It’s never been easy to get gender reassignment surgery on the NHS. More than a decade ago, when I was living in Birmingham, I was referred by a psychiatrist to a Gender Identity Clinic in London. NHS England funded seven adult clinics: none of which were anywhere near me. I had to take six days off work just to attend a series of brief appointments at the Charing Cross GIC in Hammersmith. My first assessment came in May 2012, six months after that referral. Four years later, I was eventually discharged after my surgery.
One could hardly call that efficient. But for patients today, my experience is the stuff of dreams. Waiting lists have ballooned out of all recognition. My former GIC in London is candid: “We are currently offering first appointments to people who were referred in January 2018.” Those people have waited four and a half years, merely to get to the starting line. But dig a little deeper into the data and the forward projections look even worse. In May 2022, there were 11,407 people languishing on the waiting list; just 50 of them were offered a first appointment that same month. This figure seems typical: in April it was 56, and in March it was 33. At those rates it will take between 17 and 28 years to clear the backlog. Typically, the clinic receives around 300 referrals every month, so with each month that passes, those waiting lists get even longer.
Elsewhere, the story is much the same. A GIC in Sheffield is offering first appointments to those referred in March 2018, while one in Exeter has seen nobody referred after June 2016. Behind this data, there are people stuck on waiting lists: almost 4,000 at Exeter in a queue that has stopped moving. The message from the clinic is stark: “Please do not contact the clinic to enquire about waiting times as our staff are very busy and we cannot provide any more information than is provided here. Thank you.”
With NHS services grinding to a halt, it’s not surprising that private clinics have sprung up to provide a faster alternative. Some clinicians are moonlighting alongside their regular jobs for the NHS. Consultant psychiatrist Dr Stuart Lorimer was brutally honest about his reasons: “Doctors have mortgages too, and my partner was on the verge of retirement… I was looking for ways to generate more income.” A tidy income, it seems — Lorimer charges £300 per hour.
Meanwhile, the London Transgender Clinic, a private practice, was established by plastic surgeon Christopher Inglefield in 2015, “in response to a noticeable increase in enquires from transgender and non-binary patients. Many of these patients were unable to access quality and timely care from the overwhelmed NHS gender services.” But his fast-track pass comes at a cost. LTC’s guide price for the management of hormone therapy is £849 for the first year, and £468 per annum subsequently. And that doesn’t include the drugs: “LTC is not a licensed dispensary, therefore, we advise that you take your private prescription to your local pharmacy.” It’s a far cry from the NHS, where a prescription prepayment certificate costs just £108.10, and that covers all your medicines for the year.
While NHS surgery is free to the user, private patients pay the full cost themselves. LTC charges from £27,000 for male-to-female gender surgery, rising to at least £32,000 if a section of colon needs to be used. LTC is perhaps on the pricey side, but their fees are not off the scale. The Parkside Hospital in Wimbledon told me that, “it’s £23,000 for a vaginoplasty”. Alongside their private patients, Parkside has a contract to treat NHS patients — 132 of them in 2019. This suggests the NHS is paying north of £3 million per year to treat around a dozen patients each month.
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SubscribeI may be a bigot, buy should gender reassignment surgery be on the NHS at all?
Whatever your feelings about the treatment itself, effectively gender reassignment surgery is no longer available to new patients on the NHS. Not for many years, anyway.
That’s good. Given that over 80% of those that present as gender dysphoric eventually desist and most figure out they’re merely homosexual the longer the better.
I know of one case where parents were themselves sent slightly mad by their son’s assertion that he wanted to transition at 18 and was entering the pathway to do so when sanity prevailed with him shortly before treatment started. The limitations of the NHS in this area may be a blessing although it is a pity that proper psychiatric treatment is not more available- but that applies to many psychiatric conditions and the NHS is already buckling under the demand for its services.
What doesn’t help are those who demand that it isn’t mental health disorder. They have little regard for those being misdiagnosed because they help boost their numbers, just collateral damage, i guess.
I would like to be more sympathetic to the plight of the trans people sat on waiting lists but at the end of the day, they are not the only people being failed by the NHS. EVERYONE is being failed by the NHS.
You are not a bigot. The N HS priority needs to be for those in pain and danger.
You never know these days…
I imagine the writer would , rightly, say that psychotherapy is somewhat urgent. Irrespective of outcome in relation to transitioning, many young people in this situation become severely depressed and even suicidal.
Funds would be better spent teaching people methods, tools and techniques on how to live life in a body which does not accord with their wishes, perceptions or desires.
I’d like to have Elle McPherson’s body, but I learned to live with my little 5’ frame all on my own, no one else’s money required.
I myself my been trying to get the world to affirm that I am as I perceive – as very tall, handsome and rich. Haters insist that this might not be the case.
Buy you a cuppa?
Then you could pretend I’m tall rich and handsome and I can pretend you’re Elle McPherson….
“The surgeons exploiting trans misery”
The “surgeons” castrating and de-breasting children are sadistic paedophiles.
I think this article’s all about adults – but there are worse Carthago delenda ests you could adopt.
The various factions involving themselves in this controversial issue will never reach an accommodation by resorting to ridiculously false accusations.
Richard – that’s the second time in a week that you’ve used the ‘paedo’ insult in this parish. As a man of letters I’m surprised that you have fallen into the same trap as Elon Musk. A female, on reaching puberty, is usually of little sexual interest to real “paedos”. How you want to describe those perverts who engage in sexual activities with people between puberty and the age-of-consent (in a particular society/country) is a diiferent matter. My concern over this mis-naming of people is triggered not so much by the Duke of York who whatever else he is (a lot) has not been charged with paedophilia but by the plight of a young woman 3 villages up my valley in Gwent. A mob from the local estate was about to torch her house when is was explained to them that the peado* was actually a Paediatric Nurse and even that job had to be explained to them.
*On a placard, I was told, held by one of the rabble leaders.
We should not be paying for this at all. It is a form of cosmetic surgery and we should only fund that on the NHS if the individual has a congenital deformity or has been mutilated in an accident or by cancer. The NHS should not be mutilating healthy bodies and the taxpayer should not be expected to fund it.
The current priorities of the NHS should be life-threatening physical diseases such as cancer, heart conditions and strokes.
A common theme amongst detransitioners is that everything snowballed – there was no real breathing-room, inadequate reflection time, in the process.
Annoying as waiting might be, it may be something of a blessing in disguise.
No doubt, in an ideal world, a person seeking gender reassignment surgery would receive extensive screening and psychological counselling before being referred for surgery. But, of course, we don’t live in an ideal world.
In the absence of adequate resources, perhaps the extensive waiting period before beginning the screening process provides time for a candidate, especially a young person, to thoroughly consider this radical decision and whether it’s right for them.
We read so much about coming scarcity in Europe this winter. It hardly has to be stated that scarcity is a bad thing. But perhaps sometimes scarcity is a blessing when the desired service has such a permanent, life-altering outcome.
“Vaginoplasty is a skilled job”–no it’s not, it is sadistically experimenting on people that need help.
Castration, ovary removal, and breast removal–these surgeons (and authors) are sadists. What happened to the “Do no harm” ethic?
Condemning people to be medically dependent on drugs for life, removing an individuals ability to have sexual orgasms, destroying their ability to have children, erosion of women’s hard earned rights, and the blatant homophobia being advocated by this authors and money hungry (at least the author is honest about that) “surgeons”.
Come on Unherd. We want some original reporting–not this kind of endless Stonewall propaganda that we are bombarded with by the mainstream media and mindless government bureaucrats.
This needs to be discussed sensibly.
Not by calling surgeons sadists.
Exactly. I maintain that lobotomists and phrenologists were deeply misunderstood too.
There is, of course, a world of difference between adult transition, usually done to prop up a failed life with sexual titillation, and the wholesale and permanent wrecking of a child’s body, externally and internally, Sunt lacrimae rerum.
Surely cancer patients should be first. And then hip replacements and heart valves. And when all of those are done and there are no waiting lists the NHS can offer these sorts of services.
GRS surgeon Phil Thomas pointed out that “there are simply not enough people in Britain who know how to make a vagina”….
Where to start?
Oh, how about “people with vaginas”?
“psychotherapy” – Most certainly. Surgery seems like the most drastic step one could take and I would imagine it more like cosmetic work than not. As such should the public be on the hook? A lot of transition involving only hormone control seems adequate and the drugs are cheap. A GP can generally examine blood markers for control to avoid serious complication. Given many men now have moobs unless overly endowed, what’s the point of removal for F-M? Nobody cares much anyway and padding for M-F seems OK to fit a style.
Of course, I’m not in the group so hardly appreciate the issues involved. I’ve had M-F friends who were mannish women but were quite comfortable in their chosen style.
A long discussion including some good and measured contributions has disappeared. Could we get it back, please? Even if the starting comment was a bit on the rough side?
Now fixed. Thanks.
Can anyone? in good faith, question the wisdom of insistence of (seriously) competent and licensed therapists to perform a holistic evaluation of someone who presents with gender dysphoria before even considering such drastic interventions as hormone treatment or surgery? Why would anyone rush?
Thanks so much for this
Let’s get real. The huge spike in numbers of people seeking reassignment surgery is almost certainly in large part due to social pressures. Even if I stipulate, arguendo, that they all should be seen promptly regardless of how “real” is their condition (unknown on an individual basis before they are seen), how reasonable is it for NHS to enormously increase its capacity in this area, at the expense of everything else, when it is quite likely that this social situation will change in a year or two or five and leave them with a lot of misallocated funds and underutilized vaginoplasty specialists while other needs like cardiac or cancer care are not being addressed?
These things are complicated and deal with an unknown future. Allocating funds between needs is not a simple moral issue with a clear answer..
“The surgeons exploiting trans misery“
A headline chosen to attract views I assume? An unworthy artifice.
If it were true then the same thing could be said about plastic surgeons performing nose jobs, face lifts, liposuction and breast implants.
In fact the same nonsense claim could be made about any doctor treating cancer patients or anyone else who is ill and suffering.
Whoever chose the heading needs to do better.
There is a world of difference between non-essential cosmetic surgery and cancer treatment.
The trans issue certainly produces strong and uncompromising opinions in bystanders.
I refer the question to Debbie and would like to hear her opinion on this point.
Does she agree with the wording of the headline?
Are surgeons truly exploiting trans misery, or are they simply doing their job, filling a gap in NHS services, and helping sometimes desperate people get the help they want?
Elsewhere in this thread John Scott called them sadists… a description I consider to be extremely unhelpful and with which I disagree. I’d be interested in her opinion on this point too.
You started this Debbie.
What’s your opinion?
I’d like to know/
Thank You Debbie. It seems as if trans people are being failed in every way by the medical profession.
Yes, that is the deepest tragedy of this eugenics movement: thousands of people needlessly allowing themselves to be genitally mutilated because of a social media trend.
Corrective eugenics? Isn’t that a contradiction in terms?
No genes are bing altered or suppressed.
Maybe it’s body dysphoria, not “gender dysphoria”
When I was sixteen, and living in Key West, snorkeling the reefs, I deeply resented having to come up for air.
I’m over it now.
It’s eugenics because when you’re chemically castrated oestrogen a la Alan Turing you’re unable to produce gametes and are therefore sterile. Some people have called the trans movement a disguised anti-autist eugenics programme given that so many gender dysphoria victims have ASD.