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Latest 13 October 2023

‘Bold and brave’ Alice let down by ‘underfunded and insufficiently resourced’ gender-affirming care

Alice Litman was left feeling ‘hopeless and helpless’ after facing an extremely long wait for gender-affirming healthcare, with ‘sporadic’ mental health support, the coroner concluded today as the inquest into her death closed.

Today, the coroner delivered her findings of fact from the inquest into the death of Alice Litman. We heard evidence of a lack of adequate systems in place to offer gender-affirming healthcare in England, as the coroner concluded that they are “underfunded and insufficiently resourced”.

The coroner said that the most commonly asked question during the inquest has been “If not your service, then where should Alice have gone?”, with Alice “told that she was on her own until she was able to access the gender affirming healthcare which was potentially years away.”

The coroner will now make various recommendations to the bodies who were responsible for Alice’s care at the time of her death.

Tragically, Alice died on 26 May 2022 when she was 20 years old. She had been on the NHS waiting list to receive gender-affirming healthcare for 1,023 days at the time of her death. She was referred in August 2019 and never received her first appointment.

During today’s hearing, we heard moving evidence from Alice’s friends and family describing her as “bold and brave” and “warm and kind”.

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But the coroner told the inquest that Alice did not receive the mental health treatment she wanted and needed, particularly in relation to the distress she experienced as a result of not being able to progress her transition. And that she was let down by a mental health support system that was “quite frankly half-hearted”.

We have been proud to support Alice’s family and welcome the Coroner’s decision to raise prevention of future death reports concerning:

  • The knowledge and training for those in the mental health setting for managing and offering care to those in the transgender community.
  • The delays in access to gender affirming healthcare.
  • The lack of provision of mental health care for those waiting for gender affirming treatment. 
  • The lack of clarity for clinicians who are in place to support young transgender individuals in primary care
  • The lack of clarity for clinicians who are in place to support young transgender individuals in the Mental Health setting,

The family of Alice Litman said:

“We are relieved to hear that the coroner will be sending prevention of future deaths reports to NHS England, the Royal College of General Practitioners, the Gender Identity Clinic and Surrey and Borders Partnership NHS Trust, and look forward to reading them in full. It is our hope that these unprecedented reports will help to achieve urgent change.

“We can never bring Alice back, but we will keep campaigning to ensure that all trans people are able to live in dignity and receive the healthcare they need and deserve. 

“The trans healthcare system is not fit for purpose. As the inquest heard, at the current rate that the Gender Identity Clinic is seeing new patients, someone referred today would have to wait twenty years before receiving their first appointment.

“We believe that if Alice had been able to access gender-affirming care when she first went to her GP in 2018, she could still be with us today. 

“Instead, Alice was left to languish on the GIC waiting list for 1,023 days. A month before she died Alice told her GP: 

‘I’ve been on the Gender Identity Clinic waitlist for over 2 1/2 years with no end in sight. I need an appointment. I am struggling. I am concerned that I have missed out on vital treatment. I often feel hopeless and helpless and feel life is not worth living.’

“Trans people should not have to wait years to access essential care through inaccessible specialist services. We believe most trans healthcare could be provided through primary care. We are asking NHS England to ensure that GPs have the resources, training and guidelines they need to deliver trans healthcare . 

“The inquest is not the end of our fight for Alice – it is the beginning. We will continue to fight for Alice, and for all the young trans people who are still being denied the care they need.”

Jo Maugham, Executive Director of Good Law Project said:

“We have been incredibly proud to support Alice’s family throughout this inquest. No family should lose someone they love after being left for too long on a waiting list for healthcare.

“This coroner’s conclusions should sound alarm bells around the abysmal state of gender-affirming and mental health care in this country- which are chronically underfunded and being outstripped by demand. Urgent change is needed.

“The real problem here is that treatment which should be led by medical expertise is instead led by politics. The victims of this tendency – which leaves medical professionals afraid to treat – are the trans community who do not get the healthcare they need.

“Policymakers must take immediate action on the back of the inquest’s findings, so no other families ever have to go through this.

“Over the last few years, Good Law Project has been challenging the extreme waiting times and barriers faced by transgender people seeking help from NHS England and we will continue to stand alongside the transgender community”.

Alice’s pen portrait read out by her mum during the inquest can be found here.