On Thursday 18 March 2021, Jenny-Anne Bishop a Trans Activist, Church Elder, Member of the Parliamentary Forum on Gender Identity, & the Trans Advisory Board for HM Prison & Probation, and co-founder of the Unique Transgender Network, a voluntary group supporting Trans (transgender) people in North Wales & West Cheshire, gave a speech to BAGIS. In it, Jenny-Anne outlines a history of the Specialist Gender Identity Health Care in Wales, and she has kindly given us permission to reproduce it here.
“Thank you Sophie for your kind Introduction and to BAGIS for the invitation to speak here today.
Good Morning to everyone and on behalf of the Welsh Gender Service, Cardiff and Vales University Health Board; WHSSC (The Commissioning Service) and Health Education and Improvement Wales, I’d like to warmly welcome Matthew Mills the President of the British Association of Gender Specialist, the esteemed members of BAGIS and honoured guest to the 6th Symposium of the Association being hosted virtually here in Wales.
A country that incorporates diversity and fairness in all its activities, A land of fabulous diversity both in its people and its topography and includes over 10 million sheep ( 3.2 x the population!)
It is very fitting that this conference should be hosted by the relatively New Welsh Gender service (WGS) which in its short life of just over 18 months has proved itself to be a leader in innovating integrated care for Trans and Non-binary people across the spectrum of primary, secondary and tertiary care.
It has given inspiration to the new GP lead gender services in London, Manchester and Liverpool. It has invigorated gender care in Wales and been an early adopter of virtual appointments to progress the reduction of the 1100+ initial waiting list of patients from Wales in spite of the difficulties of the Pandemic. The service continues to innovate and improve especially in its co-production with the Trans Wales Partnership stakeholder group; which includes a wide diversity of service users from all across Wales which meets monthly with the WGS to act as a critical friend providing feedback from service users and the wider Trans Community and to suggest new ways to further improve the service.
It is important to understand the history of Specialist Gender Identity Health Care in Wales to see how the Service has been empowered to achieve so much in the short time it has been open; following the long-term collaboration between Service commissioners, the local Health Boards, the Clinicians, The Welsh Government and the Welsh Trans and Gender Diverse community.
Its antecedents can be traced back to a service first set up in North Wales in the 1990s, which included Gender Clinics in Bangor (Kenny Midence) and Wrexham (Martin Riley), Endocrinology in the Royal Alexandra Hospital in Rhyl (Dr Stephen Wong) and a gender Affirming Surgeon (Miss Christine Mary Evans) at Glan Clwyd Hospital near Rhyl, where coincidently I live.
It was two Trans people Jayne and Barbara who set up our North Wales Trans support group Unique in 2002; when following Gender Affirming Surgery at Glan Clwyd Hospital they discovered there was no support group available for them in North Wales; and promptly formed it with Millennium funding.
Sadly following the retirement of Miss Evans in 2004, the North Wales Gender service was largely disbanded, effectively meaning that there was no defined service in Wales; just random pockets of good practice that Trans people had; with great difficulty, to discover for themselves. Thus it was left to the potential Service users to start agitating for an all-Wales service starting in a collaboration with the Gender Trust Brighton in 2006.
Then we followed up by sending several FOI requests to Health Commission Wales; which refused to define the pathway for gender health care, and suggested we took legal action if we wanted to learn more about what they had commissioned!
Next a collaboration between several Trans groups from across Wales to write a well-researched report “The Trans Struggle” that was used to lobby the petitions committee of the Welsh government in The Senedd.
The response was that our then Welsh Government Health Secretary Edwina Hart set up the Stakeholder group to collaborate with the Welsh Health Specialist Services Committee (WHSSC-The tertiary commissioners) to design and commission an all Wales Adult Gender Identity Service. This was accomplished in the relatively short time of just over two years as commissioning specification CP-21(2012) – The adult gender identity service which largely mirrored the existing service in England. It had to include gatekeeping in Local Mental Health as the London Gender Identity Clinic would not accept a referral for Gender Identity treatment without a prior diagnosis of Gender Dysphoria (DSM-V) or Transsexualism (ICD-10)– there was no direct GP referral to the clinic then.
This great start spurred on the community to undertake the long and often very difficult struggle with the Commissioners which lasted 7.5 years – it took to specify the new more holistic and inclusive service and to gain the agreement of the Trans community, the commissioners and the clinicians on how the service would work with the first clinic set up in Cardiff in Sept 2019. To achieve this, a public community meeting attended by over 120 service users, commissioners, the Welsh Government and specialist clinicians was organised in Cardiff in Oct 2016 to vote on the proposed specifications.
Two proposed specifications achieved almost equal ranking and these were combined to form the basis of the commissioning specification approved by the joint Chief Executive’s (of the 9 Welsh Health Boards) Committee which approves and funds the work of WHSSC. The Welsh government who are the main funders of the WGS also gave their approval to the new service and £0,5 Million in funding.
The new innovative service combines the Clinic with the seven health board local gender teams who, following hormone Therapy approval by the Cardiff clinic; initiate and stabilise hormones over a period of approx. 1 year and then pass the patient on to the Directed Enhanced GP Hormone prescribing service sponsored by the Welsh Government; so that most of the service and support is provided close to home. Currently, even closer with most of the clinic appointments being virtual!
If for any reason the local GP does not pick up the Hormone prescribing, monitoring and annual review of the patient’s health and specialist Gender health care, the Local Gender Team continues to provide the service.
Many, many people have been involved in the setting up of the New All Wales Service; including the great collaboration between the community and the dedication of the clinic clinicians to provide the service the Trans community had specified in that co-production with the health professionals and which is so desperately needed.
So we may pause for a moment to celebrate such an achievement with the Adult Service whilst remembering the great Urgency to set up a parallel service for our Gender Diverse Children and Young people.
I’m sure equal dedication and persistence will be applied to producing a similarly innovative service in Wales for those under 18.
It is fitting to also remember that Dr. John Randall who set up the first UK service as the Charring Cross Hospital Gender Identity Clinic in 1966, organise the First International Symposium on Gender Identity in London in July 1969; he was a GP born in Penarth and qualifying in South Wales, not so far from the current Welsh Gender Service. He was also the first gender clinician I saw in early 1980 who told me that one day I would take the transitioning path, how right he was! He was also a Trans person.
Thank you for your kind attention and I would like to pass you on to Mathew Mills the current president of BAGIS.”