*Updated 26/11/24 correcting a couple of typos & amended title to better reflect content.
Despite not having all the data I need for a full update thanks to the continued stonewalling by the Sandyford in Glasgow in releasing correct information, I’ve got enough data to do a 99% complete update.
This update will look at data at a country & national level, with some indicative commentary at clinic level. When (if) this data is received in relation to the missing data from Sandyford I’ll update this article to reflect that. After that Im planning a deeper dive at data & GIC level.
This analysis represents a snapshot as of end of March 2024 (the end of the 23/24 financial year, which runs from April through to March), compared to the 22/23 financial year. Figures are rounded which may result in some slight differentials, and excludes pilot schemes.
As previously, the data set will be released for public use one it is fully complete.
Let's start with one of the strongest performers from my first report.
Wales
Wales is served primarily by the Welsh Gender Service (WGS), which is basically a hub / spoke model comprised of a central hub service served by 6 local clinics run by GPs. Its service model is the nearest we have in the UK to an ‘informed consent’ model. Overall, Wales / WGS appears to be maintaining its service performance, although it has declined slightly and there is an anomaly with regards to waiting list data which could do with a follow up question.
Referrals: increased by an average of 12 per calendar month (PCM) from 93 to 105, which equates to an increase of 13%. Wales comprises of 9% of all referrals made to gender services in the UK, despite only comprising around 3.5% of the trans / gender diverse community according to Census 21.
Waiting List: decreased by 121 in total from 1235 to 1114, a decrease of almost 10%. This represents 2.65% of the total UK waiting list. My projected waiting time for an initial assessment remains consistent with that reported on the WGS web site.
Initial Assessments (IAs): decreased by an average of 23 PCM from 92 down to 69, a decrease of 25%.
Total Appointments: decreased by an average of 46 PCM from 175 down to 128, a decrease of 26%. Excluding IAs this actually represented a drop of 23 PCM from 83 down to 60, a decrease of 28%.
Total Treatment Duration: Not Available.
Duration between IA & 2nd Appt: Not Available.
All Clinical Staff: decreased by 1.7 Full Time Equivalent (FTE), from 11 to 9.3, a decrease of 15%, included in this are diagnostic staff (those capable of providing a diagnosis of gender dysphoria / gender incongruence), which decreased by 1 FTE, from 4.6 to 3.6, a decrease of 22%. The decrease in staffing would appear to explain the drop in appointments delivered.
Appts Per Clinician: IAs delivered decreased by 1 PCM, from 20 to 19, a drop of 4%. Total Appointments delivered (excluding IAs) decreased by 1 PCM from 7 to 6, a drop of 15%.
Admin Staff: No change
Total Budget: No change. Wales comprises of 5.5% of the UK gender services budget.
Referrals vs Initial Assessments: The WGS conducts 1 IA for every 1.5 referrals received, up from 1 to 1 the previous year. Overall this would mean waiting lists should be seen to increase, however as can be seen from the graph below they have decreased in a way which is inconsistent with the data.
Waiting Lists vs Referrals: While the graph below appears positive, the decrease in the waiting list may be caused by a number of different factors, especially given that the number of appointments delivered by the GS has declined. This drop could, for example, be caused by people being removed from the list.
Northern Ireland
NI is served primarily by a single clinic located in Belfast.
Referrals: increased by an average of 2.5 PCM from 17 to 19.5, which equates to an increase of 13%. NI comprises of 1.7% of all referrals made to gender services in the UK, despite only comprising around 2.6% of the trans / gender diverse community according to Census 21.
Waiting List: increased by 167 in total from 736 to 903, an increase of almost 23%. This represents 2.15% of the total UK waiting list. Waiting time listed for this GIC on their website remains deeply inaccurate, and substantially out of line with my projected waiting time model.
Initial Assessments (IAs): decreased by an average of 2 PCM from 2.3 down to 0.5, a decrease of 78%.
Total Appointments: Not Available.
Total Treatment Duration: Not Available.
Duration between IA & 2nd Appt: Not Available.
All Clinical Staff: decreased by 1 FTE, from 3 to 2, a decrease of 33%, included in this are diagnostic staff (those capable of providing a diagnosis of gender dysphoria / gender incongruence), which has remained the same at 2 FTE. As the number of diagnostic staff has not changed at all, there is no discernable reason for the number of IAs being delivered to decrease so dramatically, although it might be accounted for by total appointments delivered, which are not recorded by the GIC.
Appts Per Clinician: IAs delivered decreased by 0.9 PCM, from 1.1 to 0.25, a drop of 78%.
Admin Staff: No change
Total Budget: Increased by £16,935 compared to 22/23, an increase of 5.6%. Likely to have been spent on increased clinician wages. NI represents 1.3% of the total UK gender services budget.
Referrals vs Initial Assessments: NI conducts 1 IA for every 39 referrals received, up from 7.7 to 1 in the previous year, accounting for the continued increase in waiting lists.
Waiting Lists vs Referrals: As we can see from the graph below, the increase in the waiting list continues to outstrip the number of referrals, which have essentially remained static when the referral decreases due to Covid are factored (19/20 & 20/21)
Scotland
Scotland is served by 4 GICs, Glasgow, Edinburgh, Grampian and Highland. Interestingly, Grampian GIC is now recording data it was previously unable to provide.
Due to Sandyford withholding data this section is incomplete. Where data is incomplete this will be indicated, and updated at a later date.
Referrals: decreased by an average of 3 PCM from 97 to 94, which equates to an decrease of 3%. Scotland comprises of 8% of all referrals made to gender services in the UK, in line with the Census 21 population proportion. Previous years did not include Grampian GIC data as they did not hold this information, but they were able to provide it this time, which will skew the figures slightly.
Waiting List: increased by 1059 in total from 3528 to 4587, an increase of 30%. This represents 11% of the total UK waiting list. NHS Waiting times listed for these GICs remain deeply inaccurate, and substantially out of line with my projected waiting time model.
Initial Assessments (IAs): data incomplete
Total Appointments: data incomplete
Total Treatment Duration: Not Available.
Duration between IA & 2nd Appt: Not Available.
All Clinical Staff: data incomplete
Appts Per Clinician: data incomplete
Admin Staff: data incomplete
Total Budget: Increased by £1,001,720 compared to 22/23, from £1.4M to £2.4M, an increase of 71%. Edinburgh GIC saw its budget more than double to £692,000 (+114%), while the other GICs saw increases of between 50% and 80%. Scotland comprises 5.8% of the total UK gender services budget.
Referrals vs Initial Assessments: data incomplete
Waiting Lists vs Referrals: As we can see from the graph below, the increase in the waiting list continues to outstrip the number of referrals. While referrals have increased by 51% over the last 6 years, the actual numbers remain modest, representing an additional 30 referrals PCM nationally in that timeframe.
England
England is served by 7 GICs across the country, as well as a number of pilot services. Please note that this data does not include pilot services except for Nottingham / East of England, where the data is merged by the GIC.
At this point in requesting data the pilot services were still in ‘pilot’ phase, meaning that their data would be unrepresentative of an operational GIC. Several services have since moved to full operation during 2024, and these will be included next year’s update.
Referrals: increased by an average of 201 PCM from 753 to 954, which equates to an increase of 27%. England comprises of 81% of all referrals made to gender services in the UK, around 5% lower than the Census 21 population proportion. Causes of this increase are not available from the data, however speculatively I would offer that increasing uncertainty in availability of gender services coupled with fear of those services being removed or restricted further are likely to be be the prime drivers for this increase.
Waiting List: increased by 5825 in total from 29543 to 36368, an increase of 20%. This represents 84% of the total UK waiting list. NHS Waiting times listed for these GICs remain deeply inaccurate, and substantially out of line with my projected waiting time model. Nottingham / East of England also appear to be underestimating their waiting time by around 12 months.
Initial Assessments (IAs): IAs delivered by GICS in England decreased by 86 PCM, from 300 to 214, a drop of 29%. Only Exeter (+5 PCM) and Sheffield (+13 PCM) increased the number of initial assessments delivered, and both Leeds (-34 PCM) and Nottingham / EoE (-54 PCM) saw significant decreases.
Total Appointments: increased by 59 PCM, from 3226 to 3284, an increase of 1.8%. Excluding IAs this actually represented a rise of 144 PCM from 2925 up to 3070, an increase of 5%. Most GICs appear to have shifted focus to providing additional appointments for those already in the system and this is reflected accordingly in the data, with the exception of Nottingham / East of England which has seen a substantial decline in the total number of appointments (excluding IAs), dropping by a shocking 300 PCM, a decrease of 35%.
Total Treatment Duration: increased by of 258 days, from 1475 days to 1733 days, an increase of 18%. Note that this is not fully complete as Northants GIC was unable to provide this data this year, so shouldnt be considered representative.
Duration between IA & 2nd Appt: increased by 36 days, from 321 days to 357 days, an increase of 11%. Newcastle is the worst offender, increasing from 475 to a shocking 1103 days. This delay between appointments has doubled over the last 6 years.
All Clinical Staff: decreased by 15 FTE, from 142 FTE to 126 FTE, a decrease of 11%. However, the number of diagnostic staff increased by 16 FTE, from 51 FTE to 66 FTE, an increase of 31%.
Appts Per Clinician: Average IAs per clinician dropped by 2.5 PCM, from 5.75 PCM to 3.25 PCM, a decrease of 43%. Total appointments (excluding IAs) per clinician increased by 6 PCM, from 20 PCM to 26 PCM, an increase of 29%. This also reinforces the finding that GICs have shifted focus from providing initial assessments to other appointments, a move which will only serve to increase waiting lists in the short to medium term.
Admin Staff: decreased by 20 FTE, from 90 FTE to 70 FTE, a decrease of 22%. London and Northants GICs saw the biggest drops in admin staff, with each dropping by around 50%.
Total Budget: Increased by £1.63M compared to 22/23, from £18.4M to £20M, an increase of 9%. Both Exeter (+£390K) and Northants (+£953k) saw significant increased to budget, while Nottingham / East of England saw its budget drop by £676K, or 20%. England comprises 77% of the total gender services budget of the UK despite having 86% of the trans / gender diverse population.
Referrals vs Initial Assessments: In England, 1 IA is conducted for for every 4.4 referrals received, up from 2.5 to 1 in the previous year. This accounts for the continued increase in waiting list volume. Nottingham has seen a substantial decline in this area, with their ratio increasing from 1 IA conducted per referrals received to 1 IA for every 2.5 referrals received, as has Leeds going from 2.4 to 7.5 referrals per IA. London GIC remains the worst GIC in England on this metric, going from 3.4 to 5.1 referrals for every IA conducted.
Waiting Lists vs Referrals: As we can see from the graph below, the increase in the waiting list continues to outstrip the number of referrals. While referrals have increased by 29% over the last 6 years, the actual numbers remain modest, representing an additional 218 referrals PCM nationally (average 31 per clinic PCM) in that timeframe.
UK
As noted previously, the national picture remains incomplete due to the Sandyford withholding data. That said, enough data remains to paint a picture of services continuing to decline thanks to suspected political interference from the previous Tory administration.
Referrals: increased by an average of 213 PCM from 906 to 1173, which equates to an increase of 22%, most of which is accounted for by England.
Waiting List: increased by 6930 in total from 35042 to 41972, an increase of 20%. This was slightly less than my initial model predictions, but in line with expectations.
Initial Assessments (IAs): IAs delivered by GICS across the UK decreased by 93 PCM, from 427 to 337, a drop of 22%, with decreases across almost the whole UK, but most significantly in England.
Total Appointments: increased by 33 PCM, from 3807 to 3840 (not inc Northern Ireland), an increase of 1.1%. Excluding IAs however this actually represented a rise of 129 PCM from 3383 up to 3512, an increase of 4%.
Total Treatment Duration: Most GICs do not record this data, only England, so no national information is available.
Duration between IA & 2nd Appt: Most GICs do not record this data, only England, so no national information is available.
All Clinical Staff: data incomplete
Appts Per Clinician: data incomplete
Admin Staff: data incomplete
Total Budget: Increased by £2.65M compared to 22/23, from £21.5M to £24.1M, an increase of 12%, with the vast majority of that increase applying to Scotland.
Referrals vs Initial Assessments: data incomplete.
Waiting Lists vs Referrals: The increase in the waiting list continues to outstrip the number of referrals. While referrals have increased by 40% over the last 6 years, most of that increase occurs in England over the last year, and the actual numbers remain modest, representing an additional 335 referrals PCM nationally (average 26 per clinic PCM) in that timeframe.
Conclusions
As we can see from the partial (but almost completed) picture presented above, NHS gender service performance has continued to decline in the 23/24 financial year, with waiting lists continuing to increase and clinician performance substantially degraded compared to six years ago.
Most telling is the large rise in referrals in England, which I suspect is the result of fear in services being removed or made more difficut to access in the future, causing people to ‘get in the system’.
And like previously, the NHS and the UK Government continue to do absolutely nothing constructive about it.