Gender Identity Services for Children & Young People in Wales
What is gender dysphoria ? Gender dysphoria in children or gender identity disorder in children (GIDC) is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent with their biological sex, assigned gender or both.
How is the service commissioned ? • Currently commissioned by Welsh Health Specialised Services Committee (WHSSC) on behalf of the seven Health Boards • Service commissioned from one NHS England provider – Tavistock & Portman NHS Foundation Trust • National Specialist service based in London but they have an outreach clinic in Llandough, Cardiff for welsh patients. • Gender Identity Development Services (GIDS) website gids.nhs.net • Current waiting time is approximately 1 year • Referral pathway for funding is thorough local CAMHS services
19 89 /1 19 990 90 /1 19 991 91 /1 19 992 92 /1 19 993 93 /1 19 994 94 /1 19 995 95 /1 19 996 96 /1 19 997 97 /1 19 998 98 /1 19 999 99 /2 20 000 00 /2 20 001 01 /2 20 002 02 /2 20 003 03 /2 20 004 04 /2 20 005 05 /2 20 006 06 /2 20 007 07 /2 20 008 08 /2 20 009 09 /2 20 010 10 /2 20 011 11 /2 20 012 12 /2 20 013 13 /2 20 014 14 /2 20 015 15 /2 20 016 16 /2 01 7
Rapid increase in referral rate to GIDS since 2009
Total referrals 1989/90 – 2016/17
2000
0
2016
1800
1600
1400
1419
1200
1000
800
600
697
400
468
200
4 7 15 13 7 139 97 85 64 12 12 24 28 14 21 26 32 41 50 50 29 50 208 314
Referrals in Wales increasing year on year 2009/10 to 2016/17 80
75
70
60
50
42
40
30
19
20
10
0
1
2009/2010
3 2010/2011
6 2011/2012
23
8 2012/2013
2013/2014
2014/2015
2015/2016
2016/2017
Increased referrals in Wales match the national trend Comparison using standardized scores
2009/2010
2010/2011
2011/2012
2012/2013
2013/2014
NHS Wales
Total
2014/2015
2015/2016
2016/2017
Changing demographics Referrals to GIDS by gender assigned at birth April 2009 to March 2016
Male
Female
65%
61% 60% 42% 58%
47% 53%
57% 43%
2009/2010
2010/2011
2011/2012
61% 39%
40%
2012/2013
2013/2014
35% 39% 2014/2015
2015/2016
Gender ratio by gender assigned at birth
2009 - 10
2015 - 16 35%
42% 58%
Assigned male
Assigned female
65%
Assigned male
Assigned female
GIDS Referrals by Age April 2009 to Mar 2016 (3253 Referrals)
3 0%
4 1%
5 1%
6 1%
17 15%
7 3%
8 9 2% 3% 10 3% 11 3% 12 4% 13 6%
16 26%
14 13%
15 19%
Associated difficulties (N=218 : Assigned Female = 137, Assigned Male = 81)
Recorded LGBT hate crime is increasing Police are recording increasing levels of hate crime:
LGBT hate crimes recorded in England and Wales 2011/12 to 2015/16 8000
1000 900 800 700 600 500 400 300 200 100 0
7000 6000
•
greater prevalence?
5000
•
improved reporting?
3000
4000 2000 1000
More hate crimes recorded against sexual orientation than transgender
0 2011/12
2012/13
2013/14
Sexual orientation
2014/15 Transgender
Sexual orientation: left; Transgender: right
2015/16
What next • AWGIPG will look at the pathway for children services and work with the provider in improving services • Understand that NHS England are going to undertake a consultation of gender identity service for children and young people –NHS wales will be part of that. • Some of that work will look at ages of accessing both children and adult services • Continue to improve the transition arrangements to adult services
Future Welsh Pathway ( Draft ) HB
All Wales Gender Identity Partnership
Gender Task & Finish Group
HB HB
Collaborative GID & Welsh Gender Service Hub
HB HB Each HB: CAMHS Gender Lead; Paediatric Endocrinologist Lead; GP/ Primary Care Lead
HB HB
WHSCC Tavistock Gender Identity Service
Current Welsh Pathway
Child presents to Referring Practitioner Referral to local CAMHS
Assessment by local CAMHS
Current Wait 8-9 months
Assessment in outreach clinic at Llandough by Team Wales from GIDS Currently every 3 - 4 months
Prescribe Hormone blockers/cross sex hormones if appropriate, supported by endocrinologist from Royal Free
Referred into adult GIC at point of transition
Invite Family to Open Day
GP prescribes hormones & monitors bloods with support from GIDFS
GID = Gender Identity Dysphoria Service Tavistock & Portman ( London )
Proposed Welsh Pathway ( Draft )
Collaborative Assessment Phase & Early Intervention (Less Emphasis on Gatekeeping)
Child presents to Referring Practitioner Referral to local CAMHS
Assessment by local CAMHS
Joint Assessment in outreach clinic at Llandough by CAMHS & GIDS
Prescribe Hormone blockers/cross sex hormones if appropriate, supported by endocrinologist from Royal Free Referred into adult GIC at point of transition
Referral to GIDS by CAMHS
GP prescribes hormones & monitors bloods with support from GIDFS
Thank you – any questions ?