Our ref: DE00000323921

14 July 2008

Dear Sir or Madam,

Thank you for your email of 26 June to the Department of Health requesting, under the Freedom of Information Act, information about treatment and diagnosis procedures and policies within the NHS on gender reassignment and gender dysphoria. You also asked for details of the formalised path for patients requesting gender reassignment and whether gender dysphoria is classed as a mental health issue. Your email has been passed to me for reply.

There is no Department of Health officially recognised path to gender reassignment and, therefore, no guidelines or models of care exist. The Department expects the clinical expertise of all the professionals involved with gender dysphoria to come into play when dealing with patients who are facing these issues. It is a matter for Primary Care Trusts (PCT) to decide based on each patient’s clinical needs and the need to support the provision of healthcare for the wider population as to whether surgery is appropriate.

The Equality and Human Rights Group has produced a practical guide to aid NHS organisations in developing a Gender Equality Scheme. Although this guide includes transgender issues, the Department has commissioned specific transgender guidance (due to be published August 2008) to raise awareness of transgender workforce and service related issues. The guide is designed to equip NHS managers at all levels, both as employers and as service purchasers and providers, to understand the needs of transgender people so that they can ensure we care for them equally alongside everyone else who has a need for our care or who works for the NHS.

The Department’s Sexual Orientation and Gender Advisory Group (SOGIAG) consists of key stakeholders from the NHS and voluntary sector, including transgender organisations and Departmental policy colleagues. The group has three workstreams, including one on transgender health. This work has lead to the publication of the following resources for patients and NHS staff, which can be found on the Department’s website at: www.dh.gov.uk/en/Managingyourorganisation/Equalityandhumanrights/Sexualorientationandgenderidentity/DH_4117240.

· Transgender experiences: a brief introduction and summary, including patient privacy and dignity and list of support groups. This is for a very wide range of people including service users, family members and medical as well as other professionals;

· A guide to hormone therapy for trans people: this includes internet usage and fertility. This is specifically for service users but also intended to be of value to a wide range of other people, including family members and medical as well as other professionals; and

· A guide for medical professionals: this includes alternative care models and preventative medicine. It also includes assessment and psychological support, as well as hormone treatment. It is written specifically for medical professionals, especially GPs and a section on legal obligations in respect to the provision of care.

Gender dysphoria canbe a manifestation of serious mental ill health and it is important that transient mental states do not lead to irrevocable surgical change. It is for this reason that no NHS surgeon would proceed with intervention in the absence of a full assessment by a psychiatrist specialising in the area.

If you have any queries about this response, please contact me. Please remember to quote the reference number above in any future communications.

I hope this reply is helpful. If you are unhappy with the way the Department of Health has handled your request you may ask for an internal review. You should write to the Section Head of the Freedom of Information group at the Department of Health, quoting the reference number above:

Freedom of Information Unit

Department of Health

Room 334b

Skipton House

80 London Road

SE1 6LH

Email: xxxxxxxxxxxxxxxxxxxx@xx.xxx.xxx.xx

If you are not content with the outcome of your complaint, you may apply directly to the Information Commissioner’s Office (ICO) for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by the Department. The ICO can be contacted at:

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

SK9 5AF

Yours sincerely,

William Scott

Customer Service Centre

Department of Health