Report on the Survey of Provision of Medical Care for Transsexualism in UK District Health Authorities carried out in 1995

Dr Z-J Playdon, University of London

for the Parliamentary Forum on Transsexualism (Chair: Dr Lynne Jones MP)
18 January 1996

The Survey  Results

1. The Survey

1.1 In 1995 the Parliamentary Forum on Transsexualism (Chair: Lynne Jones MP) carried out a survey of the provision of medical care for transsexualism in UK District Health Authorities (DHAs). The aim of the survey was to collect hard data about the levels of support which were provided and about estimates of future needs.

1.2 The Chief Executives of one hundred and fifty DHAs were circulated with a questionnaire and accompanying letter, signed by Dr Jones and sent out by her office.The letter referred to the Parliamentary Forum, indicated its concern that people who have been diagnosed with the condition of transsexualism might not receive equitable medical treatment and invited Chief Executives to take part in the survey.

1.3 The questionnaire asked for information about:

• the range of treatments which the DHA provided;
• the number of requests for treatment which had been funded since 1 April 1991;
• the number of requests for treatment which had been funded;
• the criteria used for funding or rejection;
• the agency to which patients were referred for treatment;
• the estimated cost of treatment per patient;
• waiting list numbers;
• planned provision for treatments for 1995-6.

1.4 Because DHAs vary considerably in size and population densities no attempt to collect information for statistical comparison was made. Rather, the intention was to gain a ’snapshot’ of provision and planning for 1995.

2. Results

2.1 Eighty-two replies were received from DHAs which were spread across the UK from Orkney to the Isle of Wight, and from Ireland to East Anglia.

2.2 The immediate findings of the survey were as follows:

2.2.1 DHAs showed a wide variety in the types of information which they collected on treatment for transsexualism. None were able to complete the questionnaire in its entirety, especially in terms of the various treatments listed. Some commented on the difficulty of returning data about this condition, giving the following reasons for their difficulty:

• clinical coding in this area is poor;
• the procedures used are multipurpose ones rather than specifically for transsexualism;
• returning detailed data might enable identification of individual patients.

2.2.2 There was often a considerable disparity between the numbers of people for whom referral to a consultant psychiatrist had been provided and the numbers for whom gender reassignment surgery had been provided. Examples of such disparity were:

Referral to Psychiatrist		GRS
48		8
13		1
20		2
19		2
17		1
17		2
24		5
51		6
9		4

2.2.3 The returns showed a wide range of policies in the funding of treatment for transsexualism, from DHAs which said they would not fund treatment to those which said that they always funded treatment. Of those DHAs which did not fund, one said that it would not fund GRS ’under any circumstances’; two others said that treatment was excluded unless under exceptional circumstances; and one gave a ’poor success rate’ as the reason for not funding treatment for transsexualism. Several DHAs said that it was a matter of policy that they would not fund treatment. By contrast, one DHA said that it always funded treatment since there was a low demand for it and it was effective and another gave its concern with equity as its reason for funding treatment. The commonest policy was to fund on a case by case basis through Extra-Contractual Referral (ECR).

2.2.4 The criteria for funding were given typically as by clinical recommendation.

2.2.5 The centres that were used for treatment were given as:

• Riverside
• University College, London
• Leeds GIC
• Hillingdon Hospital
• Avenue Clinic, Hove
• Lothian Hospital

One respondent said they they understood a new clinic was to be opened at the Tavistock and Portman in the near future.

2.2.6 Typically, the future policy of those DHAs which funded treatment for transsexualism was to continue to fund on the same basis. One DHA which had funded treatment for five people between 1991 and 1995 said that it had changed its policy and would no longer fund treatment in the future.

2.2.7 The returns also showed interest in the condition of transsexualism. Some DHAs included internal information and policy documents about transsexualism with their returns. One respondent welcomed the research. Several respondents expressed interest in the survey and in seeing its results.

Dr Z-J Playdon
University of London

for the Parliamentary Forum on Transsexualism (Chair: Dr Lynne Jones MP)
18 January 1996