Petition title: Establish a Welsh under 18 gender service in Wales for Welsh children and young people asap.

Text of petition:

Following the long term and current poor performance of the English under 18 gender service and their extortionate waiting lists that Welsh children and young people have been subjected to, we (Transvisioncymru) have been discussing with the Welsh Government and Commissioner for Wales for over two years about having our own exemplary under 18 Welsh service. The commissioner wants change too but WG health have not moved forward at all yet.

We are a group established by parents of transgender children who have found the current system impossible to navigate and no support to our wonderful children. Over time we have grown into a group that consists of young people, parents/carers and allies. We also have combined in this campaign with lots of other groups to make a strong voice for trans young people’s rights.

There is an amazing, inclusive, all Wales LGBTQ+ action plan published in January 2023 that excitingly states one of the main outcomes is to improve health provision and health and social care. They state they will review the Gender Identity Development pathway for young people in Wales and continue to develop the Gender Identity Service. In a recent meeting with WG health this is not the route they are taking and are going to continue making Welsh young people wait a further 4-5 years on the waiting list for an unsatisfactory service. We need a service now.

1. Background

NHS Wales defines gender dysphoria[AL1] as “a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.” Children and young people under 18 who experience gender dysphoria are referred to a specialist child and adolescent Gender Identity Service.

The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England in Autumn 2020 to assess and make recommendations on these services for children and young people who are questioning their gender identity or experiencing gender dysphoria. The Interim Report was published in February 2022, and the Final Report was published in April 2024.

The Cass Review makes a number of recommendations, including that the capacity of gender identity services should be expanded through the establishment of regional hubs, with Gender Identity Services based in existing tertiary paediatric services. To implement these recommendations, NHS England have opened new services based in the North West of England and London. These are the first of up to eight new Gender Identity Services for children and young people that NHS England plans to commission over the next two years.

2. NHS Wales Specialist Children and Young People Gender Identity Services

The NHS Wales Joint Commissioning Committee[AL2] (JCC) is responsible for the commissioning of certain specialised services on behalf of Local Health Boards in Wales, including Gender Identity Services for children and young people[AL3] . The policy document NHS Wales Specialist Children and Young People Gender Identity Services[AL4] outlines the services available, which are commissioned by the JCC through NHS England (this document was originally published by the Welsh Health Specialised Services Committee (WHSSC) which was replaced by the JCC on 1 April 2024.)

In Wales, children and young people access NHS England Gender Identity Services through a referral by Child and Adolescent Mental Health Services (CAHMS). All referrals in England and Wales are managed by the National Referral Support Service. The JCC say[AL5] that, as of the 31 March 2024, there were 259 Welsh patients on the waiting list for the children and young people’s Gender Identity Services.

The JCC have published their response[AL6] to The Cass Review’s Final Report, which confirms the position in Wales. It says:

The NHS Wales Joint Commissioning Committee and colleagues from Cardiff & Vale University Health Board attend the NHS CYP Gender Service Programme Board (South West) with Bristol Royal Hospital for Children as a phase 2 regional provider. The Board are considering how services can be brought closer to home for Welsh patients with the potential of a satellite clinic being set up on Health Board premises as an initial starting point for collaborative working.

3. Welsh Government action

In her response to the petition (letter dated 10 June 2024) the Cabinet Secretary for Health and Social Care, Eluned Morgan MS, said, “the Welsh Government is committed to improving the gender identity development pathway and the support available for young people in Wales, in line with the commitments in our LGBTQ+ Action plan.”

The Welsh Government’s LGBTQ+ Action Plan for Wales[AL7] , published in February 2023, includes the long-term action of reviewing the gender identity development pathway for young people in Wales. It says that the impact of this review will be that “trans children and young people in Wales can access services closer to where they live” and that “health services for trans children and young people are focused on clinical need and based on clinical evidence.”

4. Welsh Parliament action

In Plenary on 21 June 2022, then Deputy Minister for Social Partnership, Hannah Blythyn MS, gave a statement about the development of the Welsh Government’s LGBTQ+ Action Plan for Wales. The Action Plan was launched in Plenary on 7 February 2023.

The Children’s Commissioner for Wales’ Annual Report and Accounts 2022-2023[AL8] includes the recommendation:

“Welsh Government should expedite work committed to in the LGBTQ+ Action Plan on exploring a Welsh Gender Service for children and young people, to replace reliance on commissioning services from NHS England. A new gender identity service for Wales should be established.”

The Welsh Government published a response[AL9] to the Annual Report and it was debated in Plenary on 17 October 2023.

A Welsh Conservatives debate on the Cass Review was held in Plenary on 1 May 2024. During the debate the Cabinet Secretary for Health and Social Services said:

“The new NHS Wales Joint Commissioning Committee is working with the transformation programme as it moves to the next stages of the delivery plan. This includes supporting the newly opened children and young people's gender services in London and the north-west, and accelerating work to develop additional regional services and consider how they can be brought closer to home for young people in Wales. This is delivering on our commitment to review the pathway for children in Wales to access gender identity services.”

Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes.