Another Day At The Evil Office: NHS-England Threatens Trans Kids

Recently when Wonkette splainered the Cass Report to you, we included some “Good” and “Meh” with the bad and ugly. But as we said then,

Remember all that good stuff? It requires money to make happen. What are the odds that the Tories invest in care for trans children and what are the odds that Tavistock stays closed while the new [multi-site service networks] never get funding?

Ever since the report came out, the Tory-led NHS has been making it clearer and clearer that the money isn’t coming, but the ugliness sure is. In just the last few days it has come out, thanks to The Good Law Project, that NHS’s England subdivision (no, England isn’t the same as the UK) has sent out letters to providers and to families with minors on the gender-services wait list that make it pretty clear they’ve got fuckery, not treatment, in mind. In fact, in the effort to ban trans-related medical care without any actual law passed to ban trans-related medical care, they seem to be taking lessons from Texas Attorney General man who got his face in the dictionary next to the definition of corruption, Ken Paxton.

Providers competent to do mental health assessments are being asked to meet with all minors on the waiting list to look for ways to “support” them. Providers involved in this process are being assigned funds for those assessments, but zero RedcoatDollars (the equivalent of $0 USD) for actual treatment. The Cass Report gave much attention to autism and mental health trauma co-occuring with (and complicating diagnosis of) gender dysphoria. As a result of both instructions to providers and lack of funds for follow-up, there is speculation that this current NHS-England effort seeks to shift children and young people under 18 years of age (“CYP” in NHS lingo) off of waiting lists for “gender services,” recategorizing them as seekers of other treatment.

Of course, this doesn’t indicate any intent to actually help these kids and teenagers, since a different diagnosis would only move them to a different waitlist, starting over at the back end. With the autism-services list only growing and quickest assessments provided to children much younger than those on the gender-services list, there is no reason to believe that providing help is any part of the motive for these new assessments.

So what is the motive? Well, to understand that, you have to understand that the NHS is primarily a health insurer. In Britain it’s not illegal to provide medical care to someone who pays you directly, thus the NHS doesn’t get to control all medicine in theUK, only what it pays for. And it’s not happy about that. Even so, it has a huge impact because it’s simply not usually profitable to rely on private pay when NHS covers so many people. With a small clientele of only patients and families willing to pay out of pocket, going independent isn’t a walk in the park.

But it is possible, and people do just that. It’s easier, of course, with a particular specialty helping a population that the NHS is unable or unwilling to help. And for the last decade and more under the Tories, the NHS has been unwilling to provide adequate funding for trans-related medical care, adolescent or adult. This has led many adults and families to seek care from private specialists, then sourcing any medication prescribed from overseas pharmacies, which can be risky, depending on where those pharmacies are located. On occasion the specialist, too, is located overseas and providing most or all care through telemedicine.

This does not mean that these drugs and services are unsafe or unregulated, but it does mean that they are outside the power of the NHS to punish, relying instead on regulators in their home countries which may be better or worse than the NHS. The Brits, though, seem not to permit this distinction between “out of our control” and “completely unregulated”:

It states that the largest “unregulated provider” is a service called GenderGP, which it says is “registered overseas and is therefore outside the reach of the UK health regulators.” Good Law Project holds no brief for GenderGP but obviously “registered overseas” is not the same as “unregulated.” Nevertheless, the document seems to treat the two as one and the same.

But the real evil is in the next bit. Relying on the facile equivalence of registered overseas with unregulated and unregulated with unsafe, the NHS has taken the Ken Paxton-stand that families providing care to their children through GenderGP or similar services are acting against the interests of their child. The NHS letter tells the mental health assessors that when children come in, they are to advise families not to rely on such services without additional, unspecified “appropriate care.” But they are also instructed “not to prescribe or to stop prescribing puberty blockers or gender-affirming hormones,” and the lack of available care in the UK is exactly why families sought help in the first place. There is no “appropriate care” anywhere in England for trans children to access.

The NHS knows that, too. All care, then, is inappropriate, and the next step is painfully predictable:

[The providers] are also told that if the trans child or young person and/or their family “disregards your advice and you consider that this puts the child/young person at increased risk, then a safeguarding referral may also be appropriate in line with standard safeguarding approaches.”

Allow Wonkette to translate that important bit into English: “Safeguarding referral” is what foreign people say when talking about tipping off child protective services about suspected child abuse.

So to sum up, NHS England is having all kids on the gender services waiting list “assessed.” But literally no one is getting treated, and the NHS guidance focuses on what not to provide and how to stop care by threatening a formal accusation of child abuse. Sounds like no sane parent would take their kids to one of these meetings, except that the letter to providers is vastly different from the notification being given to parents, which the Good Law Project quotes saying,

“We understand it cannot be easy for [name] having to wait a long time to be seen by specialist Gender Services. Therefore, the NHS wanted to offer them some support through local Children and Young People Mental Health Services [CAMHS].”

As we reported before, the Cass Report has been used as an excuse by the Tories to stop new intakes off the gender services waiting list. But now they sympathize with the long wait times and want to offer “some support” which may include switching you to the back of a different waiting list so that the Tories can report that the gender services wait list has dropped. Of course even if the list doesn’t get any shorter, at least NHS-England can rest satisfied that they’ve threatened families who access care outside the insurer’s control.

Some people might be inclined to think that this is more proof that the Tories are actively trying to inflict as much pain on trans people and families as possible, but yr Wonkette is content to describe this entire clusterfuck as just another day at the Wolfram & Hart NHS office.

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