guidance particularly for those with complex needs.

A working group set up to examine the pathways and procedures for patients aged 18 to 24 was expected to report back in January. However, its work was expedited to help reduce delays for patients.

The board said that work would continue in the background to “further refine” the processes, while the group begins work to reaffirm the connections between clinical pathways and equality and human rights principles.

“We know that any delay can be a source of real distress when waiting for assessment or treatment, and sincerely apologise to people who will experience an extension to their waiting time as a result of the reviews,” a statement said.

“Patients who are currently waiting for assessment will remain on the waiting list. Patients whose referrals were on hold will be reviewed and signed off and appointments will be restarted. Referrals will then be sent on to the NHS Gender Dysphoria National Referral Support Services, the body that assesses and reviews surgical referrals in England.

“Waiting lists at surgical centres are managed by the NHS organisations providing surgery and people will then be added to their waiting list once they have received and accepted the referral.”

It advised people to check the Lothian Sexual Health website’s gender clinic FAQs for updates, with any new information posted on the site “as soon as possible”.

The health board’s gender services are centred at the Chalmers Gender Identity Clinic in Edinburgh, which offers assessment and access to medical interventions in relation to gender incongruence or dysphoria.

The clinic’s multi-disciplinary team includes specialists in gender identity, mental health, reproductive endocrinology, and speech and language. Patients seeking to access its services are asked to do so via a referral from their GP, but its website stressed there was a “very high demand” and that it was actively working towards improving waiting times.

The new policy represents the latest shift in the care and treatment provided by gender services across in NHS in Scotland. In August, NHS Greater Glasgow & Clyde said its service was no longer accepting patients who self-referred. Officials said the decision would ensure the "appropriate support and care" was provided to patients.