Q1. What is the Regional Gender Identity Service?
The Regional Gender Identity Service is a service provided by the Belfast Trust for all residents of Northern Ireland. The service provides care, treatment and support through psychological, social and physical transition for adults who are assessed as having gender dysphoria. Individuals who use the Regional Gender Identity Service may also access other services such as endocrinology (hormone treatment), speech and language therapy, mental health services and dermatology as part of their care pathway.
Where individuals are approved by the Health and Social Care Board (HSCB) for gender reassignment surgery, they are currently referred to surgical providers outside of Northern Ireland as there is no local surgical service.
Q2. What is Gender Dysphoria?
Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity (how they see themselves with respect to gender) and that person’s sex assigned at birth.
Q3. What is happening with the review of the gender identity pathway?
The Department of Health has asked the Health and Social Care Board to lead on a review of the Gender Identity Pathway (see Q5). A multi-agency group has been established to take this important work forward. Representatives from the Belfast Trust, the Department of Health, the Health and Social Care Board and the Patient and Client Council are included as are GPs and individuals representing the wider transgender community. Terms of reference have been drawn up. The review was expected to be completed and submitted to the Department of Health (DoH) by June 2020 however, as a result of the pandemic, it is now expected that the review will be submitted to the DoH by Spring 2021
An implementation plan will be drawn up thereafter scoping what needs to be done to introduce the new service model. Given the expected training requirements, it is likely that the new model will take 2-3 years to become fully operational.
Q4. How are the views of service users being incorporated into the review?
Two listening events were held (November and December 2019) to garner the views of service users and other interested parties. The events were widely advertised and invitations were issued to voluntary and community sector groups representing transgender individuals. At those events, expressions of interest were sought from individuals who were interested in joining the review group. A small number of individuals expressed an interest and two were selected to join the group.
Engagement with service users and interested groups and organisations is being planned for autumn 2020. For more information click on the link – here
Q5. What is the function of the Review Group and who sits on it?
The aim of the Gender Identity Service Pathway Review Group (‘the Review Group’) is to undertake a time-limited review which will:
The Review Group will not address or propose any changes to the gender reassignment surgery service but will highlight any interface issues which need to be managed as part of the pathway.
The Review Group will meet every 6 – 8 weeks and will be chaired by the HSCB. Representation will include the following; Belfast Health & Social Care Trust; Health & Social Care Board; Public Health Agency; Patient and Client Council; Service user representatives; Department of Health; Northern Local Commissioning Group; Royal College of General Practitioners; Northern Ireland General Practitioners’ Committee
Other colleagues may be asked to attend on an ‘as and when’ basis. Input from service users and representative groups will be facilitated through a parallel service user forum. Administrative arrangements / business support will be provided by HSCB Commissioning.
A draft review pathway will be submitted to the DoH with an assessment of what is required in terms of consultation, if appropriate, together with an indication of what additional resources may be required to deliver the revised pathway.
It is proposed that the review will be completed by Spring 2021.
Q6. What is the current service model and how is it likely to change?
There is a very small regional gender identity service for adults in Belfast. Based in the Brackenburn clinic in Knockbracken, the service is consultant- led with input from a range of other professionals including speech and language therapy, endocrinology, mental health and dermatology. Unfortunately, the service is not running at its full capacity due to a number of staff departures and retirements. Belfast Trust has made, and continues to make, efforts to recruit to vacant posts, but currently, the service has very limited capacity. Given the staff shortages, many people referred to the gender identity clinic are waiting a long time for assessment and treatment. As such, the service has not been able to offer an appointment to any new patients on the waiting list since March 2018.
As of 31 July 2020, there are 481 patients waiting for their first outpatient assessment.
In common with gender identity services across these islands, demand for the service has grown markedly in recent years and there is a significant mismatch between the capacity of the service and the numbers being referred to it. The growth in demand elsewhere also means that other GB and RoI providers have very little, if any, spare capacity to help with long waiting times in NI.
An examination of models across these islands and further afield is being undertaken by the review group in an effort to try and identify a service model that will be resilient, accessible, and offer more timely access to those seeking assessment and treatment.
Q7. What service is available for young people with gender identity issues?
Children and young people with gender identity issues can be referred to the Knowing Our Identity service (KOI). It is also a small service that is witnessing an increase in demand. Once young people reach the age of 17 ½ they should transition to adult services. This has become problematic because of the significant capacity issues in the adult service. The Belfast Trust is working with other providers in GB to see if additional capacity can be secured to continue to look after these young adults.
Q8. How have gender services been impacted by Covid?
During the COVID lockdown, the Belfast Trust continued to offer a service by providing contact and treatment to individuals on existing caseloads (both adults and children/young people.)
Although face-to-face contact was largely stood down within the service during lockdown, innovative approaches to support individuals included remote working and virtual consultations. It would be important to include any learning and best practice in the future development of services.