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Claire's Trans Talks

@clairestranstalks.bsky.social

4.8K followers 580 following 4.2K posts

Education, Research & Advocacy about & for Transgender & Non-Binary People. Views my own. https://linktr.ee/CTransTalks

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Claire's Trans Talks @clairestranstalks.bsky.social · Jul 24

In 2021 I had the honour of taking part in TedX Bath, where I talked about how trans people are dehumanised.

Since then its only got worse. Much, much worse.

https://youtu.be/48jC1E0Y5sw

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Claire's Trans Talks @clairestranstalks.bsky.social · 2h

Is it plugged in?

Claire's Trans Talks @clairestranstalks.bsky.social · 2h

Its incredible what can be done when you actually listen to trans people.

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Claire's Trans Talks @clairestranstalks.bsky.social · 7h

Potential delaying tactic, nothing more.

Claire's Trans Talks @clairestranstalks.bsky.social · 10h

Yeah, all round its monumentally crap & all politically driven.

Claire's Trans Talks @clairestranstalks.bsky.social · 11h

Times vary widely between trans+ at 1 month, to newcastle at 24 months, and everything in between.

The avg only dropped because newcastle has decreased substantially downwards from 36 months.

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Claire's Trans Talks @clairestranstalks.bsky.social · 11h

I can answer Q1 (to a point) off the top of my head.

Wait time between 1st & 2nd Appt has decreased from 14 months to 8 months between 23/24 and 24/25.

Incomplete data set as not all services collect this, but 10/15 services.

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

Its been delayed every month since April, iirc.

Claire's Trans Talks @clairestranstalks.bsky.social · 14h

TL:DR

Removing under 25s from adult services as per Cass would not fix the problems with either waiting times nor lack of capacity within services, both of which are being generated by traditional GICs, which are an abject failure.

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

Imho, its an unworkable 'solution' that should be immediately discarded, and thats assuming it doesnt remove existing resources from adult services to deal with a new 'pathway'.

If Levy is seriously considering implementing it, he should be struck off as incompetent, imho.

[17/17]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

In other words, its highly likely the revised waiting lists would continue to grow (at a slower rate, for a while) until this timebomb hits every year.

Leaving us back at square one.

[16]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

It's not something I can model because Id need an exact breakdown of numbers by age in the 17-25 cohort.

But effectively theres more than 32k people in that bracket - a sizeable chunk of which would then age into adult services each year - which have no additional capacity to deal with them.

[15]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

Even adding the existing pilots (Transcend & Sussex) into the mix wouldnt have an appreciable impact on the 16k+ remaining wait list, adding around 1k additional appointments (assuming similar performance to Indigo).

And thats without the big elephant in the room - the demographic timebomb.

[14]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

Thats assuming the additional capacity is used effectively - which it wont be thanks to the disparate nature of the NHS.

Theoretically the Scottish extra capacity would be used to reduce Glasgows failure, and Wales possibly some of Exeters.

It becomes an even bigger postcode lottery.

[13]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

As we can see, England would still have a significant shortfall in capacity, while Scotland and Wales an excess, and NI a small shortfall.

Across the UK the shortfall is only small (37) but still not enough to meet current demand, let alone impact the waiting lists.

[12]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

As we can see, it creates capacity in some clinics (figs in black) but many clinics, especially the traditional GICs, still have a shortfall (in red).

In other words, their waiting lists would continue to grow.

[11]

Table showing revised referrals & demand vs capacity if under 25s were removed from adult services.

In summary the table reads :
Exeter shortfall of 93 appointments
Leeds shortfall of 130 appointments
London shortfall of 436 appointments
London TransPlus shortfall of 151 appointments
Manchester (Indigo) excess of 219 appointments
Newcastle shortfall of 111 appointments
Northants shortfall of 38 appointments
Notts / EoE shortfall of 36 appointments
Sheffield excess of 73 appointments
NI (Belfast) shortfall of 19 appointments
Edinburgh excess of 540 appointments
Glasgow shortfall of 138 appointments
Grampian excess of 14 appointments
Highlands excess of 66 appointments
Wales excess of 202 appointments

England shortfall of 703 appointments
Scotland excess of 483 appointments
Wales excess of 202 appointments
NI shortfall of 19 appointments
UK shortfall of 37 appointments

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

Remember, in 24/25 there was a 10k+ cspacity shortfall in initial assessments.

So what happens if under 25s are removed from the referrals as well? Does that introduce capacity gains?

Lets model that.

[10]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

'But itll also impact referrals' I hear you cry.

Yes, it will. For waiting lists to come down significantly, referrals would need to come down as well, gerrymandering demand to meet capacity rather than enhancing capacity to meet demand.

[9]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

What does that look like by clinic?

As we can see, the vast majority of traditional clinics continue to fail hard, with a revised wait ranging from 3 years to 9 years.

In short, removing under 25s does not have the desired effect on reducing waiting lists to reasonable timescales.

[8]

Table showing average clinic waiting times if under 25s were removed.

In summary the table reads :
Exeter 9 years
Leeds 4 years
London 4 years
London TransPlus 1 year
Manchester (Indigo) 1 year
Newcastle 8 years
Northants 6 years
Notts / EoE 1 year
Sheffield 3 years
NI (Belfast) 14 years
Edinburgh <1 year
Glasgow 83 years
Grampian 2 years
Highlands <1 year
Wales 1 year

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

The country averages end up looking like this, using the waiting lists from 31/3/25 :

As we can see, its not the panacea that the NHS are hoping it would be, with the avg UK wait still almost a decade.

[7]

Table showing revised average wait times for gender services by country in the UK if under 25's were removed from adult waiting lists.

The table reads :
England 4 years
Scotland 21 years
Wales 1 year
Northern Ireland 14 years
UK 9 years.

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

So Im going to focus on the impact to existing waiting lists from scenario 1) and what that might look like on waiting times for those that remain.

Again, this is speculative, but reasoned speculation.

So, if we remove under 25's from adult service waiting lists, what happens?

[6]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

A big factor will be whether 1) or 2) use resources from existing adult services. Without this info, this is cannot be modelled, but the likely impact if they do is to make waiting times for those left on the waiting list worse, not better, by effectively redirecting resources.

[5]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

1) 17-25s are removed from adult waiting lists completely onto a separate ,unrelated pathway.

2) 17-25s stay on the existing adult pathway with enhanced monitoring / restrictions

3) No change

[4]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

I want to stress that from this point forwards this is purely speculative, but based on reasoned assumptions and extrapolations Id be expecting Levy to model.

So, what scenarios are we looking at?

In no particular order, and as I see it :

[3]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

To recap, Cass 'recommended' (based on zero presented evidence) a separate NHS pathway for 17-25 year olds, something its suspected Levy is considering.

That gives us some potential scenarios to work on, with the data I have.

[2]

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Claire's Trans Talks @clairestranstalks.bsky.social · 14h

I wanted to talk a bit more about this yesterday but was a bit under the weather for anything detailed or coherent, so lets have a go today.

I want to expand upon some of the analysis around potential impacts for a bit of a deeper dive.

🧵

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QueerAF @wearequeeraf.com · 1d

Gender Clinic Files: Two-thirds of adults waiting for transgender healthcare in UK are under 25 👇

https://www.wearequeeraf.com/gender-clinic-files-two-thirds-of-adults-waiting-for-transgender-healthcare-in-uk-are-under-25/

Majority of adults waiting for Trans+ healthcare are under 25

Two-thirds of Trans+ people would lose care if all Cass Review recommendations implemented

www.wearequeeraf.com

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