‘We are just people too’: Four years is too long to wait for trans healthcare

England is an international outlier in trans healthcare – but sadly, not in a good way.

With just one NHS gender identity service for young people serving the whole of England, and only a handful of centres for adults, it’s almost impossible for people to get the treatment and support they are entitled to. 

Legally, patients should be offered their first appointment within 18 weeks of a GP referral. But children are waiting on average 18 months, and some as long as three years. And some adults referred in October 2017 are only now having their first appointment – four years later. Waiting lists stretch into the thousands. 

Such long waits mean trans adolescents are missing the short window of time in which puberty blockers are useful. Without them, their bodies will change in ways that they know they may have to live with for the rest of their lives. To force teenagers to contemplate this, when a safe treatment is available which would give them breathing space to think, is unimaginably cruel. No wonder it correlates closely with increased suicide risks or self-harm. No wonder some feel they have no choice but to self-medicate with drugs purchased on the dark web. 

While adults don’t face the same ‘window of opportunity’, the denial of treatment restricts the lives trans people are able to lead and has hugely harmful consequences for their mental health.

Delays have been getting worse and worse for some time. This cannot continue.

Back in November 2020, we began a challenge to the waiting times young people faced for first appointments. This was put on hold while we worked on the Bell appeal, but now that deeply legally flawed and inhumane decision has been overturned we are picking up where we left off.

We are supporting two adults, Eva and Alex, as well as two young people to take cases against NHS England for these unlawful delays. They explain the significance of this better than we ever could: 

Eva said: “After spending so much of my life coming to terms with who I am, I took the decision to face it and I came out as transgender. But that liberation was short-lived when I discovered the extent of the gender clinic waiting times.

“I’ve waited four years for my first appointment…I am still waiting. This has impacted my personal life in so many ways, and I feel so let down. It’s like we’re an afterthought in a service that’s become complacent to its own astronomical waiting times.

“Being trans isn’t a choice. Let’s face it – who would choose being hated, attacked, discriminated against? We are just people too.” 

Alex adds: “Trans people are just trying to live their lives and feel comfortable and safe. We’re not trying to trick you. We’re not trying to get into your bathrooms. We’re not trying to see how many people per day we can fool. We’re not a puzzle, or a quiz, or a game.

“For many of us, this is probably one of the few things we are certain about. We know we are trans and we know we need help – because right now, the lack of support is having such a negative effect.”

We’ve asked NHS England to explain why they are failing to meet their legal obligation to ensure patients are seen within 18 weeks, and to set out the steps they are taking to secure alternative provision and bring waiting lists down. We don’t think they are doing enough, so are launching full legal proceedings. 

The bottom line is waits for treatment are leading to the loss of lives and things are getting worse, not better. This cannot continue unchecked. 

If you are in a position to do so, you can donate to the legal action here.

We are launching a new crowdfunder for this case as we have used a large proportion of the Trans Legal Defence Fund on our interventions in the Bell v Tavi appeal and a case about parental consent – both of which were successful – along with initial work on the present action. We have also carried out extensive work on Clinical Commissioning Groups’ refusal to fund fertility preservation for trans people and expect to do more when a suitable test case emerges. You can see an account of our spending here. 

All funds raised will be governed by the same rules as our community-led Legal Defence Fund for Transgender Lives and any surplus will go towards future cases that protect trans and non-binary people.