Care of Transgender Patients
Unique Identifier:
CORP/GUID/308
Version Number:
4
Type of Update / Status: Ratified with Minor / No Technical Changes
Divisional and
HR
Department:
Equality and Diversity
Author / Originator and
Tina Daniels
Job Title:
Equality and Diversity Lead
Replaces:
CORP/GUID/308 V3.1 Care of Transgender Patients
Description of
Review of document and updated where required
amendments:
Approved by:
Lesley Smith-Payne, Head of Workforce Health & Wellbeing
Approved Date:
05/08/2020
Issue Date:
05/08/2020
Review Date from Date
1 Year
2 Years
3 Years
4 Years
5 Years
of Approval:
☐
☐
☒
☐
☐
05/08/2023
Version Control Sheet
This must be completed and form part of the document appendices each time the
document is updated and approved
Date
dd/mm/yy Version
Author
Reason for changes
05/08/20
4
Tina Daniels
Periodic review
Consultation / Acknowledgements with Stakeholders
Name
Designation
Date Response
Received
Staff ED&I
Staff ED&I Meeting
January 2020
Ambassadors
Trust Committee
Equality Diversity and inclusions
February 2020
Implementation Committee
Staff Side
JNCC
Lewis Turner
Lancashire LGBT
Anthony West
Horizon Blackpool
link to page 1 link to page 1 link to page 3 link to page 3 link to page 3 link to page 5 link to page 5 link to page 6 link to page 8 link to page 10
CONTENTS
Version Control Sheet .......................................................................................................... 1
Consultation / Acknowledgements with Stakeholders .......................................................... 1
1
Introduction / Purpose ................................................................................................. 3
2
General Principles / Target Audience .......................................................................... 3
3
Definitions and Abbreviations ...................................................................................... 3
4
Responsibilities (Ownership and Accountability) ......................................................... 5
5
Guidelines ................................................................................................................... 5
5.2 Care and Treatment ................................................................................................ 6
6
References and Associated Documents ..................................................................... 8
Appendix 1: Equality Impact Assessment Form ................................................................. 10
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 2 of 11
1 Introduction / Purpose
•
To give clear and relevant guidelines to ensure safe and appropriate care is given to
trans people who are patients in hospital.
•
To ensure that statutory and locally produced guidelines regarding people whose
status is transgender are adhered to.
•
To ensure that any necessary advice / information is made available to the patient.
•
The Trust is committed to creating an environment where the gender identity of a/any
trans person is respected and afforded dignity and equal rights.
2 General Principles / Target Audience
The guidelines apply to all persons working within Blackpool Teaching Hospitals NHS
Foundation Trust involved in the care and treatment of transgender patients within the
hospital setting.
3 Definitions and Abbreviations
Bi-gendered
One who has a significant gender identity that encompasses both
genders male and female Some may feel that one side or the
other is stronger, but both sides are there.
Cross-dresser
A term for people who dress in clothing traditionally or
stereotypically worn by the other sex, but who generally have no
intent to live full-time as the other gender. The older term
“transvestite” is considered derogatory by many.
Drag Queen
Used to refer to male performers who dress as women for the
purpose of entertaining others at bars, clubs, or other events. It is
also sometimes used in a derogatory manner to refer to
transgender women.
Drag King
Used to refer to female performers who dress as men for the
purposes of entertaining others at bars, clubs, or other events.
FTM
A person who transitions from “female-to-male,” meaning a person
who was assigned female at birth, but identifies and lives as a
male. Also known as a “transgender man.”
Gender
Gender is expressed in terms of masculinity and femininity. It is
largely cultural y determined and is assigned at birth based on the
sex of the individual. It affects how people perceive themselves
and how they expect others to behave.
Gender Expression
How a person represents or expresses one’s gender identity to
others, often through behaviour, clothing, hairstyles, voice or body
characteristics.
Gender Identity
An individual’s internal sense of being male, female, or something
else. Since gender identity is internal, one’s gender identity is not
necessarily visible to others.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 3 of 11
Gender Non-conforming
A term for individuals whose gender expression is different from
societal expectations related to gender.
Genderqueer
A term used by some individuals who identify as neither entirely
male nor entirely female.
Gender Reassignment Surgery
Surgical procedures that change one’s body to better reflect a
person’s gender identity. This may include different procedures,
including those sometimes also referred to as “top surgery” (breast
augmentation or removal) or “bottom surgery” (altering genitals).
Contrary to popular belief, there is not one surgery; in fact there
are many different surgeries. These surgeries are medically
necessary for some people, however not all people want, need, or
can have surgery as part of their transition. “Sex change surgery”
is considered a derogatory term by many.
GRC
Gender Recognition Certificate
Intersex
A term used for people who are born with a reproductive or sexual
anatomy and/or chromosome pattern that does not seem to fit
typical definitions of male or female. Intersex conditions are also
known as differences of sex development (DSD).
MTF
A person who transitions from “male-to-female,” meaning a person
who was assigned male at birth, but identifies and lives as a
female. Also known as a “transgender woman.”
Physical Sex
To what sex do the organs of the body match, i.e. male or female.
Birth with ambiguous genitalia occurs in roughly 1:2000 live births
(see Intersex Person)
Queer
A term used to refer to lesbian, gay, bisexual and, often also
transgender, people. Some use queer as an alternative to “gay” in
an effort to be more inclusive. Depending on the user, the term
has either a derogatory or an affirming connotation, as many have
sought to reclaim the term that was once widely used in a negative
way.
Sexual Orientation
A term describing a person’s attraction to members of the same
sex and/or a different sex, usually defined as lesbian, gay,
bisexual, heterosexual, or asexual.
Transgender
A term for people whose gender identity, expression or behaviour
is different from those typically associated with their assigned sex
at birth. Transgender is a broad term and is good for non-
transgender people to use. “Trans” is shorthand for “transgender.”
(Note: Transgender is correctly used as an adjective, not a noun,
thus “transgender people” is appropriate but “transgenders” is
often viewed as disrespectful.)
Transgender Man
A term for a transgender individual who currently identifies as a
man (see also “FTM”).
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 4 of 11
Transgender Woman A term for a transgender individual who currently identifies as a
woman (see also “MTF”).
Transition
The time when a person begins to living as the gender with which
they identify rather than the gender they were assigned at birth,
which often includes changing one’s first name and dressing and
grooming differently. Transitioning may or may not also include
medical and legal aspects, including taking hormones, having
surgery, or changing identity documents (e.g. driver’s license,
Social Security record) to reflect one’s gender identity. Medical
and legal steps are often difficult for people to afford.
Transsexual
Transsexual: An older term for people whose gender identity is
different from their assigned sex at birth who seeks to transition
from male to female or female to male. Many do not prefer this
term because it is thought to sound overly clinical.
Two-Spirit
A contemporary term that refers to the historical and current First
Nations people whose individuals spirits were a blend of male and
female spirits. This term has been reclaimed by some in Native
American LGBT communities in order to honour their heritage and
provides an alternative to the Western labels of gay, lesbian,
bisexual, or transgender.
4 Responsibilities (Ownership and Accountability)
It is imperative that all staff act appropriately and are responsible for the confidentiality of
the patient. The Act imposes new responsibilities to maintain client confidentiality. Section
22 of the Gender Recognition Act 2004 (Crown, 2004) makes it a criminal act for any
individual who has obtained information in an official capacity to divulge to another that a
person has a GRC, or is applying for a GRC, or do anything that would cause such a
disclosure. This includes social and health care agencies, or a prospective agency.
Under Section 22 of the GRA trans people have privacy rights. Anyone who acquires
knowledge in their professional capacity, of a trans person’s history, and knows or is able
to surmise that the person has a new birth certificate, can be prosecuted and fined up to
£5,000 and/or be jailed for up to 6 months, if they pass that information onto a third party
without the trans persons consent. However, a trans person does not need a GRC for their
confidentiality to be breached in this way.
5 Guidelines
6.1 The Law
The Gender Recognition Act 2004 (GRA), now part of the Equality Act 2010 (Crown,
2010),
enables trans people to apply for full legal recognition in their
acquired gender and
those born in the UK can obtain a new birth certificate signifying this fact. In order to
qualify for a full Gender Recognition Certificate (GRC), a trans person has to show that
•
They are at least 18 years of age at the time of application,
and
•
They have or have had a diagnosis of gender dysphoria,
and
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 5 of 11
•
They have lived in their acquired gender role for two years;
and
•
They intend to do so permanently for the remainder of their life.
For further information see the Gender Recognition Register (Marriage and Civil
Partnerships) Regulations 2015 (Crown, 2015).
Gender recognition means that trans people all must be treated as of their acquired
gender (sex) for all legal purposes including health and social care.
Trans people have no obligation to disclose whether they have a Gender Recognition
Certificate or not.
Regardless of whether the patient has one, it is best practice to keep what you know about
the patient confidential unless they tell you otherwise. It is also good practice to assume
that a trans person who has changed their name by statutory declaration or deed poll, is a
member of their new gender for all purposes unless you are told otherwise by the
individual.
Knowledge about a trans person’s history should be on a “need to know basis” and even
then if you have obtained the information in your official capacity, the information cannot
be passed on, verbally or in writing, unless the patient has given you, preferably in writing,
permission that you may tell other certain people.
The Gender Recognition (Exceptions to the Offence of Disclosure) Order 2005 creates an
exception to S.22 of the Gender Recognition Act 2004 (Crown, 2004), for healthcare
professionals, including nurses, where the person making the disclosure has a reasonable
belief that:
•
Either consent has been given or that consent cannot be given by that person; and
•
The disclosure is made to a health professional for medical purposes.
5.2 Care and Treatment
Trans people use health services for all sorts of reasons, and not just for transgender
specific issues. Equal access to healthcare for all is a must, regardless of their ethnicity,
sexual orientation, gender etc.
The following are some key areas to note -
•
Be aware that many people who are transitioning or who have transitioned do not
identify as transgender at all but as men and women.
•
Use the name and title (e.g. Mr, Ms, Mrs, Miss) that the person prefers. If unsure ask
how they would like to be addressed.
•
Use the correct pronoun i.e. for a trans man “he” “Mr” etc. and for a trans woman
“she” Ms, Miss or Mrs.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 6 of 11
•
Gender neutral language - some nonbinary people prefer to be referred to using
gender neutral language and pronouns. Some choos
e a gender neutral title such as
Mx or Misc, Ze or Zir for formal communications. Others may opt for no title.
•
Al ow trans people access to appropriate single-sex facilities which are in line with
their gender identity.
Please note - This may raise issues from other clients / patients
but should never result in the denial of access to these facilities by the trans person.
•
Be aware that some trans people may have specific personal care needs and handle
these sensitively e.g. trans women may stil need to shave regularly. Trans people
who need assistance going to the toilet or bathing require support from staff who
understand that their body may not match their gender identity.
•
Trans people may need support if they face prejudice from other people using the
service or their family.
•
Confidentiality around someone’s transgender status is very important. Their wish for
other people to know about their status may change over time, particularly if the
person is in transition.
•
If a patient is seen within the hospital setting and does not disclose transsexual
identity but following diagnostic tests or examination it becomes apparent, ensure
that appropriate care and respect is given at all times.
•
When physical examinations and screening tests are offered to patients be aware
that screening tests may be based on birth gender e.g. a trans woman wil stil
require prostate screening.
•
Discuss with the Patient possible implications of not passing on relevant gender
information to other healthcare professionals.
•
Discussions should be had with the patient about the ward they are best suited to be
placed on, depending on their treatment. For example a trans man having a
hysterectomy may be better placed on a women’s ward in a separate private room. If
you are unsure about the person’s dignity and respect consult them as to what they
would like, bearing in mind that some patients may have mixed sex characteristics.
•
Be aware of the impact on the person and other people if there are mixed sex
characteristics apparent and the sensitivity needed for both the person and other
patients.
•
If the person is living their everyday life as a specific gender then it is those toilets
they should use as this is considered best practice.
•
For every day clinical purposes if the patient is in a female role (or vice versa) in their
everyday life then that is how they should be treated on admission. Discussions
should be had with the patient about the ward they are best suited to be placed on.
For example people who are not living full-time as a woman have been on women’s
wards with no issues at all.
•
Do not make assumptions about the sexual orientation of a trans person. The
expression of sexual orientation in trans people is as variable as in the wider
population.
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 7 of 11
6 References and Associated Documents
BTHFT - Procedure, 2015.
Guidelines for the Care of People with Learning Disabilities
when accessing Trust services. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-GUID-
450.docx
[Accessed 24 02 2020].
BTHFT - Procedure, 2016.
Eliminating Mixed Sex Accommodation (EMSA). [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-
426.docx
[Accessed 17 04 2020].
BTHFT - Procedure, 2016.
Equality Diversity and Inclusion. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-
206.docx
[Accessed 17 04 2020].
BTHFT - Procedure, 2016.
Religious and Cultural Beliefs. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-GUID-
027.docx
[Accessed 22 01 2020].
BTHFT - Procedure, 2017.
Equality Diversity and Inclusion. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-STRAT-
001.docx
[Accessed 16 01 2020].
BTHFT - Procedure, 2017.
Interpretation and Translation Procedure. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-
022.docx
[Accessed 20 02 2020].
BTHFT - Procedure, 2018.
Prevention of Bullying and Harassment Procedure. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-
208.docx
[Accessed 20 01 2020].
BTHFT - Procedure, 2018.
Providing and Maintaining Privacy and Dignity to Patients.
[Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-
002.docx
[Accessed 04 03 2020].
BTHFT - Procedure, 2019.
Data Protection. [Online]
Available at: http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-
064.docx
[Accessed 30 03 2020].
Crown, 1997.
Protection from Harassment Act 1997. [Online]
Available at: http://www.legislation.gov.uk/ukpga/1997/40/contents
[Accessed 17 04 2020].
Crown, 1998.
Human Rights Act 1998. [Online]
Available at: http://www.legislation.gov.uk/ukpga/1998/42/contents
[Accessed 13 02 2020].
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 8 of 11
Crown, 2004.
Gender Recognition Act 2004. [Online]
Available at: http://www.legislation.gov.uk/ukpga/2004/7/contents
[Accessed 17 04 2020].
Crown, 2005.
The Gender Recognition (Disclosure of Information) (England, Wales and
Northern Ireland) (No. 2) Order 2005. [Online]
Available at: http://www.legislation.gov.uk/uksi/2005/916/contents/made
[Accessed 17 04 2020].
Crown, 2010.
Equality Act 2010. [Online]
Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents
[Accessed 13 02 2020].
Crown, 2015.
The Gender Recognition Register (Marriage and Civil Partnership)
Regulations 2015. [Online]
Available at: http://www.legislation.gov.uk/uksi/2015/50/contents/made
[Accessed 17 04 2020].
Crown, 2018.
Data protection. [Online]
Available at: https://www.gov.uk/data-protection
[Accessed 15 01 2020].
Department of Health and Social Care, 2015.
The NHS Constitution for England. [Online]
Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-
england/the-nhs-constitution-for-england
[Accessed 20 01 2020].
Dr Julie Fish (De Montfort University) , 2007.
Reducing health inequalities for lesbian, gay,
bisexual and trans people - briefings for health and social care staff. [Online]
Available at:
https://webarchive.nationalarchives.gov.uk/20130123192422/http://www.dh.gov.uk/en/Publ
icationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078347
[Accessed 17 04 2020].
Gender Trust, n.d. [Online]
Available at: http://www.gendertrust.org.uk/
[Accessed 17 04 2020].
Lesbian, Gay, Bisexual, Transgender, Queer Plus (LDBTQ+) Resource Centre, n.d.
Gender Pronouns. [Online]
Available at: https://uwm.edu/lgbtrc/support/gender-pronouns/
[Accessed 17 04 2020].
Parliament, 2016.
Transgender Equality Inquiry. [Online]
Available at: https://www.parliament.uk/business/committees/committees-a-z/commons-
select/women-and-equalities-committee/inquiries/parliament-2015/transgender-equality/
[Accessed 17 04 2020].
The NHS Staff Council, 2014.
Guidance relating to disability for the NHS. [Online]
Available at: https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-
reward/Guidance-relating-to-disability-28-Jan.pdf
[Accessed 17 04 2020].
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 9 of 11
Appendix 1: Equality Impact Assessment Form
Department
HR & OD
Service or Policy Policy
Date Completed:
11 November 2016
GROUPS TO BE CONSIDERED
Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young
people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider
community, offenders.
EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED
Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic /
deprivation.
QUESTION
RESPONSE
IMPACT
Issue
Action
Positive
Negative
What is the service, leaflet or policy
To develop better understanding of
Promote the procedure
Improved
development?
our staff about caring for the Trans
across all departments
understanding by
What are its aims, who are the target
community living on the Fylde Coast.
within the hospital.
staff on care for
audience?
Its aim is to promote equal access to
transgender
services.
patients.
Does the service, leaflet or policy/
N/A
N/A
N/A
N/A
development impact on community
safety
•
Crime
•
Community cohesion
Is there any evidence that groups who
There is no evidence at this time as
Consultation with Trans
Positive feedback
should benefit do not? i.e. equal
collating data on transgender people
groups on the Fylde Coast. from the trans
opportunity monitoring of service users is difficult, many are fearful of
community on the
and/or staff. If none/insufficient local or disclosing this information.
Fylde Coast.
national data available consider what
We wil need to consult with this group
information you need.
of people to ensure there is no
negative impact.
Does the service, leaflet or
There should not be any negative or
Monitor for any negative or Improved patient
development/ policy have a negative
adverse impact on any geographical
adverse impact on
experiences for
impact on any geographical or sub
or sub groups of the population.
transgender patients.
the transgender
group of the population?
community.
How does the service, leaflet or policy/ The policy raises awareness of Trust
Promote the policy to all
Reduces any
development promote equality and
staff about interaction/communication
staff across the Trust.
stereotypes or
diversity?
with trans people and respecting their
biases staff may
privacy and dignity.
have about trans
people by helping
them gain
knowledge.
Does the service, leaflet or policy/
The policy development includes a
Improve the training on
Increased
development explicitly include a
commitment to equality and diversity
transgender which wil
knowledge and
commitment to equality and diversity
by meeting the needs of the
impact on the knowledge
understanding
and meeting needs? How does it
transgender community when
and understanding of staff.
should help
demonstrate its impact?
delivering health care. It demonstrates
prevent
this through raising awareness of staff
discrimination and
on the needs of transgender patients.
victimisation
towards this group
of people.
Does the Organisation or service
The organisation employees are
Further work is required
workforce reflect the local population?
reflective of the local population in
clarifying socioeconomic
Do we employ people from
respect of BME – see WRES and
elements.
disadvantaged groups
E&D Monitoring report which includes
doctors. Work commencing on WDES
in 2017. ONS for the Fylde coast.
Data on trans employees is not
collected on ESR but is on the TRAC
recruitment system. People may not
want to disclose they are from a
disadvantaged background.
Wil the service, leaflet or policy/
N/A
N/A
N/A
N/A
development
i. Improve economic social
conditions in
deprived areas
ii. Use brown field sites
iii. Improve public spaces including
creation of green spaces?
Does the service, leaflet or policy/
N/A
N/A
N/A
N/A
development promote equity of lifelong
learning?
Does the service, leaflet or policy/
N/A
N/A
N/A
N/A
development encourage healthy
lifestyles and reduce risks to health?
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 10 of 11
Appendix 1: Equality Impact Assessment Form
Does the service, leaflet or policy/
N/A
N/A
N/A
N/A
development impact on transport?
What are the implications of this?
Does the service, leaflet or
N/A
N/A
N/A
N/A
policy/development impact on
housing, housing needs,
homelessness, or a person’s ability to
remain at home?
Are there any groups for whom this
This policy should have a positive
Identify complaints from
policy/ service/leaflet would have an
impact to improve the care and
the trans community then
impact? Is it an adverse/negative
respect in the provision of healthcare
liaise with trans groups in
impact? Does it or could it (or is the
for transgender patients. It is hoped
the Fylde to address any
perception that it could) exclude
that the policy wil reduce any
issues which have arisen.
disadvantaged or marginalised
disadvantage for the trans community
groups?
in accessing services.
Does the policy/development promote
N/A
N/A
N/A
N/A
access to services and facilities for
any group in particular?
Does the service, leaflet or
N/A
N/A
N/A
N/A
policy/development impact on the
environment
•
During development
• At implementation?
ACTION:
Please identify if you are now required to carry out a Full Equality
No
(Please delete as appropriate)
Analysis
Name of Author:
Tina Daniels
Date Signed:
07/04/2020
Signature of Author:
Name of Lead Person:
Tina Daniels
Date Signed:
07/04/2020
Signature of Lead Person:
Blackpool Teaching Hospitals NHS Foundation Trust
ID No. CORP/GUID/308
Title: Care of Transgender Patients
Revision No: 4
Next Review Date: 05/08/2023
Do you have the up to date version? See the intranet for the latest version
Page 11 of 11
Document Outline