Scotland’s NHS plans to speed up irreversible surgeries to transgender patientsreveal documents seen by The Telegraph.
A report from NHS Scotland, suggesting new treatment rules for transgender people, calls for “barriers” to gender reassignment surgery to be removed and proposes sweeping measures to make operations more widely available.
These include allowing GPs, rather than specialists, to refer patients for procedures and allowing a ‘single opinion’ to be sufficient to refer to surgery in most cases.
Trans patients can “benefit” from operations including mastectomies, breast implants and genital reassignment, as well as hormonal treatments, even if they do not experience “distress” over their gender identity, it is claimed.
The proposed treatment rules say a patient’s history or mental health need not be examined in detail before they are referred for procedures.
The report goes on to call for an “affirmative” model of non-surgical care. still to be given to childrendespite an expert review for England’s NHS, by esteemed pediatrician Hilary Cass, which raised concerns about the approach.
‘Very worrying indeed’
The recommendations are largely based on the approaches advocated by the controversial World Professional Association for Transgender Health (WPATH) and to suggest that other surgical procedures supported by the group might become available on the Scottish NHS in the future.
Among the procedures advocated by WPATH, which trans activists claim is an international authority on trans health but opponents say is an extremist lobby group, are castrations for people who identify as eunuchs.
Critical gender activists said the unpublished document supported fears that transgender healthcare policies in Scotland were being influenced by extremist ideology, with potentially devastating consequences for patients.
David Bell, consultant psychiatrist and Tavistock Clinic Whistleblowerhe said it was “very worrying indeed” to see the Scottish NHS treat WPATH as an “authority” on trans health issues, something he said was “complete fiction”.
He also claimed that contrary to the document, doctors had a responsibility to fully examine a patient’s mental health and history before referring them for irreversible surgeries they later regret.
“It’s a very worrying situation,” said Dr. Bell. “The attention of ministers seems to be captured more by groups that represent an ideological movement than by those that represent an objective scientific approach to these issues, such as NHS England and the Cass Review.
“It is never a doctor’s job to affirm or not affirm, it is a doctor’s job to understand. That means understanding a patient’s life narrative, her childhood, how he developed particularly in terms of sexuality and gender, and how he came to be the person he is.
“We have an ethical duty towards young people and adults not to treat things literally. That is something that is completely incompatible with a proper clinical approach.”
‘A mental health problem’
The group that wrote the report decided to call their new protocol SPATH (Scottish Pathway for Trans Healthcare) in an apparent attempt to link up with WPATH, a group that advocates for gender surgery for adolescents.
The report states that counseling or psychotherapy that examines gender identity “is not a prerequisite for any gender-affirming medical care,” meaning that people could be sent for operations without any questioning about alternative reasons for the gender dysphoria.
It adds: “People should not be expected to describe their childhood, sexuality or current gender identity and gender expression in stereotypical ways in order to access gender-affirming healthcare.
“Access to hormones and surgeries can act as a prophylactic measure against anxiety. A trans person can have persistent gender incongruity without distress and may still benefit from hormones or gender-affirming surgeries.”
Trina Budge, director of the Campaign group For Women ScotlandHe said that surgeries on healthy bodies should not be seen as a “quick fix” and that there was no evidence that they would resolve gender dysphoria.
“This now appears to be a service to expedite patient-selected surgeries to suit how they want to look, rather than any professional or clinical attempt to address a mental health issue,” he said.
State-backed form of ‘social transition’
A spokesperson for NHS National Services Scotlandwhich commissioned the report, said it would present its final recommendations to SNP ministers for a new transgender treatment protocol “shortly”.
“This new protocol is based on the broadest appropriate evidence base and relevant clinical data,” he added.
“Subject to Scottish Government approval, it will replace the current arrangements, which date from 2012, and determine gender reassignment pathways across the NHS in Scotland.
“It would be inappropriate to comment before the imminent publication of the new Gender Reassignment Protocol.”
On Monday night, the Equality and Human Rights Commission (EHRC) raised concerns about the SNP’s plans to allow minors under 18 to change their legal sex before a vote on the legislation on Tuesday.
The EHRC raised fears that 16- and 17-year-olds, who could obtain Gender Recognition Certificates (GRCs) for the first time, would have access to a state-backed form of “social transition”, the merits of which have been questioned by an independent review of the NHS England.
The gender recognition bill it would allow Scots to change their legal sex simply by signing a declaration. MSPs have tabled more than 150 amendments to the bill, whose second-stage scrutiny begins Tuesday.
NHS Scotland plans to send the plans to Nicola Sturgeon and her ministers for approval “imminently”.