First reported 27 Feb 2023•Latest report 30 Apr 2024
Definition
What this concern includes
Includes failures in dedicated interim-care arrangements for patients waiting for gender-identity treatment, including safe bridging-hormone prescribing guidance, access to mental-health care, liaison between relevant clinicians and services, and prioritisation or support arrangements during the waiting period.
Not included
Excludes general gender-identity treatment access delays where no deficiency in interim care or support during the wait is identified.
Excludes generic prescribing or mental-health service deficiencies not specifically connected to patients awaiting gender-identity treatment.
Excludes failures in definitive gender-identity treatment after the waiting period has ended.
Excludes unrelated care-transition or waiting-list processes without a gender-identity treatment qualifier.
Reports
4
Distinct published reports
Individual concerns
8
A report can raise multiple concerns
Date range
2023–2024
First to latest report issue date
Stated actions
13
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
NHS England4
London Adult Gender Identity Clinic1
National Referral Support Service1
North London NHS Foundation Trust1
Royal College of General Practitioners1
Surrey and Borders Partnership NHS Foundation Trust1
Executive non-departmental public body4
Healthcare site2
NHS trust2
Health professional body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
East Sussex
Concerns raised2
Unavailability of assured mental wellbeing support for young people waiting for gender services
Failure to refer young people awaiting gender services for specialist psychiatric support from CAMHS
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Contact children and young people on the waiting list and offer assessment by their local NHS mental-health services.
Stated by NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSUStated in progressThe respondent said that this action was in progress when they made their response on 9 May 2024.
Action
Send referral information for consenting patients to their local children and young people’s mental-health providers.
Stated by NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSUStated plannedThe respondent said that this action was planned when they made their response on 9 May 2024.
Action
Contact all children and young people on the waiting list and offer local NHS mental-health assessment, with ongoing support for identified needs.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 9 May 2024.
Action
Provide additional funding to local mental-health systems to support waiting-list assessments and care.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 9 May 2024.
Action
Decide whether to require all Children and Young People’s Gender Service referrals to come through NHS secondary care after public consultation.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 9 May 2024.
Action
Decide whether to strengthen pre-referral relationships between gender services and local secondary-care services after public consultation.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 9 May 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Clinical support for waiting-list patients is to be provided by their GPs or other local clinicians, not the administrative referral service.
Stated by NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSURedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
East London
Concerns raised4
Lack of knowledge of guidance for safe prescribing of bridging hormones
Lack of local support for patients awaiting Gender Identity Clinic assessment and treatment
Lack of clarity about responsibility for patient wellbeing during the waiting period
Failure of primary and secondary/tertiary services to work optimally together to support patients during lengthy waiting periods
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Deploy £2.2 million of additional investment to established clinics for clinical-capacity expansion or direct patient support.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 18 December 2023.
Action
Commission waiting-list support resources, including referral screening, outreach and peer workers, advice lines, and pre-assessment workshops.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 18 December 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Commissioning responsibility for local support services rests with Integrated Care Boards, not NHS England.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Clinical responsibility during a GDC waiting period rests with the patient’s GP or involved local healthcare professional, not an unseen clinician.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
West Sussex, Brighton and Hove
Concerns raised1
Lack of provision of mental health care for people waiting for gender-affirming treatment
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Review and expand the third-sector organisation list in the Supporting People who are Trans Policy.
Stated by Surrey and Borders Partnership NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 11 December 2023.
Action
Implement an enhanced risk-assessment approach with local CYP mental health services for children and young people on the national waiting list.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 11 December 2023.
Action
Provide additional funding to local mental health teams to deploy resources for timely waiting-list risk-assessment access.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 11 December 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Decisions on specific therapy, including medication, are specialist responsibilities outside general practitioners’ scope of practice.
Stated by Royal College of General PractitionersOutside remitThe respondent said that this matter was outside its role or authority.
Position
Mental health care for GIC patients is the responsibility of GPs or secondary mental health services, with the GIC sharing information as required.
Stated by North London NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Local mental health service commissioning, including training and education, rests with Integrated Care Boards rather than NHS England.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
North London
Concerns raised1
Lack of mental health care for patients on waiting lists
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Establish and commission waiting-list support for gender dysphoria patients, including screening, outreach, peer support, advice lines and pre-assessment workshops.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 10 March 2023.
Action
Increase financial investment in Gender Dysphoria Clinics to support recruitment of additional clinicians where possible.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 10 March 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.6
Position
The Trust cannot provide services for patients waiting for GIC assessment because those services are not currently commissioned.
Stated by North London NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
NHS England commissioners must decide whether waiting-list services should be commissioned and funded.
Stated by North London NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The GIC treats gender incongruence, which is not classified as a mental health diagnosis.
Stated by North London NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Mental healthcare for GIC patients is provided through GPs or secondary mental health services, with information sharing as needed.
Stated by North London NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Trusts directly involved in care are better placed to address many concerns raised in the report.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Integrated Care Boards, rather than NHS England, are responsible for commissioning local mental health services.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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Includes failures in dedicated interim-care arrangements for patients waiting for gender-identity treatment, including safe bridging-hormone prescribing guidance, access to mental-health care, liaison between relevant clinicians and services, and prioritisation or support arrangements during the waiting period.
