Jumping Hoops – A Rant on the Welsh NHS

Today, as I learn that my legal caseworker is leaving her job and my MP can’t be of any help in local health issues, I am far from being in the best frame of mind…

Let’s quickly recap… Early last year, my husband and I went to our GP to finally pursue gender reassignment, as is our right under NHS protocols. However, the NHS in Wales is more restrictive than its English counterpart, as the GP correctly informed us, and accordingly set up the various hoops that we would need to jump through to receive treatment. These were…

Referral to the community mental health team for assessment.

Referral from the CMHT back to the GP.

Application to the “gatekeepers” (nothing to do with Ghostbusters) for funding.

Once funding obtained, referral to the West London Mental Health Gender Identity Clinic – the only one available to Welsh NHS patients.

A year’s waiting from said referral to our appointment times.

First GIC appointment.

…and that is as far as we have got, at present. However, our first appointments did go very well, and as far as London goes we have no complaints. The clinicians we saw were sympathetic and eager to help, and in my case even provided me with a prescription for HRT to be handed to my GP. Hormone therapy is, of course, an essential first stage of transition, and one that patients in England (and even some Welsh health boards) can obtain even before their first appointments, to dissuade them from self-medicating on internet-bought hormones… which I have been doing for over a year now. My GP, unfortunately, said that they could only help with authorisation from London, so you can imagine how pleased I was to finally obtain some.

Having imagined that, you can now imagine how displeased and shocked I was when my GP practice – a Cardiff Bay-based clinic that had been recommended to me as trans-friendly – still refused treatment. Their latest justification is that there are proposed changes to the Welsh gender identity care pathway, and they want those implemented before taking the responsibility. They assured me it would not take long.

About a week ago I went to a trans information meeting hosted by a local NHS official, who spoke on these proposals and told me they may take up to three years to implement… though she did also tell me – as one might expect – that my GP is making pathetic excuses, and has a responsibility to treat their current patients according to the existing gender care provisions. Also, much to my surprise, she informed me that our GP had lied when they claimed there was no provision for speech therapy under the Welsh system – though both Cal and I had expressed a great interest in it.

She even told me she would be in touch to help me challenge this state of affairs… but unfortunately was not. I have since told my caseworker and my MP – to the sad lack of effect stated above – and contacted my Welsh Assembly Member, but have heard nothing back. That leaves me, at present, at a bit of an impasse, where all I can think to do for now is express my dismay and disgust that things have had to come to this. Unless the local health authorities will support Cal and I in our transition, there is nothing much London can do all by itself (monitored HRT being, as far as I know, still being a prerequisite for surgery, and Cal not being able to self-medicate in any case – testosterone being far too dangerous to take without professional help).

Our worst fear, though, is that they are playing for time, hoping that if they can stall us for long enough then inevitable NHS cuts will impact on the whole gender care service and they will simply be able to deny us care and get us off their monthly budget for good. Paranoid of us? Possibly, but that practice hasn’t exactly been enthusiastic or sensitive in helping us. I recall asking them if they could prescribe Vaniqa hair reduction cream just after my GIC referral… only to be answered with a blunt “we can’t give that to men.”

Though, to be fair, one doctor down that practice has been sympathetic to us both, though the last thing he said to me was “the squeaky wheel is the one that gets oiled.” Cryptic at the time, but in retrospect we both think he was giving us broad hints that the system is not our friend, and we will have to fight tooth and nail if we want to see this through. Not something I excel in, but I guess it can’t hurt to learn.

If anyone has any suggestions for our next manoeuvre in this battle, please pass them along. I could use some fresh perspectives after today’s disillusionments.

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22 thoughts on “Jumping Hoops – A Rant on the Welsh NHS

  1. I have no problem being the squeaky wheel, but there is a difference between being a squeaky wheel and having to fight for basic rights and care. I’m sorry you have to fight for that. It just seems to me and I’m sure to most sane people that you’ve done everything right and you should not be held back in any way because someone isn’t doing their job. You and Cal have done yours. You’ve followed the rules and did what was expected of you…you hoop jumped…seems that that action should be rewarded, not met with stalling techniques for what ever reason. Not fair. Hugs sent your way. xxx

    Liked by 1 person

    • Hugs gratefully received, by us both. xxx I was hoping for an easy second half of the year, but clearly I shan’t get it. On the other hand, I could look upon this as a confidence-building exercise for something I care too much about to let go. On that level it might be useful… though I’d have sooner done without. It does help to have such sincere moral support, though. ๐Ÿ™‚ โค

      Liked by 1 person

  2. I wish I had more to offer you and Cal than positive thoughts and best wishes that things turn around and get easier. I do honestly offer those with all my heart and energy. Your friend – Steve

    Liked by 2 people

  3. I wish I had some advice but I’m afraid all I can do is offer my sympathy. My situation is different but I’ve had my own annoyances. Currently I’m receiving my HRT privately, which is going okay, but annoying my GP refuses to prescribe based on a specialist telling them to please do so. Instead they’re not comfortable doing so, meaning I have to keep paying the more expensive private costs. I understand my GP not wanting to handle monitoring, I don’t expect them to, but I at least thought they’d handle my normal prescriptions, especially when I’ve now been on HRT for 6 months.

    Liked by 1 person

    • Sounds suspiciously like my situation. ๐Ÿ˜ฆ You wouldn’t think in this day and age this sort of thing still came down to the GPs own sense of discomfort / prejudice, but our experience suggests not much has changed for the better. I only hope things do, for all three of us. *hugs* xxx

      Liked by 1 person

  4. 1. You go back to your GP and demand that they work under the existing rules/guidelines (they really have no choice).
    2. You take it up with your AM.
    3. You refer the case to the public services ombudsman for Wales.

    Liked by 1 person

  5. What a dreadfully long and bureaucratic process, my heart goes out to you and yours. It seems no matter the country, governments are slow to move and even slower to act. They will pour millions and millions into projects that barely matter, but don’t siphon money for basic human needs and health related issues. It’s sad.

    I have no substantive advice to offer, but just wanted to send some positive vibes your way. Hang in there. Good news could always be a day away.

    Liked by 1 person

  6. A friend of mine thinks the way forward is, unfortunately, asking all the local GPs in turn if they’ll honour the prescription, but she says you shouldn’t have to do that yourself, and is going to speak to James Morton at Scottish Transgender Alliance (obviously you’re outside their jurisdiction but he has UK-wide contacts) to see if he knows anyone local who can recommend a suitable GP. In the meantime, have you spoken to Stonewall Cymru (for advocacy, not just for advice)?

    Liked by 1 person

    • I haven’t tried Stonewall yet, but I know a friend volunteering there so I think that will be our next port of call. Thank you. ๐Ÿ™‚

      Generally not looking good, though. I am hearing from various quarters that all Welsh GPs are stopping care for their trans patients. Just had some poor trans guy on the phone (friend of a friend) saying his doctor has stopped his hormones flat and told him there is nothing he can do, and all I can do is pass his info on to my own contacts, none of whom have been able to offer much hope as yet. I am beginning to fear an English (or French) exodus may be our best hope for transition.

      Like

      • That doesn’t sound good. At any rate, I’ll pass on my friend’s info if she comes back with anything. Kevin Brennan (our old MP) is going to try to speak directly to your MP and constituency AM as well. Advice from another friend whose husband works in A&E: ‘Practice manager and health board re the GP – the health board might suggest another, or ring around and explain. Those drugs are so expensive, probably stalling on cost. I’d also suggest Cardiff CAB. If the GP is saying go to Ldn, there’s a problem with the Welsh system AMs should be made aware of. Or the GP really is kicking it into the long grass. There might be a PALS service for GPs. I think the CAB is the best call for all this tbh. GP practice is utterly broken at the mo so nothing would surprise me.’

        Liked by 1 person

    • Thank you so much. xxx

      One thing we know now is that we are not being singled out: there is a concerted effort going on to wind down the provision of trans care in Wales, ostensibly only until the new care system is set up but since that could mean three years of zero care provision I am inclined to distrust all Welsh GPs right now. Moving is tempting, but would not immediately help. If possible, we still need to finish our visits at the London GIC, then at least we will have the diagnoses from those to carry with us (even if we can’t get treated where we are). However, a lot of people are saying we really need to fight this one or the Welsh NHS will happily walk over all its trans patients, and I think they may have a point…

      Liked by 1 person

  7. I am so sorry to read about how difficult the process of transitioning has been for you both! I am woefully ignorant of how this works outside of the States, where I have had a few friends transition rather smoothly. They did, unfortunately, have to cover the cost themselves since we are still in the stone age with healthcare. I hope that things go more smoothly for the two of you, and for everyone else in Wales that is being discriminated against. Strength, friend!

    Liked by 1 person

    • It has been tough, and recently it was revealed the London GIC is closing down in a few months, so what the future holds for Welsh patients is very uncertain. We have options though, insofar as we can move. I fear for all those who can’t…

      Liked by 1 person

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