GICs do not serve our community: protesting for their abolition with Transgender Action Block
As the majority of trans people in the UK know, the NHS trans healthcare system fails us and their legal requirements of care on almost every level. The Gender Identity Clinics (GICS) – the segregated form of healthcare provision for trans people in the UK – are all but defunct due to their dangerous waiting lists: those being referred today, should expect to have their first appointment in 27 years. No one can be asked to wait this long for healthcare, and many of our siblings have died waiting. By the time many of us get our first appointments, we’ve already spent fortunes on our transitions and nearing the medical ‘end’ of the process. Many of us have turned to less than ideal DIY routes or expensive private care as our only alternatives. Particularly in the private route, doctors end up profiting enormously from trans people’s desperation, adding to the precarity of trans lives. In this crisis, the NHS has established a select number of GICS pilots. Although somewhat of a relief, these clinics already have extensive waiting lists, arbitrary eligibility conditions and continue the segregation of healthcare.
In light of this continuing crisis, Transgender Action Block held a protest on Saturday 4 December calling for the abolition of GICS. Held outside the NHS Commision in Elephant and Castle, the group had 5 key demands:
1) an informed consent model of care
2) the abolition of segregated gender identity clinics
3) no more segregated pilot schemes
4) the resumption of puberty blockers for trans youth
5) equity of treatment in all aspects of healthcare.
The just under a hundred trans people and allies in attendance joined in a spirit of frustration, longing, loss, anger and glints of hope. Everyone was frustratingly familiar with the indignity of this system, patience running thin if not wholly exhausted, some seriously harmed by inadequate care or having lost friends and family to this willful negligence. As the veteran trans healthcare advocate Jack Doyle acknowledged in the opening speech “This is a system that is invested in making us suffer [but]…this is the first time I have hope that we’re not going to die out here waiting for change.”
At the core of these demands, the policy thread that holds it all together was the demands for an informed model of consent. The informed consent model, adopted in countries like the US and Canada gives trans people the autonomy over their bodies, without a gender dysphoria diagnosis and the right to work with their GP as a primary healthcare provider to gain access to hormones, therapies and surgeries. Doyle gave an example of how this isn’t a utopian dream but in fact a reality, sharing that “someone in New York decided to take hormones last week and are picking them up today.” Under the current UK system, the NHS spends huge resources on diagnosing gender dysphoria, which pathologises trans people and creates these unacceptable waiting lists. This system, as Hazel from Reclaim Brighton Pride shared, resulted in a 7 year wait for her to get hormones, starting from her first appointment at 16. Having to get a diagnosis before receiving treatment, she was asked invasive and irrelevant questions about her sex life and the gender of her partners. The informed model of consent would allow trans people autonomy over their bodies with dignity and respect and streamline a system that is burdened by outdated, inefficient and humiliating diagnoses.
“When the ethos and resources are available, the system does not have an issue with providing gender affirming care. The problem being, the system does not see trans healthcare as healthcare.”
Much of the gender affirming healtcare trans people need is already provided to cis people through their GPs, including hormones, breast augmentation, fertility treatment and gender affirming prostheses. In no other NHS services do patients face such barriers. As an amputee, once I moved to the UK from Ireland I was immediately offered care without assessment. I was provided with a new prosthetic leg once a year, plus associated care worth tens of thousands. In addition, once I transitioned my name was changed, my files under my deadname archived, I was moved to the female consultation room, and given a high heel prosthetic left. When the ethos and resources are available, the system does not have an issue with providing gender affirming care. The problem being, the system does not see trans healthcare as healthcare. As Chey from Trans Action stated “We’re trans people. To them we’re trans. We’re not people.” A clear example of this negligence is the fact trans men and non-binary people undergoing the 3 stage phallosplasy (bottom surgery) have been left in limbo, by the NHS cancelling the only contract they had for the procedure, with “some people waiting for 4 years for their next stage of phalloplasty” Chey shares.
It is clear that we as trans people have the knowledge, ability and systems in place to care for ourselves and our siblings. We have established systems of care such as mutual-aid groups, chat rooms, hormones sharing resources, fundraisers and clinics such as CliniQ. As Jack Doyle said: “We are really good at looking after ourselves… if we want to win, we have to learn from ourselves and our queer ancestors.” What the Transgender Action Block action demanded was that trans people be trusted to be at the centre of their own care and for the NHS to facilitate that, not build barriers. As Abigail Thorn makes clear “The NHS is breaking the law by not treating us. We have waited for years. We have waited for decades. People have died, as victims of this negligent manslaughter”
As the speeches came to an end, we held a die in as a solemn act of mournful resistance. As we lay on the cold ground, it felt as if we all had our siblings who could not bear the wait any longer on our minds. On my way home with a sister, I reflected on the clarity of the demands and how we for too long have not asked enough; asked for what we truly need. As Abigail sardonically quipped “I’d hate to repeat what they’re asking for in Germany. Asking for an apology, asking for compensation and asking for resignations!”
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