The general guidlines adopted in the main by all PCT heads.



http://www.ncumbria.nhs.u[...]ide.pdf


Surinder Sharma
National Director for Equality and Human
Rights, Department of Health.

Crown Copywrite 2007
Product Code 06 LD044440/o

Licence to reproduce all or in part copy
C.J Shye 14/05/2010 -CRB/3184312


Foreword


This research project was undertaken for the Equalities Review between the
period of July 14th and September 1st 2006. During this 6 week period, the
researchers undertook a mixed quantitative/qualitative approach to collecting and
analysing information on transgender and transsexual people’s experiences
of inequality and discrimination in the UK.


This report is an analysis and summary of the results obtained, and it outlines the
levels of inequality and discrimination that trans people face.
The work undertaken is certainly the largest data collection ever analysed and the
largest survey response ever received when doing research on trans people’s lives.
One can never claim that research data is entirely representative of a community,
even less so when the community being studied consists of many small subcommunities
as is the case with trans people. However, as will be alluded to in the
introduction, the reality of the estimated number of transsexual people in the UK
means that this piece of work reflects the experiences of a substantial section of
the trans community. As such, we are proud of this research, and would claim
that it is as near a reflection of the reality of trans people’s lives as is possible
through data collection.


Acknowledgements
Our contributors, Em Rundall of the Department of International Relations, Politics
and Sociology at Oxford Brookes University for her extensive contribution to our
understanding of contemporary issues in Employment for trans people. Also Ben
Thom, Barrister at Law, who helped again extensively, with our outline of the
current position of trans people within the law.
Christine Burns from Plain Sense1 for providing a significant amount of the
qualitative data analysed, and for other key ‘memory moments’. Angela Clayton
from Press for Change, Emma Cole and Rosie Seymour from the Equalities
Review, and Catherine Little and Melanie Latham from Manchester Metropolitan
University for their guidance and advice.
The Equalities Review for commissioning this work.

Take time to click the link and read on

http://www.pfc.org.uk/fil[...]ies.pdf

BASICALLY

Transsexual people are those who establish a permanent identity with the gender opposite to that which they were assigned at birth. As most legal jurisdictions have at least some recognition of the two traditional genders at the exclusion of other categories, this raises many legal issues and aspects of transsexualism. Most of these issues tend to be located in what is generally considered family law, especially the issue of marriage, but also things such as the ability of a transgendered person to benefit from a partner's insurance or social security.

The degree of legal recognition provided to transsexualism varies widely throughout the world. Many countries now extend legal recognition to sex reassignment by permitting a change of gender on the birth certificate. Many transsexual people have their bodies permanently changed by surgical means or semi-permanently changed by hormonal means. In many countries, some of these modifications are required for legal recognition. In a few, the legal aspects are directly tied to health care; i.e. the same bodies or doctors decide whether a person can go ahead, and the subsequent processes automatically incorporate both matters.

The amount to which non-transsexual transgender people can benefit from the legal recognition given to transsexual people varies. In some countries, an explicit medical diagnosis of transsexualism is (at least formally) necessary. In others, a diagnosis of gender identity disorder, or simply the fact that one has established a different gender role, can be sufficient for some or all of the legal recognition available.

Europe
Several countries in Europe give transsexual people the right to at least change their first name. Most also provide a way of changing birth certificates. Several European countries recognize the right of transsexuals to marry in their post-operative sex. France, Germany, Italy, the Netherlands, Portugal, Romania, Denmark, Finland, Sweden and the United Kingdom all recognize this right.

The situation is different in some eastern European countries. For instance, countries like the Czech Republic have laws governing sex change or, at least, give people the right to change their name and legal documents (Latvia). Other countries like Lithuania do not have any working legislation governing sex change.

United Kingdom
Historically in the United Kingdom, transsexual people had succeeded in getting their birth certificates changed and marriages conducted. However, this was not legally tested until the case of Corbett v Corbett in 1970, where Arthur Corbett attempted to annul his marriage to April Ashley on the grounds that transsexuals were not recognised in English law. It was decided that, for the purposes of marriage, a post-operative transsexual was considered to be of the sex they had at birth.

This set the precedent for the coming decades. People who thought they had existing valid marriages turned out not to - and the previous unofficial changing of birth certificates was stopped.

Transsexual people were able to change their names freely; to get passports and driving licences altered; to have their National Insurance details changed; and so forth. A piece of legislation was also introduced to ban discrimination against transsexual people for employment.

In the 1980s and 1990s the pressure group, Press for Change, helped people take several cases to the European Court of Human Rights about this. In Rees vs. United Kingdom, 1986, it was decided that the UK was not violating any human rights; but, that they should keep the situation under review. The UK government did nothing to look at the situation - and in 2002 in the case Goodwin vs. United Kingdom, it was decided that the rights to privacy and family life were being infringed.

In response to its obligation, Parliament passed the Gender Recognition Act 2004, which effectively granted full legal recognition for transsexual people.

In contrast to systems elsewhere in the world, the Gender Recognition process will not require applicants to be post-operative. They need only demonstrate that they have suffered gender dysphoria, have lived in the 'acquired gender' for two years, and intend to continue doing so until death.

Medical treatment
It has been established by the courts that no National Health Service Health Authority has the right to deny treatment for gender dysphoria as a matter of policy. However, effective access to treatment varies wildly depending upon the policies of the individual Gender Identity Clinics - with some taking a more relaxed approach than others. Transsexual people frequently characterise some centres as arrogant and controlling. A minimum requirement of 24 months real life experience, before a surgical referral is permitted, is not uncommon; and many GICs will force patients to transition before they are allowed access to hormone replacement therapy.

A common alternative for the more well off is to seek private treatment; though most private health insurance plans specifically exclude it. Often, people will seek hormone therapy privately and then later seek surgery on the NHS; which, may prove troublesome because the NHS likes to be involved at all stages of the process.

However, that position has now seemingly been overridden by a subsequent decision, Goodwin v. United Kingdom (11 July 2002) in which the right to marry (Article 12 of the ECHR) and the right to a private and family life (Article 8 ECHR) were infringed by the UK's refusal to allow a post-operative transsexual person to change the gender on their birth certificate (the only conclusive documentary proof of gender in most cases including marriage). One of the factors considered by the Court was the acceptance of gender identity disorder by the UK's National Health Service and the provision of treatment including surgery. Another factor was the fact that the government had effectively done nothing to keep the law under review. The UK must therefore take steps to provide such recognition. In 2004 Parliament implemented its obligation with the Gender Recognition Act 2004.

Its my understanding, that once you have been diagnosed as gender dysphoric/suffer a gender identity disorder and prescribed treatment by way of referal, then you should be entitled to the following care needed, eventually resulting in SRS if so desired. But its obvious that after reading so many reports of people being denied surgery or continually being deffered for surgery, without any real medical reasons in the way of health, its down to a few individuals to allocate treatment and their personal opinions on wether funding should be available. Unfortunately in so many cases, delays cause frustration and depression, the referal teams pick up on this and delay referals, which snowball, and people wonder why the suicide rate for pre-op transexuals in expectation of speedy surgery after completing RLE is the highest per capita of population and the highest in any minority group.

Hospital accommodation of trans people and gender variant children

Transsexual people are protected in law on the grounds of “proposed, commenced or completed reassignment of gender” by the Gender Recognition Act (2004), the Equality Act (2006), and the Sex Discrimination (Amendment to legislation) Regulations (2008): in ‘goods, facilities and services, and premises’.

It is good practice to ensure that transsexual individuals, and also those not specifically covered by these laws, but who fall under the wider ‘trans’ or ‘transgender’ umbrella are accorded patient-centred, respectful, sensitive and flexible responses to their unique gender needs. The entire trans population is protected to some degree by the Human Rights Act 1998, that gives further effect to rights and freedoms guaranteed under the European Convention on Human Rights.

* Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns that they currently use.
* This may not always accord with the physical sex appearance of the chest or genitalia, and
* it does not depend upon their having a Gender Recognition Certificate (GRC) or legal name change;
* it applies to toilet and bathing facilities (except, for instance, that pre-operative trans people should not be required to share open shower facilities);
* views of family members may not accord with the trans person’s wishes, in which case, the trans person’s view takes priority.


In Hospital Wards

Those who have undergone full-time transition to a new gender role should always be accommodated according to their gender presentation.

Different genital or breast sex appearance is not a bar to this, since sufficient privacy can usually be ensured through the use of curtains or by accommodation in a single side room adjacent to a gender appropriate ward. A trans woman in a women’s ward may still need to shave, so privacy must also be ensured for this. Cubicles in toilet and shower facilities should provide adequate privacy for trans people and other patients. The policy of accommodating according to gender presentation may only be varied under special circumstances where, for instance, the treatment is sex specific and necessitates a trans person being placed in an otherwise opposite gender ward. Such departures should be proportionate to achieving a ‘legitimate aim’, for instance, a safe nursing environment.

This may arise, for instance, when a trans man is having a hysterectomy in a hospital, or hospital ward that is designated specifically for women, and no side room is available; or a trans woman is having prostate surgery and is unavoidably placed in a men’s ward. The situation should be discussed with the individual concerned and a joint decision made as to how to resolve it. At all times this should be done according to the wishes of the patient, rather than the convenience of the staff


In Emergency Admissions/ Day Unit

In addition to the usual safeguards, where admission/triage staff are unsure of a person’s gender, where possible, they should ask discreetly where the person would be most comfortably accommodated. They should then comply with the patient’s preference immediately, or as soon as practicable.

If upon admission, it is impossible to ask the view of the person because he or she is unconscious or incapacitated then, in the first instance, inferences should be drawn from presentation and mode of dress. No investigation as to the genital sex of the person should be undertaken unless this is specifically necessary in order to carry out treatment.

Cubicles in toilet facilities provide adequate privacy for those whose outward gender presentation does not accord with their genital sex.

Intensive Care– High Dependency

In addition to the usual safeguards outlined in relation to all other patients, it is important to take into account that immediately post-operatively, or while unconscious for any reason, those trans women who usually wear wigs, are unlikely to wear them in these circumstances, and they may also still grow some facial hair so may be ‘read’, incorrectly, as men. Extra care is therefore required so that their privacy and dignity as women is appropriately ensured.