The High Court has rejected our attempt to challenge the long waiting times experienced by trans people seeking help from the NHS. The waits are measured in years rather than weeks and months. We will seek permission from the Court of Appeal to try and overturn this decision.  

It’s always disappointing to lose a case, especially when the loss impacts on people already discriminated against in society. 

The fact remains that NHS England has a duty to see 92% of those referred to specialist healthcare services within 18 weeks. The average waiting time for young transgender people is nearly three years, and many adults face waits of four years or more.  

Good Law Project went to court last November to challenge these unacceptably long waits. Sadly the Judge decided that: “NHS England is doing all it can reasonably be expected to do to reduce waiting times”. Obviously we disagree. 

In a positive development the Judge rejected the NHS’s argument that young people seeking gender reassignment are not protected under the Equality Act 2010. This is an important legal conclusion and is likely to have wider implications for young people in the trans community.

Claimant Eva Echo said:

“I’m extremely disappointed by the decisions overall, which only serve to prolong the mental health suffering of the trans community, and I welcome the chance to appeal. I also welcome clarification that trans youths are protected under the Equality Act 2010, which will provide more people with protection against discrimination.”

We are very grateful to those who took on this case: Eva and Alex, two child claimants and the trans-led grassroots charity Gendered Intelligence.

Whilst this is not the outcome we hoped for, we will continue to do what we can to help trans and non-binary people live their lives free from inequality. 

We’re proud of our record in supporting the trans community.  We have won two out of the three cases brought to help strengthen the rights of trans and non-binary people. 

Thank you for your support.

On 29 and 30 November, the court heard our claim – brought alongside five co-claimants: adult claimants Eva and Alex, two child claimants, and trans-led grassroots charity Gendered Intelligence – that these waiting times, and other failures in trans healthcare services, are discriminatory and unlawful.

David Lock KC, speaking on behalf of the six claimants, outlined the ‘extreme’ waiting times faced by trans people when accessing specialist healthcare – as much as four years for young people and five for adults.

He set out that, while the NHS has taken some steps to remedy this situation, these waiting times have continued to get longer and longer, and this situation predates the pandemic by a long margin. 

He argued that the NHS has been acting unlawfully, given that it is required to see 92% of those referred within 18 weeks – a requirement which, he explained, is a hard-edged legal obligation, not a discretionary target duty. As of August 2022, he said, there are 26,234 adults waiting for a first appointment, 90% of whom have been waiting more than 18 weeks. 

He then turned to highlight the discrimination faced by the four individual claimants in this case given the significantly longer waiting times faced by trans patients for specialist healthcare compared to other patients. 

Finally, he argued that NHS England is in breach of its public sector equality duty, as it hasn’t sufficiently considered the impact that decisions it has made regarding the provision of specialist healthcare has on trans patients. 

In a witness statement presented to the court, Eva highlighted how she felt ‘ignored’ by the NHS during her five-year wait for treatment, stating: “Nobody should have to go through this painful indefinite limbo, just to be able to carry on with their life.” Meanwhile, Alex said the lengthy waiting times had caused him ‘extreme distress’ and made him feel ‘helpless’.

Following David Lock KC’s submissions, Eleanor Grey KC – on behalf of NHS England – argued that the NHS is not in breach of its duties as the 92% obligation is a ‘target’ duty to ‘make arrangements to ensure’ patients access care, and that they are making efforts to achieve these targets. 

Despite this, she acknowledged the 92% duty was being breached, saying that this predated – but has been worsened by – the pandemic. She argued that a declaration of unlawfulness should not be made. 

We and our co-claimants are asking the court for a declaration that NHS England has been acting unlawfully in relation to its provision of healthcare to trans children and adults. While we recognise the strain NHS England is under, it must fulfil its legal duty to provide timely treatment.

We expect a judgment within a few weeks or months. 

You can read the claimants’ skeleton argument here and the defendant’s skeleton argument here. You can also read witness evidence on the claimants’ side from Gendered Intelligence, Eva Echo, Alex Harvey and Jo Maugham and on the defendant’s side from Jeremy Glyde (here and here) and Andrew Jackson.

You can also read the expert witness statement from academic specialist Dr Michael Toze, which provides important background to the case.

If you are in a position to support the fight for trans healthcare rights, you can donate here. We are grateful for your support.

We’ll be in court at the end of the month to challenge NHS England over long-standing, lengthy and unlawful delays to meeting the trans community’s healthcare needs.

On November 29 and 30, we and our co-claimants will be arguing that these waiting times - and other failures in trans healthcare services - are discriminatory and unlawful.

Here’s what you need to know about the case. 

What’s the issue?

NHS England has a legal duty to see 92% of children and young people who are referred to the Gender Identity Development Service (GIDS), and adults referred to the Gender Dysphoria Clinics (GDCs, previously GICs) within 18 weeks. 

Despite this, the average waiting time for young people is nearly three years, with some waiting significantly longer. Similarly, many adults have faced wait times of four years or more. 

This means thousands of people are being denied the specialist healthcare they need, which can have serious consequences for their mental health. Eva Echo, one of the claimants in this case, explained: “I would describe being on the waiting list as torture, and there were times when I felt that I may not even be alive long enough to receive my first appointment. Being on the waiting list was no comfort; I desperately needed help.”

These delays also mean teenagers are missing the short window of time in which they can secure puberty blockers, if they need them. With such a long wait for safe treatment, some feel they have no choice but to self-medicate with drugs purchased on the dark web.

This situation predates the pandemic by a long margin. 

Why is this happening?

In England, it is almost impossible for trans people to get timely access to healthcare they are entitled to. One reason for this is the sheer lack of specialist centres. 

There is just one service for trans young people in the whole of England, though the closure of this service and its replacement with a “localised approach” has been announced for Spring 2023. There are only a handful of services for adults. 

The UK is an international outlier when it comes to the lack of trans healthcare, particularly for young people. 

What are we doing about it?

We’re bringing a claim against NHS England alongside two adult claimants, Eva and Alex, two child claimants, and trans-led grassroots charity Gendered Intelligence, arguing that it is failing to fulfil its legal duty of offering a first appointment within 18 weeks. 

We are also arguing that these waiting times are discriminatory, as the delays faced by trans people are far longer than those faced by other people waiting for treatment. 

This is about individuals getting important and, in some cases, life saving care. 

What are we hoping to achieve?

We are asking the court for a declaration that NHS England has been acting unlawfully in relation to its provision of healthcare to trans children and adults. 

While we recognise the strain NHS England is under, it must fulfil its legal duty of offering a first appointment within 18 weeks.

The Government must start listening to trans people, their families and medical experts about the care they need and commission more services so people are not deprived of the healthcare and support that is readily available in other countries. 

_________________________

You can read witness evidence from Gendered Intelligence, Eva Echo, Alex Harvey and Jo Maugham. Read our main grounds here. 

You can also read the expert witness statement from academic specialist Dr Michael Toze, which provides important background to the case.

We are pleased to inform you that a hearing date for our challenge over the longstanding delays and barriers to healthcare for trans people has now been allocated by the Court. 

The case will be heard over 1.5 days on 29th and 30th November 2022. 

We will update you as the preparation for the hearing progresses. 

Thank you, as always, for your support. 

Solidarity.

This week, we received the fantastic news that we have permission to bring our legal challenge against trans healthcare failures to court.  

For too long, trans people have faced life-altering - and sometimes life-threatening - waits for specialist NHS healthcare. We believe that these waiting times, and other failures in trans healthcare services, are discriminatory and unlawful. The delays predate the pandemic by many years. 

Eva Echo, one of the claimants in this case, explains the impact of waiting so long for treatment: 

"I would describe being on the waiting list as torture, and there were times when I felt that I may not even be alive long enough to receive my first appointment. Being on the waiting list was no comfort; I desperately needed help. 

"My mental health was worse than it had ever been. Coming out had allowed me to recognise my gender dysphoria, but I was left completely alone to manage it. I felt, and still feel, completely let down by the system that I thought was there to save me."

Alongside our two adult claimants, Eva and Alex, two child claimants, and trans-led organisation Gendered Intelligence, we applied last December for permission to bring a judicial review against NHS England on six grounds. This month, Mr Justice Choudhury agreed that all six of these grounds are arguable. So, the case will now proceed to a full hearing in the High Court. 

The date has not yet been set, but we expect to be in court this autumn. We will update you when a date is confirmed.

Time and again, trans people are being failed; it's clear the current system is not fit for purpose. This court case will be a vital moment in the fight for healthcare for trans and non-binary people. Healthcare should be for everyone. 

We are grateful for your support. 

You can read the permission decision here. 

We have now filed our claim for Judicial Review against NHS England over its long-standing, lengthy and unlawful delays to meeting trans people’s healthcare needs. 

The shape of the case has changed slightly since our last update in October, so we wanted to tell you what’s new. 

We’re bringing this claim alongside two adult claimants, two child claimants and trans-led grassroots charity Gendered Intelligence. The claim now focuses on six key problems with NHS trans healthcare provision. 

We argue: 

1. NHS England has failed, under regulation 45(3) of the 2012 Regulations, to ensure that 92 per cent of trans patients who are referred for medical treatment begin that treatment within 18 weeks of referral.

2. NHS England has failed, under section 3B of the National Health Service Act 2006, to provide services for children needing puberty blockers that they can access before starting puberty.

3. NHS England have failed, under the NHS Constitution, to uphold the rights of adult patients with gender dysphoria to begin treatment within 18 weeks of referral.

4. NHS England has unlawfully discriminated against trans people because waiting times for gender identity services are longer than for the vast majority of other healthcare services.

5. NHS England’s decision to introduce and maintain a ‘Multi-Professional Review Group’ as part of puberty-delaying treatment for trans children is unlawfully directly or indirectly discriminatory. We also think the Service Specification unlawfully requires both the child and their parents to consent to treatment, contrary to the principles established in Gillick and AB v CD. 

6. NHS England has failed to comply with its public sector equality duty to ensure trans people can access acute services by setting up the Multi-Professional Review Group for trans children and in the arrangements it makes with providers.  

Eva Echo, one of the adult claimants in this case, explains the impact of waiting so long for treatment: "I would describe being on the waiting list as torture, and there were times when I felt that I may not even be alive long enough to receive my first appointment. Being on the waiting list was no comfort; I desperately needed help. 

"My mental health was worse than it had ever been; coming out had allowed me to recognise my gender dysphoria, but I was left completely alone to manage it. I felt, and still feel, completely let down by the system that I thought was there to save me."

For too long, the NHS has failed to prioritise trans healthcare. We, alongside many affected individuals, medical professionals, families and campaigners for trans rights, believe the current system is not fit for purpose. The available services simply aren't meeting the needs of the people they should be helping. 

Too many trans people have died waiting for the treatment they were entitled to. Many more suffer in ways that are entirely preventable. The bottom line is that trans people have a right to access essential care, just like everyone else. 

You can read witness evidence from Gendered Intelligence, Eva Echo and Jo Maugham. Read our main grounds here. 

You can also read the expert witness statement from academic specialist Dr Michael Toze, which provides an important background to the case. 

If you are able, please donate to support our fight for trans healthcare rights. Thank you. 

We are now preparing to issue judicial review proceedings against NHS England over long-standing, lengthy and unlawful delays to meeting the trans community’s healthcare needs.

The NHS is in breach of regulations 45, 47 and 48 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. NHS England accepts it is in breach, and says the issue is not funding constraints. It also claims to have done everything possible. 

We do not accept this analysis. Trans people have heard this story repeatedly, the situation continues to deteriorate, and the hostility on the part of the NHS to trans healthcare speaks for itself. We intend to put the matter before a judge to decide.

Separately, Good Law Project is also preparing to issue judicial review proceedings against NHS England for its unlawful service specification for healthcare provision for trans children. 

Within an hour of the Bell decision being handed down in the Divisional Court in December 2020, the NHS halted all referrals to endocrinology without a court order. 

But when the Court of Appeal overruled Bell in September 2021, NHS England refused to update their rules for service provision until we sent our pre-action letter, when they finally amended it. But they did so in a way that we think is still unlawful: firstly, because they require treatment decisions made by qualified specialists to be reviewed by a Multi-Professional Review Group and secondly, because parental consent is still required.

We have written back to NHS England pointing out that the first of those two limitations is discriminatory. Why should the treatment of trans people by qualified specialists be subject to review, while the treatment of cis people is not? The process they’ve put in place also adds substantially to the delays trans people face for treatment. 

As the letter says:

“Our clients remain dismayed at the hurdles that NHS England is continuing to put in place to allow trans children to be assessed by an endocrinologist for puberty blockers. This hurdles exist (a) after clinical professionals at the Tavistock have reached the view that a trans child should be referred to an endocrinologist to consider prescribing puberty blockers and (b) prior to the endocrinologist taking a decision whether it is clinically appropriate for a child to be prescribed puberty blockers. These are hurdles which directly interfere with the clinical relationship between the child’s clinicians and the child. They are not replicated elsewhere within the NHS and cannot be justified solely for trans children.”

Requiring parental consent is unlawful too. It ignores the decision in Bell in the Court of Appeal, it ignores the decision of Gillick in the House of Lords, and it ignores the rights of competent young people to make decisions about their own lives. 

We have, without optimism, given the NHS 14 days to correct their service specification but we are also preparing to issue proceedings.

Standing back, NHS England’s stance on trans healthcare seems increasingly to follow the “political” rhetoric rather than treatment realities. Treatment protocols for trans adolescents are well-established and have existed for decades. Providing puberty blockers to delay puberty is a reversible form of medical treatment which creates time to reflect before any prescription of cross-sex hormones. 

Denying puberty blockers, whether through deliberate decision or neglect, results in inevitable changes to a trans young person’s body. Some of these changes are only reversible with serious surgery later in life, and some of them are entirely irreversible. 

Puberty blockers pause those changes and create space for the young person to reflect. Denying them to a young trans person is arguably an act of cruelty.

Trans people need healthcare from the NHS – not politics.