Classification of the Gender Identity Development Service as 'Highly Specialised'

The request was successful.

Dear NHS England,

As a point of principle, the NHS promotes localism and patient choice in commissioning services. However, some services are classified as 'Highly Specialised' (or 'Tier 4'), on the basis that they have relatively few patients (this is stated on NHS England's website to be typically less than 500), require specialised staff or equipment, and/or cannot be cost-effectively provided locally, or even regionally.

The Gender Identity Development Service is currently commissioned as Highly Specialised, despite the fact that:
- The service reports receiving 2500 referrals a year (and cannot see those patients in a timely fashion).
- The WPATH standards of care (which the service is required to work to) does not require a particularly uncommon set of staff skills/competencies.
- Care does not require access to specialised equipment or technology.
- Patients and their families have to travel long distances to receive care, and have no choice of provider.

I am therefore requesting:
a) A copy of the most recent report or other document assessing whether GIDS should be classified as Tier 4/Highly Specialised for commissioning purposes. If there have been multiple such documents produced recently, I would like all documents produced in the last 2 years on this subject.
b) The date at which GIDS' status as Tier 4/Highly Specialised will next be reviewed.
c) Details of the process by which service users, their parents/guardians, or members of the public could request or trigger a review of GIDS' status as Tier 4/Highly Specialised.
d) Details of any process by which a service user or their parent/guardian could challenge a decision by NHS England to commission a service in a way which does not allow that patient a choice of provider.

Yours faithfully,

Michael Thomas

CONTACTUS, England (NHS ENGLAND), NHS England

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FOI, England (NHS ENGLAND), NHS England

Dear Michael Thomas,

 

Freedom of Information Request Acknowledgement (Our Ref: FOI-058613)

 

Thank you for your communication dated 18 February 2019.

 

NHS England has assessed your communication as a request under the Freedom
of Information (FOI) Act 2000. As such, please be assured that your
request is being dealt with under the terms of the FOI Act and will be
answered within twenty working days.

 

For further information regarding the FOI Act, please refer to the
Information Commissioner’s Office (ICO) website. For further information
regarding NHS England and the information it publishes please visit our
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If you have any queries about this request or wish to contact us again,
please email [1][NHS England request email] and the message will be
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Please do not reply to this email. This message has been sent from a
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communications are progressed correctly. Their postal address, telephone
number and email details are as follows:- PO Box 16738, Redditch, B97 9PT;
0300 3 11 22 33, [2][NHS England request email].

 

Yours sincerely,

 

Freedom of Information

Corporate Communications Team

Transformation and Corporate Operations Directorate

 

NHS England

PO Box 16738

REDDITCH

B97 9PT

 

Tel: 0300 311 22 33

Email: [3][NHS England request email]

 

‘Health and High quality care for all, now and for future generations’

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FOI, England (NHS ENGLAND), NHS England

Dear Michael Thomas,

 

Re:     Freedom of Information request (Our Ref: FOI-058613)

 

Thank you for your Freedom of Information (FOI) request dated 17 February
2019

 

Your exact request was:-

 

“As a point of principle, the NHS promotes localism and patient choice in
commissioning services. However, some services are classified as 'Highly
Specialised' (or 'Tier 4'), on the basis that they have relatively few
patients (this is stated on NHS England's website to be typically less
than 500), require specialised staff or equipment, and/or cannot be
cost-effectively provided locally, or even regionally.

 

The Gender Identity Development Service is currently commissioned as
Highly Specialised, despite the fact that:

- The service reports receiving 2500 referrals a year (and cannot see
those patients in a timely fashion).

- The WPATH standards of care (which the service is required to work to)
does not require a particularly uncommon set of staff skills/competencies.

- Care does not require access to specialised equipment or technology.

- Patients and their families have to travel long distances to receive
care, and have no choice of provider.

 

I am therefore requesting:

a) A copy of the most recent report or other document assessing whether
GIDS should be classified as Tier 4/Highly Specialised for commissioning
purposes. If there have been multiple such documents produced recently, I
would like all documents produced in the last 2 years on this subject.

b) The date at which GIDS' status as Tier 4/Highly Specialised will next
be reviewed.

c) Details of the process by which service users, their parents/guardians,
or members of the public could request or trigger a review of GIDS' status
as Tier 4/Highly Specialised.

d) Details of any process by which a service user or their parent/guardian
could challenge a decision by NHS England to commission a service in a way
which does not allow that patient a choice of provider.”

NHS England holds some information in relation to this request.

 

 a. A copy of the most recent report or other document assessing whether
GIDS should be classified as Tier 4/Highly Specialised for
commissioning purposes. If there have been multiple such documents
produced recently, I would like all documents produced in the last 2
years on this subject.

 

The Gender Identity Development Service was designated by Ministers in
2009 as a nationally commissioned, highly specialised service. At the
time, the service was commissioned by the National Specialised
Commissioning Team, who were hosted by London Strategic Health Authority.
Prior to the putting into place of the current commissioning structure in
2013, recommendations on which services were to be prescribed specialised
services were made to Ministers in 2012 by the Clinical Advisory Group
("CAG") which was established by the Department of Health for that purpose
following which Ministers accepted the full recommendations of CAG, as
published in 2012. The following report was published by the Department of
Health:

 

[1]https://www.gov.uk/government/publicatio...

 

The report states: ‘We were not asked to review the list of services
currently included in regulations and commissioned by the National
Specialised Commissioning Team. We have included mention of these where
they appear in definitions but accept that the inclusion in regulations as
a highly specialised service can be taken to mean the service will be
prescribed.’ The report goes on to list those highly specialised services
that were set out in regulations at that time, i.e. The National Health
Service (Functions of Strategic Health Authorities and Primary Care Trusts
and Administration Arrangements) (England) (Amendment) Regulations 2012
[Statutory Instrument 2012 No. 417]. The ‘Gender Identity Development
Service for Children and Adolescents’ is included in this list of services
with the following definition ‘Gender identity development services
include services provided by Highly Specialist Gender Identity Development
centres including outreach when delivered as part of a provider network.’

 

 b. The date at which GIDS' status as Tier 4/Highly Specialised will next
be reviewed.

 

There are no plans to review the specialised commissioning status of
services for the alleviation of gender dysphoria in children and
adolescents.

 

 c. Details of the process by which service users, their
parents/guardians, or members of the public could request or trigger a
review of GIDS' status as Tier 4/Highly Specialised.

 

The designation of a service as a prescribed specialised service is a
decision made by the Secretary of State for Health by virtue of the
National Health Service Commissioning Board and Clinical Commissioning
Groups (Responsibilities and Standing Rules) Regulations 2012. As such,
NHS England has not established a process by which service users, their
parents/guardians, or members of the public could request or trigger a
review of GIDS' status as a specialised service.

 

 d. Details of any process by which a service user or their
parent/guardian could challenge a decision by NHS England to
commission a service in a way which does not allow that patient a
choice of provider

 

NHS England has not established a specific process by which a service user
or their parent/guardian could challenge a decision by NHS England to
commission a service in a way which does not allow that patient a choice
of provider. However, in accordance with NHS England’s statutory duties to
engage and consult with stakeholders and the public in commissioning
decisions NHS England routinely engages and consults with stakeholders,
for example most recently in 2016 when NHS England published a proposed
service specification and clinical commissioning policy for the Gender
Identity Development Service for public consultation, supported by face to
face events. If you wish to register as a stakeholder with NHS England’s
Specialised Commissioning Team you can find details of how to join here
[2]https://www.england.nhs.uk/commissioning...

 

Also, if you wish to raise your concerns with NHS England in a more
detailed way you may write to the Customer Contact centre;

 

By Writing:    NHS England

PO Box 16738,

Redditch,

B97 9PT

 

By Email:      [3][NHS England request email]

 

Copyright:- NHS England operates under the terms of the open government
licence. Please see the NHS England Terms and conditions on the following
link [4]http://www.england.nhs.uk/terms-and-cond...

 

We hope this information is helpful. However, if you are dissatisfied, you
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NHS England

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REDDITCH

B97 9PT

 

Email: [5][NHS England request email]

 

Please quote the reference number FOI-058613 in any future communications.

 

If you are not content with the outcome of the internal review, you have
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Please be aware that in line with the Information Commissioner’s directive
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anonymised and published on our website as part of our disclosure log.

 

Please do not reply to this email. This message has been sent from a
central mailbox. To communicate with NHS England regarding Freedom of
Information (FOI) requests, enquiries or complaints we ask these are sent
directly to NHS England’s customer contact centre. This is to ensure all
communications are progressed correctly. Their postal address, telephone
number and email details are as follows:- PO Box 16738, Redditch, B97 9PT;
0300 3 11 22 33, [8][NHS England request email].

 

Yours sincerely,

 

Freedom of Information

Corporate Communications Team

Transformation and Corporate Operations Directorate

 

NHS England

PO Box 16738

REDDITCH

B97 9PT

 

Tel: 0300 311 22 33

Email: [9][NHS England request email]

 

‘Health and high quality care for all, now and for future generations’

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