How one family’s bravery can make a difference: the Alice Litman inquest

Content warning: mentions of suicide.

TL;DR: An inquest into the death of Alice Litman, a young trans woman who died by suicide last year, has stated that gender-affirming care is ‘underfunded and insufficiently resourced’ in the UK. The Litman family told the inquest that delays in accessing care were partly to blame for her death.

The inquest into the death of Alice Litman was held this week at Brighton and Hove Coroner’s Court.

Over three days, the court heard evidence from the Litman family, the Tavistock and Portman gender identity clinic, Alice’s GP, a local NHS trust, and online gender clinic GenderGP - The Argus

Alice Litman was referred to the NHS Gender Identity Development service in 2019. At the time of her death, over 1000 days later, she was still waiting to be seen for an initial assessment - Bindmans

There are over 13 thousand people currently on the waiting list for the Tavistock and Portman clinic alone.

The inquest heard that, if service provision continues at the current rate, it would take over 20 years for someone referred today to be seen. The NHS target from referral to appointment is 18 weeks - The Tortoise

In a statement ahead of the inquest, the Litman family said:

“We want the coroner to recognise failings in trans healthcare as a cause of Alice’s death so we can get justice - and push for changes that will improve the lives of other trans people” - PinkNews

What happened at the Alice Litman inquest?

Medical professionals from national and local services told the inquest about the shortcomings of trans healthcare in the UK.

Dr James Barrett of the Tavistock and Portman NHS trust said that the number of patients currently seeking gender affirming healthcare was an “order of magnitude” greater than the service was designed for - BBC

Dr Samuel Hall, a GP at a practice in Brighton where Alice was a patient, emphasised that GPs could and should be prescribing hormones for trans patients waiting for gender identity clinic appointments:

“GPs can and should be doing this. Not least because we can get to people sooner” - PinkNews

Adjourning the inquest on Wednesday, Assistant Coroner Sarah Clarke said services for trans people in England are “underfunded” and “insufficiently resourced”.

Clarke will be issuing recommendations to NHS bodies to help prevent future deaths and will announce her findings in a report in two weeks - Brighton and Hove News

What is the state of trans healthcare in England?

A statement from the Department of Health and Social Care in relation to Alice’s death highlighted NHS England’s investment of “nearly £8 million in the new gender identity pilot clinics” - The Tortoise

Three of these new pilot projects – in London, Manchester and Merseyside – opened in 2020, and a fourth opened in the East of England in May 2021. That summer, the NHS commissioned a community consultation into a proposed fifth pilot in Sussex - Clare Project

That same Sussex clinic is due to open this month, September 2023. An NHS report for Brighton and Hove Council published this March notes that there is a total lack of gender identity clinics in the South East of England, but does not comment on why the pilot scheme serving that region took so much longer to set up than the four other pilots - Brighton and Hove Council

Analysis: Families shouldn't have to be so brave, for such great change to happen

As Mike Webberley of GenderGP made clear in his statement to the inquest, the story of Alice Litman’s death is about more than just long waiting times. It’s part of a bigger picture of discrimination and prejudice that trans people face throughout society - GenderGP

We cannot count on courts and inquests to solve all the problems contributing to tragedies like this. As we saw in the Covid-19 inquiry this week, this government will do everything it can to avoid playing ball with the legal system.

But this inquest does provide some hope for the future. As the inquest was closing, Litman’s family said:

“We’re absolutely delighted that the extent of the wait list has finally been acknowledged [by the NHS]”.

It may not seem like much, but that is a significant milestone.

The bravery of people like the Litman family, who faced reliving their tragedy on a public stage to improve the lives of trans people, is a powerful asset in the struggle for trans rights.

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