Healthcare is a human right
Healthcare is a human right for all patients, including those who are transgender.(1) The NHS Constitution clearly and proudly states “You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status.”(2) Yet, this week the Secretary of State for Health has announced a move towards removing transgender people from this protection.(3)
This position deeply concerns us at OUTpatients. As the UK’s LGBTIQ+ cancer charity, we cannot help but question:
- How can the NHS purport to advocate for ‘person-centred care’ whilst simultaneously allowing the Secretary of State to exclude people based on their gender identity?
- How do we expect patients to engage with healthcare in a timely manner and adhere to their care if we remove existing policies and guarantees of appropriate care?
- How can the NHS allow this and expect to continue to hold our trust as a community?
Transgender people are not new
We have always been here and exist globally in many wondrous gender variations. The discussion about how to place trans people who are inpatients is also not new. A policy already exists to support this within NHS England which recommends that, where it is found to be most appropriate, a side room can be offered to the patient. As anyone in healthcare knows, spare side rooms are a rare commodity, so if the Secretary were to mandate their use for all trans patients it would simply be unenforceable.
Our trustee Dr Alison Berner, Academic Clinical Lecturer in Medical Oncology & Specialty Doctor in Adult Gender Identity Medicine, shares:
“It is with sadness that I hear the comments of the Secretary of State for Health regarding a potential consultation on accommodation of transgender patients admitted to hospital. Such consultation would represent a step backwards and risks widening health inequalities by further discouraging trans people from accessing medical care.
The priority when any person is admitted to hospital should be attending to their immediate medical need. Searching for a single room could delay care as these are already in high demand, particularly for cancer patients where there is a need to isolate those who are infectious or have weakened immune systems. There are also scenarios when it is safer for patients to be in an open bay, in regular view of medical staff.
If the Government feels that there is not suitable privacy or safety on wards in their current form, this is not going to be changed by excluding trans patients. Instead, they should focus on an investment in NHS buildings and staff.
In my personal view, Mr Barclay’s words are transphobic, implying that trans patients are by default somehow a threat to other patients. A government wishing to uphold dignity, should be fighting for every patient, regardless of gender identity.”
"The war on wokery"
These outlandish assertions form the basis of the “the war on wokery”(4) which has become a fantastically ambiguous construct and strategic tool that allows for opponents of equality to throw anything they dislike into its current definition.
A prime target of this approach is inclusive language, which attempts to describe anatomy and eligibility as a means of clinical accuracy and inclusion. To provide context: To say cervical screening is for all women is a misnomer, it is for those with a cervix. If someone has had a procedure that has completely removed the cervix, they no longer need to attend for cervical screening.
This phrasing is important to help patients make informed decisions about their care, understand their risk, and know which appointments they need to attend. It is important that this information is made available in multiple languages and in Easy Read format. In turn, this approach to information also benefits those who are trans and takes an intersectional view in recognising those trans people with English as a second language, those with a learning disability, and those who are neurodiverse.
The need for this detailed and nuanced approach to information was previously understood and supported by NHS Digital. However, we now have a government that is removing this type of information from webpages, reducing the ability for trans patients and others to make informed decisions about their care. This is not the behaviour one should expect from the Secretary of State for Health.
In truth, sex specific language is alive and well throughout healthcare. Anyone working in the sector knows this fact. The LGBTIQ+ community does not refute its importance, instead we recognise that both sexual characteristics AND gender identity are impactful in patient and public health.
Assuming all aspects of health and medicine are rooted in a person’s sex registered at birth is simplistic and naive. Though some genetic and biological factors can drive disease and ill health, so too can social and gender based factors. For instance, in our community we know that lesbian women smoke at higher rates.(5) This is not due to their biology as we know that heterosexual women smoke at lower rates than men.(6) It is rather an aspect of activity related to social identity and sexual orientation.
As negative reporting on trans people increases(7,8) we see public attitudes decline(9) and hate crime increase at an exponential rate, faster than any other group.(10) With substantial delays to trans healthcare defended(11) and differences in patient experiences identified by NHS and Government surveys(12,13,14) one would expect the Secretary to lead with calls to improve our community’s access to healthcare services, not the opposite.
We are clearly at a crisis point where our community’s health and safety is expendable for political posturing. I fear if we do not vocalise our dissent, the path we are on will only worsen. As a charity, we are proud to stand up for trans rights in healthcare, and as the CEO I personally implore everyone who feels the same to join us in calling out this harmful rhetoric.
Stewart O’Callaghan (they/them)
Founder + Director