Recurring concern

Unreliable access to gender-affirming healthcare

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First reported 16 Feb 2022•Latest report 25 Jul 2024

Definition

What this concern includes

Includes failures in gender-affirming healthcare access and referral arrangements, including unclear national referral mechanisms, insufficient or poorly communicated service resources, delayed access, waiting-list barriers and failures to direct patients through the appropriate gender-service pathway.

Not included

Excludes clinical treatment quality or outcomes after gender-affirming healthcare has been accessed reliably.
Excludes generic mental-health, psychological-therapy or healthcare waiting-time concerns without a material gender-affirming healthcare access or referral connection.
Excludes failures concerning unrelated gender-based safeguarding or bullying processes.
Excludes neutral descriptions of gender services, referral pathways or available resources without an identified access, delay or reliability deficiency.

Reports: 5
Individual concerns: 8
Date range: 2022–2024
Stated actions: 23

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

NHS England3

Cambridgeshire and Peterborough NHS Foundation Trust1

Cambridgeshire County Council1

Department of Health and Social Care1

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

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.

25 Jul2024
North London
Concerns raised1
1. Excessively long waiting lists for first appointments at Gender Dysphoria clinics
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 4
1. Action
  Work with NHS England and other providers to develop ways to reduce GIC waiting lists and support patients while waiting.
  Stated by North London NHS Foundation TrustStated in progress
2. Action
  Conduct a review of adult Gender Dysphoria Clinic operations, service models, quality concerns and improvement actions.
  Stated by Department of Health and Social CareStated in progress
3. Action
  Publish the adult Gender Dysphoria Clinic review report and its findings and recommendations.
  Stated by Department of Health and Social CareStated planned
1. Action
  Develop a new service specification for adult Gender Dysphoria Clinics through public consultation.
  Stated by Department of Health and Social CareStated planned
Respondent positions 3
1. Position
  NHS England, as commissioner of specialised gender dysphoria services, is responsible for commissioning sufficient service capacity.
  Stated by North London NHS Foundation TrustRedirects responsibility
1. Position
  Insufficient specialist clinical staff and increasing demand have prevented NHS England from commissioning enough capacity to meet waiting-time expectations.
  Stated by North London NHS Foundation TrustUnable to act
2. Position
  New clinical capacity cannot be built quickly because specialist staff require training and experience.
  Stated by Department of Health and Social CareUnable to act
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.

Read the report on judiciary.uk
Source evidence
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
Page 2 · concerns
Open source report
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
Page 2 · response
Published 29 July 2025
Open published response
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
Page 5 · response
Published 29 July 2025
Open published response
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
Page 5 · response
Published 29 July 2025
Open published response
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
Page 5 · response
Published 29 July 2025
Open published response
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
Page 2 · response
Published 29 July 2025
Open published response
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
Page 3 · response
Published 29 July 2025
Open published response
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
Page 3 · response
Published 29 July 2025
Open published response
30 Apr2024
East Sussex
Concerns raised4
1. Lack of clarity about national gender-service referral mechanisms and available resources
2. Long waits for access to gender services
3. Failure to refer young people awaiting gender services for specialist psychiatric support from CAMHS
1. Delays in access to specialist gender dysphoria treatment while on the GIDS waiting list
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 5
1. 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 planned
2. Action
  Establish new regional Children and Young People’s Gender Incongruence Services under an interim service specification.
  Stated by NHS EnglandStated completed
3. Action
  Develop a substantive service specification strengthening infrastructure and regional links between specialist centres and local services.
  Stated by NHS EnglandStated in progress
1. 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 planned
2. Action
  Decide whether to strengthen pre-referral relationships between gender services and local secondary-care services after public consultation.
  Stated by NHS EnglandStated planned
Respondent positions 3
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 responsibility
1. Position
  NHS Arden and Greater East Midlands Commissioning Support Unit will respond separately to concerns within its commissioned waiting-list management role.
  Stated by NHS EnglandRedirects responsibility
2. Position
  Expanding clinical capacity is constrained by shortages of suitable workforce potential in children’s and adult gender services, rather than funding.
  Stated by NHS EnglandUnable to act
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.

Read the report on judiciary.uk
Source evidence
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
Page 2 · concerns
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
Page 1 · concerns
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
Page 1 · concerns
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
Page 1 · concerns
Open source report
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
Page 3 · response
Published 9 May 2024
Open published response
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
Page 1 · response
Published 9 May 2024
Open published response
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
Page 2 · response
Published 9 May 2024
Open published response
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
Page 2 · response
Published 9 May 2024
Open published response
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
Page 3 · response
Published 9 May 2024
Open published response
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
Page 1 · response
Published 9 May 2024
Open published response
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
Page 1 · response
Published 9 May 2024
Open published response
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
Page 2 · response
Published 9 May 2024
Open published response
11 Dec2023
East London
Concerns raised1
1. Very long waiting lists for Gender Identity Clinics
This report raised 5 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 6
1. Action
  Develop five pilot gender dysphoria services to expand clinical capacity and reduce established-clinic waiting lists.
  Stated by NHS EnglandStated completed
2. Action
  Move the London and Greater Manchester pilot services to substantive seven-year contracts following positive evaluations.
  Stated by NHS EnglandStated completed
3. Action
  Conduct the procurement process for a substantive Cheshire and Merseyside gender dysphoria service contract.
  Stated by NHS EnglandStated in progress
1. Action
  Establish and fund the UK’s first accredited gender identity healthcare training programme.
  Stated by NHS EnglandStated completed
2. Action
  Deploy £2.2 million of additional investment to established clinics for clinical-capacity expansion or direct patient support.
  Stated by NHS EnglandStated completed
3. Action
  Refresh adult gender dysphoria service specifications, including consideration of service inefficiencies and further clinical-capacity expansion.
  Stated by NHS EnglandStated planned
Respondent positions 1
1. Position
  Sufficient gender dysphoria clinic capacity cannot be commissioned because specialist clinical staff are unavailable amid increasing demand.
  Stated by NHS EnglandUnable to act
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.

Read the report on judiciary.uk
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
Page 2 · concerns
Open source report
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 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
Page 2 · response
Published 18 December 2023
Open published response
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
Page 3 · response
Published 18 December 2023
Open published response
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
Page 3 · response
Published 18 December 2023
Open published response
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
Page 3 · response
Published 18 December 2023
Open published response
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
Page 3 · response
Published 18 December 2023
Open published response
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
Page 4 · response
Published 18 December 2023
Open published response
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
Page 2 · response
Published 18 December 2023
Open published response
5 Dec2023
West Sussex, Brighton and Hove
Concerns raised1
1. Delays in access to gender-affirming healthcare
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 8
1. Action
  Participate in the current review led by a former Royal College of Paediatrics and Child Health president.
  Stated by Royal College of General PractitionersStated completed
2. Action
  Develop innovative waiting-list reduction and patient-support measures, including nurse-led triage and peer-support worker roles.
  Stated by North London NHS Foundation TrustStated in progress
3. Action
  Commission and deliver an accredited postgraduate training programme in gender identity healthcare.
  Stated by NHS EnglandStated completed
1. Action
  Develop and fund five pilot services to expand gender dysphoria clinical capacity and reduce established-clinic waiting lists.
  Stated by NHS EnglandStated completed
2. Action
  Move the London and Greater Manchester pilot services to substantive seven-year NHS England contracts.
  Stated by NHS EnglandStated completed
3. Action
  Run the tender for a substantive Cheshire and Merseyside gender service contract.
  Stated by NHS EnglandStated in progress
4. Action
  Refresh adult gender dysphoria service specifications, including consideration of inefficiencies, further clinical-capacity expansion, and learning from pilot services.
  Stated by NHS EnglandStated planned
5. Action
  Reconfigure children’s and young people’s specialised gender services, including closing the Tavistock service and establishing around seven regional services.
  Stated by NHS EnglandStated planned
Respondent positions 2
1. Position
  Decisions on specific therapy, including medication, are specialist responsibilities outside general practitioners’ scope of practice.
  Stated by Royal College of General PractitionersOutside remit
1. Position
  Sufficient gender dysphoria service capacity could not be commissioned because specialist clinical staff were unavailable amid substantially increasing demand.
  Stated by NHS EnglandUnable to act
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
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 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
Page 2 · concerns
Open source report
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
Page 3 · response
Published 11 December 2023
Open published response
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 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
Page 2 · response
Published 11 December 2023
Open published response
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
Page 3 · response
Published 11 December 2023
Open published response
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
Page 3 · response
Published 11 December 2023
Open published response
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
Page 4 · response
Published 11 December 2023
Open published response
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
Page 4 · response
Published 11 December 2023
Open published response
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
Page 5 · response
Published 11 December 2023
Open published response
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
Page 6 · response
Published 11 December 2023
Open published response
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
Page 2 · response
Published 11 December 2023
Open published response
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
Page 2 · response
Published 11 December 2023
Open published response
16 Feb2022
Cambridgeshire and Peterborough
Concerns raised1
1. Delays in obtaining Gender Identity Clinic appointments
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.

No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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
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 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
Page 2 · concerns
Open source report

Data last updated 7 September 2026

What this concern includes

Not included

Reports over time

Concerns raised1

Excessively long waiting lists for first appointments at Gender Dysphoria clinics

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.4

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3

Concerns raised4

Lack of clarity about national gender-service referral mechanisms and available resources

Long waits for access to gender services

Failure to refer young people awaiting gender services for specialist psychiatric support from CAMHS

Delays in access to specialist gender dysphoria treatment while on the GIDS waiting list

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.5

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3

Concerns raised1

Very long waiting lists for Gender Identity Clinics

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

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1

Concerns raised1

Delays in access to gender-affirming healthcare

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.8

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2

Actions described in response 4

Respondent positions 3

Actions described in response 5

Respondent positions 3

Actions described in response 6

Respondent positions 1

Actions described in response 8

Respondent positions 2