Transgender patients could face years-long wait for NHS treatment

Transgender patients facing a years-long wait for NHS gender care are being handed a "death sentence", says the mum of a trans woman who took her own life.

Data obtained by Newsnight and analysed by the BBC found it would take 10 years to clear the backlog of people waiting for first appointments in gender care.

The mother of Alice Litman, who killed herself while waiting for treatment, called for urgent changes to NHS care.

NHS England said it planned to launch a review into adult gender services.

A spokesperson said it has "increased investment in gender services by about 130% over the past five years".

A Department of Health and Social Care spokesperson said it was "making progress to tackle waiting lists for adult gender services amid unprecedented demand".

18-week target

Newsnight sent freedom of information requests to all 13 NHS trusts who operate adult gender clinics in the UK, asking how long patients would wait for a first appointment if they were referred today.

Gender clinics provide healthcare specific to gender, such as for those with gender dysphoria. The NHS's target wait time for first appointments at gender clinics is 18 weeks.

The majority of clinics told us they would only provide data on how long patients they were currently seeing had waited.

This ranged from just over 14 months in Wales, to between two to five years in Scotland, and more than five years in Northern Ireland.

In England, patients receiving first appointments in November 2023 had waited an average of seven years, NHS data shows.

However, further analysis of NHS data by BBC News suggests some may now face longer waits due to growing waiting lists.

The size of current waiting lists, together with the number of first appointments offered in 2023, suggest it would take at least 10 years to clear the current appointment backlog - provided there were no changes to service provisions or the size of waiting lists.

Waits are due to a shortage of surgeons and specialist staff, clinicians say.

BBC Action Line

  • If you have been affected by the issues raised in this article, help and support is available via BBC Action Line.

Alice Litman from Brighton took her own life while she was on a waiting list for a NHS gender clinic. Her mother says the figures show there "is no care for trans people".

Alice, 20, had been on the waiting list for Tavistock and Portman NHS Foundation Trust's gender clinic for more than three years when she was found dead in Brighton, in May 2022.

A coroner ruled the long waiting times to access gender care had directly contributed to her death.

Caroline Litman
Caroline Litman said long waiting lists felt like a "holding cell"

Ms Litman says Alice became "withdrawn" and "closed off" while waiting.

"I think she felt like she didn't matter. And it kind of fed into this hopelessness and helplessness that she had about her future, living in a society that didn't really value her enough to offer her timely treatment," Ms Litman says.

"I think a lot of the time she put on a brave face, she tried her very hardest to live." The 56-year-old says it felt like Alice was in a "holding cell" rather than a waiting list, saying it was a "death sentence".

Last year, coroners in three cases - including Alice's - ruling that waiting times to access gender care had contributed to a patient's death.

In response to Alice's inquest, Tavistock and Portman NHS Trust Foundation Trust said it was working with NHS England to "develop innovative ways of reducing the waiting list" and providing support to those on it.

'Repress who I was'

Naomi, who asked the BBC not to use her surname, was referred to Leeds and York Partnership NHS Foundation Trust's gender identity clinic in 2020. She says she is still waiting for a first appointment.

The 59-year-old says the waiting lists represent an "it'll-never-happen" diagnosis for older patients. "It's now stretched into four and a half, maybe five years, and it's getting worse," she adds.

She says her mental health deteriorated and descended into alcoholism, and she began drinking "a whole bottle of spirits" a day.

"The worst was when I tried to repress who I was," she says, adding that "didn't work". "I was planning suicide," she adds, "not just thinking about it."

A Leeds and York Partnership NHS Foundation Trust spokesperson said waiting lists for first assessment at its gender clinic were "unacceptably long".

"We are constantly working to improve the experience of people waiting," they said.

"This includes offering support from our gender outreach workers, improving the efficiency of follow-up appointments, encouraging more people to work in gender services, and enabling GPs to play a greater role in care for gender patients."

Dr Mike Shaw
Dr Mike Shaw said patients were waiting so long they had to be re-interviewed before having surgery

Dr Mike Shaw, a lead clinician at a gender clinic in the north of England and British Medical Association consultants committee member, says a shortage of specialist staff and surgeons was impacting on waiting times throughout the NHS's gender care system.

"On occasions, the waiting time for surgery has got so long that actually the patient needs to be re-interviewed for surgery and have a full recap of their care to pass that updated information to the surgeons," he says.

He says the NHS and Department of Health and Social Care needed to think more about staff recruitment, with dedicated pathways and training put in place from medical school to get clinicians into key gender care roles.

Ms Litman says she hopes NHS England will implement "changes in the whole structure of how transgender care is delivered".

"At the moment, it's centred in very specialist, very hard to access clinics, and there's no need for that," she adds.

An NHS England spokesperson said it is working to "bring down waiting lists" across NHS services and it has rolled out five new pilot gender clinics for adult patients since July 2020.

"This is already helping to tackle long waiting times, which had increased because of a shortage of specialist clinical staff to meet the rapidly rising demand.

"In 2024/25 the NHS will launch a timely review of the adult service specifications through a process of engagement with professional bodies, clinicians and academics, and patients and the public."

A Department of Health and Social Care spokesperson said NHS England had "increased the number of specialist clinics" and it was "growing the number of clinicians".

Additional reporting from Jonathan Fagg.

If you have been affected by the issues raised in this article, help and support is available via BBC Action Line.

BBC iPlayer
BBC iPlayer

Watch the investigation on BBC Newsnight on BBC2 at 22:30 GMT and on BBC iPlayer.

BBC iPlayer
BBC iPlayer