[personal profile] sallyalice
I estimate that, with occasional breaks to eat, take painkillers, dilate, wash, and be scared of the BNP, I've slept for 17 hours of the last 24. My body is apparently trying to remind me that, although my recovery at last seems to be going well, I still need to rest up. I still feel exhausted.

This is a little worrying, because *I have work to do*.

Following recent pressure that has been placed on Oxfordshire PCT by, um, concerned stakeholders, the South Central Priorities Support Unit has issued a draft paper for consultation regarding the new gender dysphoria policy to be adopted on a regional level. I've received a copy of this paper, and taken time to digest its content. While much of what it says seems quite positive, particularly early on (there's an acknowledgement that care needs to be patient-centred and that different care pathways will be appropriate for individual patients; there's even consideration of the risks of non-treatment, including suicide rates), by the end of the document, the two potential policies for consideration are virtually the same as those suggested in 2006:

- The first resembles the one adopted by Oxfordshire three years ago, stating that core and non-core surgery will only be funded in exceptional circumstances... but this time, it includes the qualifier that appropriate exceptional circumstances will need to be identified. As though they ever came *close* to doing so before. Even if it looks unlikely that they'd be able to justify adopting this policy after everything that's happened, it's worrying that it's made the draft again, especially as it would not just be Oxfordshire, but the whole of NHS South Central, that would be affected by it.

- The second possible policy is virtually identical to that previously adopted by all of the other South Central PCTs -.that core surgery (i.e. genital surgery for trans women, and genital surgery and top surgery for trans men) may be funded for patients fulfilling the WPATH (Harry Benjamin) suitabiliy criteria, if they have been referred by two NHS specialist clinicians. Non-core procedures may only be funded in exceptional circumstances. Non-core procedures appear to include genital hair removal, which is for many people a necessary precursor to genital surgery.

The big pity is that, earlier on, *three* possible policies are identified - the other one accepts that the distinction between core and non-core procedures is fairly arbitrary and will differ between patients, so can be decided on an individual basis by specialist clinicians. In spite of the fact that so much of the cited evidence emphasizes the importance of appreciation of the needs of individual patients, and selection by qualified specialists, this option has mysteriously dropped out by the end of the document. This is presumably owing to the issue of limited NHS resources, to which the draft makes frequent reference. However, I believe that the one-size-fits-all approach operates a false economy in the long term.

I'm now trying to compose a letter to the Priorities Support Group. The deadline for comment is scarily close - Friday - so I really ought to get it finished by Wednesday. The timing is unfortunate, considering how sleepy and lethargic I am at present, and considering that two of the other three who went with me to talk to the PCT representatives are now in hospital recovering from surgery. I'm hoping to include a few references they missed in their literature review; a criticism of another reference cited; a query as to why exactly the third policy option has been dropped and the first policy option has been retained in spite of Catch-22 implications;... and possibly also something about the merits of outsourcing work to private clinicians. I'll try to keep it concise, and with the limitations of time I'm faced with, this may not be difficult.

I'd like to be able to get in touch with as many people who might conceivably be affected directly by this policy review as possible. That means any gender dysphoric person currently progressing through the system (or failed by it) in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight (including Milton Keynes, Southampton and Portsmouth, even though they have separate PCTs). I'd originally considered getting signatures from as many *allies* as possible, but as I can already reference the petition, I thought I'd limit myself to people from whom they might receive a potential direct threat of litigation.

Please feel free to forward anyone potentially affected by this to me - the more people we can bring together over this, the better.



September 2009


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