Trans: a Practical Guide for the NHS
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Trans A practical guide for the NHS Trans: A practical guide for the NHS © Crown copyright 2008 289748 1p 2k October 08 (ESP) Produced by COI for the Department of Health If you require further copies of this title visit www.orderline.dh.gov.uk and quote: 289748/Trans: A practical guide for the NHS or write to: DH Publications Orderline PO Box 777 London SE1 6XH Email: [email protected] 289748/Trans: A practical guide for the NHS may also be made available on request in alternative formats. Tel: 0300 123 1002 Fax: 01623 724 524 Minicom: 0300 123 1003 (8am to 6pm, Monday to Friday) www.dh.gov.uk/publications 82838-COI-Trans Practical Guide COVER.indd 1 17/10/08 16:14:13 DH INFORMATION READER BOX Policy Estates HR/Workforce Commissioning Management IM & T Planning/ Finance Clinical Social Care/Partnership Working Document purpose Best Practice Guidance Gateway reference 9294 Title Trans: A practical guide for the NHS Author Department of Health Publication date October 2008 Target audience PCT CEs, NHS Trust CEs, SHA CEs, Foundation Trust CEs, Directors of PH, Directors of Nursing, NHS Trust Board Chairs, Special HA CEs, Directors of HR, GPs Circulation list Description This document gives practical best practice advice for NHS organisations to address their responsibilities relating to trans employment and healthcare delivery. Cross reference N/A Superseded documents N/A Action required N/A Timing n/A Contact details Equality and Human Rights Group Department of Health Skipton House 80 London Road London SE1 6LH 020 7972 5026 For recipient’s use 82838-COI-Trans Practical Guide COVER.indd 2 17/10/08 16:14:13 Trans: A practical guide for the NHS Contents Foreword 5 1. Executive summary 6 Creating better services 6 Becoming a better employer 7 Beyond the law’s requirements: good practice 7 Beyond single strands: multi-dimensional people 8 The layout of this guide 8 Section One: Background knowledge and advice 10 2. Labels, terminology and lives 11 What is meant by ‘trans’ or ‘transgender’? 11 Why can ‘transsexual’ be a sensitive term? 11 Why are the different terms important? 12 Getting pronouns and gender terms right 12 Understanding the challenges faced 13 Not a trivial or capricious ‘choice’ 13 Trans people’s families and partners 14 Trans children and teenagers 14 Moving from disease and disorder to wellbeing 15 Population levels and service demand 16 3. Policy considerations 19 Why this guide? 19 Statutory requirements 19 Good practice 20 Is this all just ‘political correctness’? 20 An holistic view in health and social care 21 Inclusive employment policy 22 Factoring with other equality needs 23 Mapping needs and consulting with communities 24 Contents 1 82838-COI-TRANS practical guide.indd 1 17/10/08 16:20:46 4. Legal and good practice considerations 26 What the law requires 26 What the law doesn’t mean 27 Employment law 27 Gender recognition 29 Privacy 30 Funding policy 32 Services 32 The public sector Gender Equality Duty 33 Going further – best practice 34 Section Two: Practical guidance on service quality, employment and training 36 5. Service commissioning and delivery 37 Context 37 Where does change need to occur? 39 What trans people think, expect and fear 39 Applying World Class Commissioning principles 41 Healthcare policy good practice 41 Equality impact assessments 42 Specifics concerning gender treatment 44 Not just trans 46 6. Employing and retaining trans people 48 Context 48 Beyond the law – NHS principles and exemplar practice 49 Recruitment, retention and business as usual 50 Employment policy good practice 51 Equality impact assessments 52 Recruitment interviews 53 Criminal Records Bureau disclosure applications 54 Record keeping 55 Understanding the transition process 56 Occupational health 58 Planning for transition at work 58 Toilets and locker rooms 60 Public-facing roles 61 Not just trans 61 7. Education, training and information 62 2 82838-COI-TRANS practical guide.indd 2 17/10/08 16:20:47 Trans: A practical guide for the NHS 8. Consolidation into a gender equality scheme 65 Putting it all together 65 Gathering information 65 Equality impact assessment 66 The action plan/monitoring 67 Section Three: Annexes and resources to assist managers 68 Annex 1 – Publications and resources 69 General Department of Health and NHS publications 69 Trans-related Department of Health and NHS publications 71 Other official publications 73 Legislation 74 Clinical guidance 75 Books 76 Training DVDs 76 Annex 2 – A concise guide to terms 77 Commonly used abbreviations and terms 79 Expressions that should be avoided 81 Annex 3 – Care pathways for gender issues 82 Approaches to trans people’s needs 82 Care pathways 83 Mixed use of psychiatry, clinical psychology and counselling 85 Focusing on outcomes 86 The need for flexible entry points 87 Where does treatment stop? 87 Follow-up and long-term healthcare 87 Trans people get colds too 88 Annex 4 – Consultation methodologies 89 A matrix approach to multiple needs 89 Envisioning what trans inclusion looks like 90 Slicing the cake – an exercise in multi-dimensional thinking 92 Annex 5 – Specialist organisations 93 Help and advice 93 Training and consultancy specialists 95 Acknowledgements 97 Contents 3 82838-COI-TRANS practical guide.indd 3 17/10/08 16:20:47 Trans: A practical guide for the NHS Foreword As an employer and a provider of healthcare services, the NHS should not only comply with the law, but should also aspire to be an exemplar of good practice and seek to ensure that its services reflect the needs of the whole of our society. This means that it is essential that we strive to involve and take account of trans people’s needs in the design and delivery of all our services. This doesn’t just apply at the time in their lives when they need support and care to undertake the There are a number of people in the United immense challenge of changing their gender Kingdom whose gender identity (their sense identity, but throughout life. of being a man or a woman) does not match their appearance and/or anatomy. It is also right that we should strive to retain valuable skills when a colleague needs to This guide is designed to equip NHS ‘transition’ from one gender role to the other. managers at all levels – as employers and as It is essential that we are seen as an inclusive planners, commissioners and providers of employer – enabling us to find and recruit services – to understand the needs of trans people with the best skills and aptitude to people so that they can ensure we care for make careers in the NHS. them equally, alongside everyone else who works for the NHS or has need of our care. Other existing public sector equality duties, ongoing reform towards personalised services and the commissioning agenda present a real opportunity for NHS organisations to Surinder Sharma reconsider the design of services to take National Director for Equality and Human full account of the equalities agenda. By Rights, Department of Health developing expertise and implementing the lessons learnt, we can embed equality at the heart of all functions and structures and contribute to a better understanding of our staff and more informed, personalised patient care. Foreword 5 82838-COI-TRANS practical guide.indd 5 17/10/08 16:20:48 1. Executive summary People who cross contemporary cultural or capricious about permanently changing gender boundaries for any reason – gender role. collectively referred to as ‘trans people’ – are an often ignored group in society, Creating better services yet all research undertaken in the areas of employment, health provision, social exclusion There is evidence to indicate that, for some and hate crime indicates that they experience trans people, the National Health Service disproportionate levels of discrimination, (NHS) has at times unfortunately contributed harassment and violence. Transsexual people, towards anguish and distress. Research those who identify as transgender and people published in February 2007 (see above) who periodically cross-dress in private have showed that almost 20% of trans people distinctly separate social experiences and surveyed for the Equalities Review reported needs; nevertheless they all experience similar that their healthcare was either affected or kinds of unwarranted social disapproval. refused altogether by GPs who knew they were trans. Whilst there are notable examples Trans people are more likely than others of excellent care and good practice, 60% to experience difficulty in finding work or of trans people who thought their GPs and retaining it if their background becomes other medical professionals would like to be known to others. High numbers report feeling more helpful and supportive reported that the obliged to change jobs because of workplace practitioners felt unable to do so through lack harassment and abuse. Upon revealing their of training and information. gender issues people are at high risk of being shunned by family and friends. Many The kinds of specific issues that arise are experience violent intimidation on the streets explained in part 5 of this booklet. Best or outside their homes. Consequently trans practice is readily achievable by combining people are also susceptible to depression and the advice contained here with the kinds at risk of suicide. A 2007 report, Engendered of training that accompany wider diversity Penalties (Whittle S, Turner L and Al-Alami initiatives. M, The Equalities Review, February 2007; see www.pfc.org.uk/files/EngenderedPenalties. Once staff are more conversant with trans pdf), highlighted that 34% of respondents in people’s needs and concerns, much of the a survey of 872 trans people had considered solution simply involves everyone applying the suicide one or more times before receiving core principles set out in the NHS operating professional assessment and support.