TL;DR: The Sandyford clinic Gender Service in Glasgow has stopped taking self-referrals from young people and, in a more unusual move, from adults. It’s the latest in a series of policy decisions driven by the Cass Review, and could be part of a dangerous precedent for further restrictions on care for trans adults.
Glasgow’s Sandyford clinic, an NHS clinic which provides the only dedicated gender identity services in the west of Scotland, has announced a change in its referrals policy. Self-referrals will no longer be accepted as a basis for applying to the service from either young people or adults - BBC
Sandyford was previously the only gender service in Scotland that allowed self-referral. The change to the adult service is particularly notable, as many gender identity clinics (GICs) in England still allow adults to self-refer - this change creates a marked difference in policy on the two sides of the Scottish border - TransActual
The move is the latest NHS policy decision to be influenced by the widely-criticised Cass Review. The Review is currently under evaluation by the British Medical Association, following criticism of its methodology by a range of academics and healthcare organisations - QueerAF
While Sandyford will still be running its gender service for young people, like all other NHS clinics it is no longer prescribing puberty blockers following the ban instituted in the spring. This week’s news follows confirmation from the NHS last week that the opening of new gender services for young people in England is being delayed - NHS
What impacts are these policy changes having on trans youth?
Ten days before the news about Sandyford’s policy change broke, the Mail on Sunday published an article quoting the figures of young people referred to the clinic. The figures, obtained via Freedom Of Information requests, reveal that around two-thirds of young people who receive appointments at Sandyford got them through self-referral - Mail on Sunday
The removal of this avenue to access could dramatically reduce the number of young people seen at the clinic, and further increase to waiting lists, which already stretch back at least four years - Scottish Trans
Meanwhile, reporting in the Guardian this week revealed how some trans youth and their families feel about the swathe of changes to trans health policy following the Cass Review - particularly the bans on puberty blockers, which Labour Health Minister Wes Streeting has said he intends to extend - QueerAF
One parent of a trans child, who had previously been recommended puberty blockers by the Sandyford clinic, highlighted how the Cass Review’s claims to protect vulnerable children were not being borne out in their case:
“There are a lot of professionals involved in [my child’s] life; all accept her absolute consistency with regard to gender identification and none have concerns about our parenting. This ban has made an already vulnerable child more vulnerable.”
Analysis: A nominal change, that could set a dangerous precedent
As trans journalist Ayman Erik Eckford wrote for us recently, we can learn a lot by actually listening to children and young people and respecting their agency.
One young person quoted by the Guardian, who the article names ‘Grin’, called the changes to access to puberty blockers “performative”. In their view, “there already was no access” to appropriate healthcare for trans youth, even before the raft of changes driven by the Cass Review.
The same could be said for this change to referral policy. With waiting lists for gender identity services stretching back four years in Scotland and even longer in England, what does it matter that trans young people can no longer self-refer to those services?
It’s hard to argue that this kind of cynicism among trans youth is unjustified. It was that frustration that led Grin and a friend to climb the headquarters of NHS England with a banner during London Pride and occupy the building overnight - DIVA
In the case of Sandyford, while this policy change may seem nominal, the precedent it sets for differences in service between Scotland and England has the potential to be quite significant.
Trans activists and reporters have been warning for a while that the Cass Review could act as a ‘trojan horse’, leading the way for restrictions on healthcare for trans adults as well as trans youth. The change to policy at Sandyford could be the first sign that the horse is approaching the gates.
Sometimes, the devil really is in the details.
It might not sound like a big deal that one clinic is making a change to its referral policy - but do a little digging, connect some threads together, and it becomes an important part of the bigger picture.
That's what we do here at QueerAF: we find the details that matter, and bring them together to tell the whole story. In short, we do what good journalism should.
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