Excessive waiting list for specialist treatment ‘blocking access to key medication’
More than a quarter of the almost 1,000 people accessing specialist transgender services in Northern Ireland are children, the Belfast Telegraph can reveal.
Official figures obtained by this newspaper show 950 individuals were put on waiting lists at two Belfast Trust-run centres in the past five years, with 258 (27%) below the age of 18.
Almost 90% of the 1,066 people referred to the adult service at the Brackenburn Clinic and Knowing Our Identity (KOI) unit for young people in that period were accepted.
Brackenburn provides a range of psychological support and medication while putting patients on a pathway to surgical transition from one sex to another.
KOI, which has no lower age limit, does not offer a direct pathway to surgery for under-18s.
Instead, it provides psychological support and medication to young patients until they are old enough to progress to the adult service.
All under-18s referred to KOI since 2014 are supposed to have access to “gender affirming” endocrine treatment, including puberty blockers and cross-sex hormones.
However, in March 2020 that option was removed.
Health Minister Robin Swann blamed “limited adult gender provision with growing waiting lists” for the decision.
The Belfast Trust was unable to confirm how many young people had been prescribed the medication, which is only given out following a psychological evaluation.
However, it did confirm 11 young people had commenced endocrine treatment here in the past two years.
In relation to the number of Brackenburn patients taking medication, it said: “Almost all new patients referred to the transgender clinic are prescribed puberty blockers and cross-sex hormones.
“Almost all are prescribed both.”
But the Belfast Telegraph understands adults are being made to wait for those prescriptions due to the excessive waiting list, which is currently five years and four months.
“There are regulations about how long a patient should be on such medication,” an expert told this newspaper.
“It’s not safe to be on it for a prolonged period.
“That means people are being forced to wait until they are closer to the end of the waiting list before they can start taking it.”
Sources blamed the situation on services being “massively underfunded”.
It’s understood money is currently being rationed in a way that prioritises adult patients.
But it’s unclear how many of them are actually getting the medication they are entitled to.
Statistics show the number of adults being referred and accepted to the Brackenburn clinic had fallen each year since 2017, with the exception of 2021.
It was down 25% to 138 in 2018, compared to 185 in the previous year.
It then fell by 12% in 2019 to 121.
It dropped again by 9% to 110 in 2020.
However, last year did see a 30% spike in the number of referrals (143).
Despite the fall in numbers, the proportion of adults being accepted to the clinic has rocketed from 81% in 2017 to 99% in 2021, when 142 of the 143 people referred were approved for treatment.
So far this year GPs have directed 58 patients onto the service, and 57 (98%) have been accepted.
The number of young people being referred to KOI is on a similar downward trend to adult referrals. But, unlike adults, the proportion of under-18 referrals being accepted has fallen.
In 2021-22 it stood at 71% (37 of 52) compared to 92% in 2018-19 (58 of 63).
LGBT+ campaigner John O’Doherty said the statistics debunked a “false narrative” and accused health chiefs of letting patients down.
“What is clear is that the Belfast Trust and Department of Health have consistently failed trans and non-binary people and their families,” he claimed.
“Trans and non-binary people have a right to patient-centred non-directive provision of care based on their individual needs.
“A joined-up strategic response must be developed for this unmet need so that trans people and their families can have confidence in the health service.”
The Rainbow Project director said the data injected a dose of truth into the conversation about trans issues.
“These figures provide a stark reality to the false narrative, particularly in the media, that ever-increasing numbers of people are seeking to access gender identity services,” he said.
“In fact, these statistics show similar numbers being referred year on year.”
The activist expressed concerns about waiting list times and called on the Belfast Trust and Department of Health to reveal more information about both services.
The Department of Health said a review into transgender healthcare commissioned in 2019 has now been completed. Officials in the department are currently drafting advice for the minister, it said, adding: “The minister’s final decision on any new service model will be informed by a public consultation.”
It insisted physical interventions, such as puberty blockers, were provided in line with national and international medical guidelines. However, it admitted “the current staffing resource in the Brackenburn Clinic is not adequate to meet the increasing level of demand”. Key staff had left due to retirement or new jobs, and repeated attempts by the Belfast Trust to recruit to the service “have been unsuccessful”.
The health trust that runs the only clinics in Northern Ireland for transgender patients has described five-year waiting lists as regrettable.
“Belfast Trust would like to take this opportunity to sincerely apologise to everyone affected by this delay,” a spokesperson said. “We fully accept that the waiting time for gender services is excessive and not in keeping with the waiting time directive.
“A review of gender services in Northern Ireland has been undertaken and the report is currently with the Department of Health for consideration.”
The trust blamed the problem on “unprecedented demand”, adding: “We strongly recommend all patients to consider carefully before deciding to take any medication or treatment privately”.