25 Jul 2024 Leia Dorothy Pandora Sampson-Grimbly · Prevention of Future Deaths report North London
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Concerns raised 1
Excessively long waiting lists for first appointments at Gender Dysphoria clinics View source
Linked responses
Department of Health and Social Care North London NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 4
North London NHS Foundation Trust
Work with NHS England and other providers to develop ways to reduce GIC waiting lists and support patients while waiting.
View source
Department of Health and Social Care
Conduct a review of adult Gender Dysphoria Clinic operations, service models, quality concerns and improvement actions.
View source
Department of Health and Social Care
Publish the adult Gender Dysphoria Clinic review report and its findings and recommendations.
View source
Department of Health and Social Care
Develop a new service specification for adult Gender Dysphoria Clinics through public consultation.
View source See 1 more action
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AI-generated summary
Leia Dorothy Pandora Sampson-Grimbly · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Leia Dorothy Pandora Sampson-Grimbly, aged 17, jumped from London Bridge into the Thames on 6 November 2024 and died in hospital later that day despite treatment. The report describes her being without preventative treatment amid lengthy waiting lists for a Gender Dysphoria clinic, alongside low mood, gender dysphoria, hostility from some sections of the community and social media links inciting suicide. The principal concern identified was that waiting lists were too long for a first appointment at a Gender Dysphoria clinic.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Excessively long waiting lists for first appointments at Gender Dysphoria clinics
Wider context from the report “Waiting lists are far too long for first appointment at a Gender Dysphoria clinic.
” Source location Leia Dorothy Pandora Sampson-Grimbly · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with NHS England and other providers to develop ways to reduce GIC waiting lists and support patients while waiting.
Verbatim wording from the response “England and other providers to develop innovative ways of reducing the waiting list and providing support to patients while on the waiting list.” Source location Response from Tavistock and Portman NHS Foundation Trust
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct a review of adult Gender Dysphoria Clinic operations, service models, quality concerns and improvement actions.
Verbatim wording from the response “This response has focused on waiting times to Children and Young People’s Gender Services and NHS England’s efforts to increase clinical capacity in this field. However, it may assist HM Coroner to learn that in April 2024 NHS England took the decision to conduct a review of the operation and delivery of adult Gender Dysphoria Clinics (GDC), in line with the recommendations of the Cass Review and in recognition that waiting times for adult gender services are also unacceptably high.” Source location Response from Department for Health and Social Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish the adult Gender Dysphoria Clinic review report and its findings and recommendations.
Verbatim wording from the response “The review is led by ████████, Medical Director of Lancashire and South Cumbria Integrated Care Board, and previously NHS England’s North West Regional Medical Director. Following on-site visits to every GDC in England, the report detailing the review’s findings and recommendations will be published in the autumn of 2025. The report will inform NHS England’s work to build a new service specification for the GDCs over 2025/26, which will involve a process of public consultation. In the context of reducing waiting times and waiting lists, NHS England will particularly want to learn the review’s findings and recommendations around productivity and efficiency within each of the GDCs.” Source location Response from Department for Health and Social Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a new service specification for adult Gender Dysphoria Clinics through public consultation.
Verbatim wording from the response “The review’s terms of reference and key lines of enquiry have been published, and they describe that the review will examine the operating procedures in each service; the appropriateness of the service model for the presenting population; areas of concern, and any action being taken to improve quality. It will identify areas for improvement in relation to service quality, good practice that could be shared with other clinics, and any support that should be made available to services to assist improvement.” Source location Response from Department for Health and Social Care
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation NHS England, as commissioner of specialised gender dysphoria services, is responsible for commissioning sufficient service capacity.
Verbatim wording from the response “The waiting times for such GIC assessments is currently around 2.5 years, which is broadly in keeping with the national picture, though there is some variation in waiting times. NHS England (NHSE) is the direct commissioner of specialised services for individuals with a diagnosis of gender dysphoria. Prior to 2019/20, seven specialist centres were commissioned in England, based in or near Newcastle, Leeds, Sheffield, Northampton, Nottingham, London and Exeter.” Source location Response from Tavistock and Portman NHS Foundation Trust
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Insufficient specialist clinical staff and increasing demand have prevented NHS England from commissioning enough capacity to meet waiting-time expectations.
Verbatim wording from the response “The consultant-led services provided by the GDCs when adult patients are referred to them are amongst those intended to commence within 18 weeks of referral. Unfortunately, NHSE has been unable to commission sufficient capacity to meet that expectation because of the lack of specialist clinical staff (recruitment and retention) – against a backdrop of significant increasing demand, reflecting an international trend. Unfortunately, waiting times for a first appointment at a GDC remain very high. The Trust will continue to engage with its commissioners, NHS England, to develop provisions to reduce waiting times where possible.” Source location Response from Tavistock and Portman NHS Foundation Trust
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation New clinical capacity cannot be built quickly because specialist staff require training and experience.
Verbatim wording from the response “It may assist HM Coroner to know that new clinical capacity cannot be built quickly given the specialist skills that are needed to staff the multi-disciplinary team comprised variously of psychologists, psychiatrists, psychotherapists, paediatricians, social workers, nurses and endocrinologists (not exhaustive). Clinicians require training and experience to build their expertise and competencies. That is why, to support a rapid build of a new clinical workforce, NHS England has commissioned the Academy of Medical Royal Colleges and University College London to design and deliver a professional competency framework and training curriculum by 2026.” Source location Response from Department for Health and Social Care
Open published response
30 Apr 2024 Jason PULMAN · Prevention of Future Deaths report East Sussex
View report summary
Concerns raised 4
Lack of clarity about national gender-service referral mechanisms and available resources View source Long waits for access to gender services View source Failure to refer young people awaiting gender services for specialist psychiatric support from CAMHS View source
Delays in access to specialist gender dysphoria treatment while on the GIDS waiting list View source See 1 more concern
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 5
NHS England
Decide whether to require all Children and Young People’s Gender Service referrals to come through NHS secondary care after public consultation.
View source
NHS England
Establish new regional Children and Young People’s Gender Incongruence Services under an interim service specification.
View source
NHS England
Develop a substantive service specification strengthening infrastructure and regional links between specialist centres and local services.
View source
NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU
Send referral information for consenting patients to their local children and young people’s mental-health providers.
View source
NHS England
Decide whether to strengthen pre-referral relationships between gender services and local secondary-care services after public consultation.
View source See 2 more actions
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AI-generated summary
Jason PULMAN · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Jason Pulman, aged 15, was found dead on 19 April 2022 and the inquest concluded that he died by suicide, by hanging. Evidence indicated that he had not received specialist gender dysphoria treatment while waiting for GIDS and was awaiting further CAMHS assessment. The principal concern was that unclear referral mechanisms and inadequate resources for mental health support during waits for gender services could lead to similar circumstances recurring.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of clarity about national gender-service referral mechanisms and available resources
Wider context from the report “5. I am concerned that if urgent clarity is not provided to CAMHS teams, patients and parents on the appropriate national referral mechanisms for gender services, and the resources available for those services , there is a risk that the circumstances arising prior to Jason’s death could be repeated.
” Source location Jason PULMAN · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Long waits for access to gender services
Wider context from the report “3. The Arden and GEM has provided an update on its website entitled the “National Referral support Service for the NHS Gender Incongruence Service for Children and Young People”. This states: “The NHS understands it isn’t easy having to wait a long time to be seen by gender services , and young people may need some extra support with their mental wellbeing while they wait. The NHS is offering this support, if needed, through local Children and Young People Mental Health services (CYPMH), also known as Children and Adolescent Mental Health Services (CAMHS). People will be contacted to ask if they are happy for their details to be shared with their local CYPMH / CAMH service so they can speak to a professional about how they are feeling. This support offer is voluntary and the people’s place on the Children and Young People’s Gender Services waiting list will not change. This service will be contacting parents, children and young people on the waiting list by email or post to ask if they wish to access this support between April and May 2024.”
” Source location Jason PULMAN · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to refer young people awaiting gender services for specialist psychiatric support from CAMHS
Wider context from the report “1. I heard evidence at the inquest that Jason did not receive specialist gender dysphoria treatment because he was on the waiting list for the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust. There was also evidence that clinicians did not refer Jason for specialist psychiatric support from Child and Adolescent Mental Health Services (CAMHS) in part because the guidance at the time suggested any specialist gender dysphoria treatment should be provided by GIDS . Jason was awaiting a further assessment from CAMHS at the time of his death.
” Source location Jason PULMAN · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Delays in access to specialist gender dysphoria treatment while on the GIDS waiting list
Wider context from the report “1. I heard evidence at the inquest that Jason did not receive specialist gender dysphoria treatment because he was on the waiting list for the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust . There was also evidence that clinicians did not refer Jason for specialist psychiatric support from Child and Adolescent Mental Health Services (CAMHS) in part because the guidance at the time suggested any specialist gender dysphoria treatment should be provided by GIDS. Jason was awaiting a further assessment from CAMHS at the time of his death.
” Source location Jason PULMAN · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Decide whether to require all Children and Young People’s Gender Service referrals to come through NHS secondary care after public consultation.
Verbatim wording from the response “• Additionally, in order to ensure that a child / young person’s mental and physical health needs are addressed at the point of referral to the CYP gender service NHS England has proposed that in the future all referrals to the Children and Young People’s Gender Service must be made through NHS secondary care services – mental health services or general paediatric services. This new arrangement will ensure that concomitant health needs are addressed by secondary care clinicians while the child or young person is waiting to be assessed by the specialist CYP gender service. NHS England will make a final decision on this proposal in June 2024 following a public consultation on the proposal.” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish new regional Children and Young People’s Gender Incongruence Services under an interim service specification.
Verbatim wording from the response “Children and Young People’s Gender Incongruence Services” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a substantive service specification strengthening infrastructure and regional links between specialist centres and local services.
Verbatim wording from the response “The two new services that are operational work to an interim service specification pending the outcome of work to build a new substantive service specification in 2024/25, for adoption in April 2025, through a process of stakeholder engagement and public consultation, to reflect the final recommendations of the Cass Report.” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Send referral information for consenting patients to their local children and young people’s mental-health providers.
Verbatim wording from the response “From April 2024 NHSE have established a process whereby all children and young people who are on the waiting list for CYP gender services are contacted by the CSU on behalf of NHSE and offered an assessment by their local NHS Mental Health Services; NHS England has put additional funding into local mental health systems for this purpose. All children and young people who are identified with mental health needs will receive ongoing support from their local services while they remain on the waiting list for CYP gender services. More than a third of patients on the waiting list have consented to be seen by their local mental health service. For consented patients, the CSU will be sending referral information to each CYP MH provider starting towards the end of June 2024. The website was updated in April 2024 to reflect this new supportive offer.” Source location Response from Arden and Greater East Midlands NHS Commissioning Support Unit
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Decide whether to strengthen pre-referral relationships between gender services and local secondary-care services after public consultation.
Verbatim wording from the response “• During the same public consultation, we proposed an enhanced relationship between the Children and Young People’s Gender Service and local secondary care services at the pre-referral stage, so that there is a coordinated approach across the health system in the care of vulnerable children and young people,” Source location Response from NHS England
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Clinical support for waiting-list patients is to be provided by their GPs or other local clinicians, not the administrative referral service.
Verbatim wording from the response “The Children and Young Person’s Gender National Referral Support Service (CYP-GNRSS) provides an administrative referral management and does not see patients. Patients and referrers are advised that should a patient require clinical support, this should be provided via their GP or other local clinician. The AGEM CSU website does contain information related to where help can be sought.” Source location Response from Arden and Greater East Midlands NHS Commissioning Support Unit
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation NHS Arden and Greater East Midlands Commissioning Support Unit will respond separately to concerns within its commissioned waiting-list management role.
Verbatim wording from the response “Your Report raises five matters of concern. Some of these are better addressed by Sussex Partnership NHS Foundation Trust who we note that you have sent your Report to as an interested party. We are also in the process of seeking further information from the Trust. You have also sent your report to NHS Arden and Greater East Midlands Commissioning Support Unit (the CSU) who will respond separately to you, but there is a common position described in the responses made by NHS England and the CSU given that the CSU is commissioned to manage the national waiting list for Children and Young People’s Gender Services on behalf of NHS England.” Source location Response from NHS England
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Expanding clinical capacity is constrained by shortages of suitable workforce potential in children’s and adult gender services, rather than funding.
Verbatim wording from the response “The main constraint in building a new clinical workforce is not funding, it is the shortage of workforce potential for both children’s and adult gender services. NHS England’s overall planned spend on all gender dysphoria services (adults and children) in 2023/24 was £78.17m – up from £33.4m in 2018/19, representing an overall increase in funding of 134% in five years. NHS England’s planning assumption is that the new providers of CYP gender services will begin to draw patients from the waiting list from November 2024, with the priority focus between April and October 2024 being the ongoing care of patients transferred from the Tavistock GIDS.” Source location Response from NHS England
Open published response
11 Dec 2023 Amarnih Lewis-Daniel · Prevention of Future Deaths report East London
View report summary
Concerns raised 1
Very long waiting lists for Gender Identity Clinics View source
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 6
NHS England
Develop five pilot gender dysphoria services to expand clinical capacity and reduce established-clinic waiting lists.
View source
NHS England
Move the London and Greater Manchester pilot services to substantive seven-year contracts following positive evaluations.
View source
NHS England
Conduct the procurement process for a substantive Cheshire and Merseyside gender dysphoria service contract.
View source
NHS England
Establish and fund the UK’s first accredited gender identity healthcare training programme.
View source
NHS England
Deploy £2.2 million of additional investment to established clinics for clinical-capacity expansion or direct patient support.
View source
NHS England
Refresh adult gender dysphoria service specifications, including consideration of service inefficiencies and further clinical-capacity expansion.
View source See 3 more actions
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AI-generated summary
Amarnih Lewis-Daniel · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Amarnih Lewis-Daniel, who had experienced mental health difficulties and gender dysphoria, died after sustaining fatal injuries in a fall on 17 March 2021 while awaiting care from a Gender Identity Clinic. The report raised concerns about lengthy waiting lists, limited local support during the wait, unclear responsibility for patients’ wellbeing, limited specialist knowledge in local mental health services, and unclear guidance on prescribing bridging hormones.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Very long waiting lists for Gender Identity Clinics
Wider context from the report “1. The inquest heard that there are very long waiting lists for GID clinics . In September 2023, the average waiting time was in the region of 7 years . The expert instructed at the inquest identified that long waiting lists could intensify distress arising from gender dysphoria.
” Source location Amarnih Lewis-Daniel · Prevention of Future Deaths report
Open source report
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop five pilot gender dysphoria services to expand clinical capacity and reduce established-clinic waiting lists.
Verbatim wording from the response “In the circumstances, NHS England sought to grow capacity in an alternative way. Five pilot services were developed. The proposal was to build a new clinical workforce using professionals who had tended not to specialise in gender identity healthcare previously, based in primary care and local sexual health services, which presented the opportunity to develop and expand clinical capacity to an extent not possible under the historical delivery model. There were various eligibility criteria for accessing the different pilot services (for example, being registered with a GP in the relevant geographical catchment area) but all the pilot services only took patients from the waiting lists of the established GDCs, in chronological order of waiting. Between April 2020 and August 2023 around 2,500 individuals were removed from a GDC waiting list to be seen by one of the pilot services.” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Move the London and Greater Manchester pilot services to substantive seven-year contracts following positive evaluations.
Verbatim wording from the response “In 2023 the pilot services at Chelsea and Westminster Hospital NHS Foundation Trust (London) and GTD Healthcare (Greater Manchester) were moved to substantive seven-year contracts with NHS England following positive evaluations. The GTD service is now open to new referrals of patients who are registered with a GP in Greater Manchester, and the London service is now taking increased numbers of patients from the waiting list of its nearest GDC – the Tavistock and Portman NHS Foundation Trust. NHS England is currently out to tender to award a substantive contract for the service in Cheshire and Merseyside following positive evaluation of this service, and there is an expectation that a similar process will be followed for the other two pilots when their evaluations are complete in 2024 (East England) and 2026 (Sussex).” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct the procurement process for a substantive Cheshire and Merseyside gender dysphoria service contract.
Verbatim wording from the response “In 2023 the pilot services at Chelsea and Westminster Hospital NHS Foundation Trust (London) and GTD Healthcare (Greater Manchester) were moved to substantive seven-year contracts with NHS England following positive evaluations. The GTD service is now open to new referrals of patients who are registered with a GP in Greater Manchester, and the London service is now taking increased numbers of patients from the waiting list of its nearest GDC – the Tavistock and Portman NHS Foundation Trust. NHS England is currently out to tender to award a substantive contract for the service in Cheshire and Merseyside following positive evaluation of this service, and there is an expectation that a similar process will be followed for the other two pilots when their evaluations are complete in 2024 (East England) and 2026 (Sussex).” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish and fund the UK’s first accredited gender identity healthcare training programme.
Verbatim wording from the response “As mentioned above, to support the growth of clinical capacity NHS England also established and funded the UK’s first accredited training programme in gender identity healthcare which was launched in 2020 and delivered through the Royal College of Physicians. The purpose of this investment is to encourage growth in the specialist clinical workforce available to contribute to the assessment and care of those presenting with gender incongruence and to treatment following a diagnosis of gender dysphoria.” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deploy £2.2 million of additional investment to established clinics for clinical-capacity expansion or direct patient support.
Verbatim wording from the response “NHS England also continues to support the expansion of services in the established GDCs where this is possible. In 2021/22 NHS England invited all seven GDCs to put forward a business case for funding for the expansion of clinical capacity or direct patient support as part of a discretionary investment process. An additional investment of £2.2m was set aside for this purpose. Although all this funding was deployed into the GDCs by NHS England, some of the funding was directed by the providers to non-clinical forms of support for patients on the waiting list due to the difficulties in attracting clinical staff to work in the service itself. There is clinical opinion that telephone and online support are a useful service for patients on the waiting list. We have also commissioned support resources at Gender Dysphoria Clinics, to include:” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Refresh adult gender dysphoria service specifications, including consideration of service inefficiencies and further clinical-capacity expansion.
Verbatim wording from the response “NHS England’s overall planned spend on all gender dysphoria services (adults and children) in 2023/24 is £78.17m – up from £33.4m in 2018/19, representing an overall increase in funding of 134% in five years. In 2024/25 NHS England will refresh the service specifications for adult gender dysphoria services, which will include consideration of how to identify and address inefficiencies that may reside in the way in which GDCs manage and deliver their services and which may contribute to long waiting times – and how to expand clinical capacity further taking the learning from the pilot services. It is too early in the current year to provide precise figures for the planned budget for gender dysphoria services in 2024/25 but the figure given represents recurrent funding commitments and so should be regarded as the opening baseline figure for planning assumptions.” Source location Response from NHS England
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Sufficient gender dysphoria clinic capacity cannot be commissioned because specialist clinical staff are unavailable amid increasing demand.
Verbatim wording from the response “The consultant-led services provided by the GDCs when adult patients are referred to them are amongst those intended to commence within 18 weeks of referral. NHS England has been unable to commission sufficient capacity to meet that expectation because of the lack of specialist clinical staff (recruitment and retention) – against a backdrop of significant increasing demand. Unfortunately, waiting times for a first appointment at a GDC remain very high. Of patients who received their first appointment in November 2023 they had on average been referred 382 weeks previously.” Source location Response from NHS England
Open published response
Concerns raised 1
Delays in access to gender-affirming healthcare View source
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
NHS England North London NHS Foundation Trust Royal College of General Practitioners
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 8
Royal College of General Practitioners
Participate in the current review led by a former Royal College of Paediatrics and Child Health president.
View source
North London NHS Foundation Trust
Develop innovative waiting-list reduction and patient-support measures, including nurse-led triage and peer-support worker roles.
View source
NHS England
Commission and deliver an accredited postgraduate training programme in gender identity healthcare.
View source
NHS England
Develop and fund five pilot services to expand gender dysphoria clinical capacity and reduce established-clinic waiting lists.
View source
NHS England
Move the London and Greater Manchester pilot services to substantive seven-year NHS England contracts.
View source
NHS England
Run the tender for a substantive Cheshire and Merseyside gender service contract.
View source
NHS England
Refresh adult gender dysphoria service specifications, including consideration of inefficiencies, further clinical-capacity expansion, and learning from pilot services.
View source
NHS England
Reconfigure children’s and young people’s specialised gender services, including closing the Tavistock service and establishing around seven regional services.
View source See 5 more actions
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AI-generated summary
Alice LITMAN · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Alice Litman, a 20-year-old trans female, was found dead on 26 May 2022 after a descent from height. The report raised concerns about mental-health training and support for transgender people, delays in accessing gender-affirming healthcare, and insufficient clarity and provision of care while awaiting treatment.
Read the report on judiciary.uk
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Delays in access to gender-affirming healthcare
Wider context from the report “b) The delays in access to gender affirming healthcare .
” Source location Alice LITMAN · Prevention of Future Deaths report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Participate in the current review led by a former Royal College of Paediatrics and Child Health president.
Verbatim wording from the response “It is worth noting that RCGP has been represented at the current review being undertaken by Professor ████████, Former President of the Royal College of Paediatrics and Child Health and our understanding is that we do not expect any change in the view that such individuals need timely access to specialist care and that general practitioners would not be expected to make decisions on treatment. With regard to adult patients, RCGP is supportive of potential plans by NHS England to have a system of regional hubs whereby guidance and support can be sought and especially in wider aspects of care such as sexual health, mental health support and safeguarding as well as prescribing.” Source location Response from Royal College of Genereal Practitioners
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop innovative waiting-list reduction and patient-support measures, including nurse-led triage and peer-support worker roles.
Verbatim wording from the response “and surgical treatments.” We are working with NHS England and other providers to develop innovative ways of reducing the waiting list and providing support to patients while on the waiting list; this includes the development of new roles including nurse led triage and peer support workers. While, sadly, this extra workstream will not have had an impact on this case, we believe it will have a significant impact on those waiting for care within the clinic in the future.” Source location Response from Travistock and Portman NHS Foundation Trust
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commission and deliver an accredited postgraduate training programme in gender identity healthcare.
Verbatim wording from the response “first accredited post-graduate training course in gender identity healthcare; the course began in 2020. Although aimed primarily at health professionals who wish to specialise in gender identity healthcare, individual modules are also suitable for other healthcare professionals who work in local settings and who wish to improve the experience of individuals with gender dysphoria in using generalist services intended for the whole population including mental health services or primary care services: https://www.rcplondon.ac.uk/education-practice/courses/gender-identity-healthcare-credentials-gihn
September 2023 NHS England published online training materials for health and education professionals in how to support young people up to 18 years with gender distress: https://www.minded.org.uk/catalogue/TileView” Source location Response from NHS England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop and fund five pilot services to expand gender dysphoria clinical capacity and reduce established-clinic waiting lists.
Verbatim wording from the response “NHS England has sought to address the serious imbalance between the demand for gender dysphoria services and the shortage in trained clinicians who are available to train and work in this field, which has led to long waiting times. In 2019/20, NHS England re-procured the provision of gender dysphoria services for adults. The expectation was that the re-procurement would bring forward new entrants and enable NHS England to increase the number of GDCs, and funding was identified by NHS England for that purpose. That expectation was not met. In fact, no new providers came forward from either the NHS or independent sector. All of the seven existing GDCs submitted bids and award of renewal of contract was confirmed for all of them. In the circumstances, NHS England sought to grow capacity in an alternative way. Five pilot services were developed.” Source location Response from NHS England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Move the London and Greater Manchester pilot services to substantive seven-year NHS England contracts.
Verbatim wording from the response “In 2023 the pilot services at Chelsea and Westminster Hospital NHS Foundation Trust (London) and GTD Healthcare (Greater Manchester) were moved to substantive seven-year contracts with NHS England following positive evaluations. The GTD service is now open to new referrals of patients who are registered with a GP in Greater Manchester, and the London service is now taking increased numbers of patients from the waiting list of its nearest GDC – the Tavistock and Portman NHS Foundation Trust. NHS England is currently out to tender to award a substantive contract for the service in Cheshire and Merseyside following positive evaluation of this service, and there is an expectation that a similar process will be followed for the other two pilots when their evaluations are complete in 2024 (East England) and 2026 (Sussex).” Source location Response from NHS England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Run the tender for a substantive Cheshire and Merseyside gender service contract.
Verbatim wording from the response “In 2023 the pilot services at Chelsea and Westminster Hospital NHS Foundation Trust (London) and GTD Healthcare (Greater Manchester) were moved to substantive seven-year contracts with NHS England following positive evaluations. The GTD service is now open to new referrals of patients who are registered with a GP in Greater Manchester, and the London service is now taking increased numbers of patients from the waiting list of its nearest GDC – the Tavistock and Portman NHS Foundation Trust. NHS England is currently out to tender to award a substantive contract for the service in Cheshire and Merseyside following positive evaluation of this service, and there is an expectation that a similar process will be followed for the other two pilots when their evaluations are complete in 2024 (East England) and 2026 (Sussex).” Source location Response from NHS England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Refresh adult gender dysphoria service specifications, including consideration of inefficiencies, further clinical-capacity expansion, and learning from pilot services.
Verbatim wording from the response “NHS England’s overall planned spend on all gender dysphoria services (adults and children) in 2023/24 is £78.17m – up from £33.4m in 2018/19, representing an overall increase in funding of 134% in five years. In 2024/25 NHS England will refresh the service specifications for adult gender dysphoria services, which will include consideration of how to identify and address inefficiencies that may reside in the way in which GDCs manage and deliver their services and which may contribute to long waiting times – and how to expand clinical capacity further taking the learning from the pilot services. It is too early in the current year to provide precise figures for the planned budget for gender dysphoria services in 2024/25 but the figure given represents recurrent funding commitments and so should be regarded as the opening baseline figure for planning assumptions.” Source location Response from NHS England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Reconfigure children’s and young people’s specialised gender services, including closing the Tavistock service and establishing around seven regional services.
Verbatim wording from the response “NHS England is currently leading a significant programme of work to reconfigure the provision of specialised services for children and young people with gender incongruence, in line with the interim recommendations of the independent Cass Review. This involves the managed closure of the current CYP children’s gender service at the Tavistock and Portman NHS Foundation Trust on 28 March 2024, and the establishment of around seven new regional services by 2026, the first of which are planned to become operational in April 2024 through collaboratives hosted by Great Ormond Street Hospital for Children NHS Foundation Trust and Alder Hey Children’s NHS Foundation Trust.” Source location Response from NHS England
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Decisions on specific therapy, including medication, are specialist responsibilities outside general practitioners’ scope of practice.
Verbatim wording from the response “A particular focus from members has been the continuing very long waiting lists for access to specialist advice and care. This has been especially a concern regarding children and young people where the waiting lists are frequently over 2 years in duration but also for adult patients, where access can be very difficult. The RCGP’s view is that for Children and Young people, GPs can provide holistic general care and support to the individual and their family, however decisions on whether or when to provide specific therapy such as medication is a specialist area of responsibility and outwith the scope of practice of general practitioners.” Source location Response from Royal College of Genereal Practitioners
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Sufficient gender dysphoria service capacity could not be commissioned because specialist clinical staff were unavailable amid substantially increasing demand.
Verbatim wording from the response “Unfortunately, NHSE has been unable to commission sufficient capacity to meet that expectation because of the lack of specialist clinical staff (recruitment and retention) – against a backdrop of significant increasing demand, reflecting an international trend. Unfortunately, waiting times for a first appointment at a GDC remain very high. Of patients who received their first appointment in November 2023 they had on average been referred 382 weeks previously.” Source location Response from NHS England
Open published response
Concerns raised 1
Delays in obtaining Gender Identity Clinic appointments View source
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements No respondent-stated action or position is linked to these concerns in the published data.
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AI-generated summary
Daniel France · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Daniel France was a 17-year-old vulnerable teenager living in a YMCA hostel who died by asphyxiation by hanging; the inquest concluded that his death was suicide. The principal concern was that vulnerable young people known to local authorities and mental health services may not receive adequate support while awaiting substantive treatment, particularly where they are assessed as not requiring urgent intervention but face lengthy waits for psychological therapy.
Read the report on judiciary.uk
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Delays in obtaining Gender Identity Clinic appointments
Wider context from the report “The inquest heard evidence about the considerable delay in obtaining appointments for the Gender Identity Clinic , and about the shortage of availability for psychological therapies such as CBT.
” Source location Daniel France · Prevention of Future Deaths report
Open source report
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.