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“Unnecessarily brutal”: Waiting times at Sheffield’s gender clinic reach breaking point

With an average wait of just under two years for a first appointment, trans people referred to Sheffield’s Porterbrook Clinic speak of their desperation.

Porterbrook Clinic, Sheffield

Porterbrook Clinic, Sheffield

Sam Walby

A total of 20,750 people in England are on seemingly endless waiting lists to be seen at a gender clinic. With 1,285 people waiting for an initial appointment in Sheffield, the city’s gender identity clinic (GIC) at Porterbrook is showing the strain.

A Freedom of Information (FOI) request showed that the average waiting time for a first appointment in Sheffield is 589 days - but that it's far from the worst in the country.

Now Then sent FOI requests to all eight trusts in England with gender identity clinics. Devon Partnership NHS Trust’s GIC has an average wait of 931 days for an initial appointment, while Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust’s wait was similar to Sheffield’s at 599 days.

We also asked about the shortest and longest times people have waited for initial appointments at a GIC. Leeds and York Partnership NHS Foundation Trust saw somebody in a speedy 61 days, but their longest waiting time was 1,333 days and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust’s waiting times spanned from 30 days to 1,159 days.

In Sheffield, the waiting times in the year spanning April 2019 to April 2020 ranged from 242 days to 1,178 days, which is over three years.

Ry Hassey got a letter from the GIC in Sheffield confirming that the clinic had received a referral from their GP in early 2018. Since this confirmation, Ry has heard nothing from Porterbrook. This has caused them considerable distress.

“I think it's just an agonising, agonising wait because you know who you are, you're trying to be yourself but your body and how you see yourself doesn't match up to that.”

Ry Hassey

Ry Hassey

Ry Hassey

Ry says the wait has had social implications, because "for a good two years" they didn't leave the house. "I hated going outside and I’d present more feminine, but people would still treat me more masculine and there's a bit of a disconnect there. So mentally it's hard to wait, especially when that's going on as well.”

Del King has been waiting to be seen by Porterbrook GIC since August 2018. He has also struggled with the long wait.

“It has been very hard. I can get why, with everything going on, but it's got to where it's like nothing matters.”

Tom* has now been seen by the GIC but waited around a year from initial referral to their first appointment with a nurse, followed by a further wait to see a doctor. Just as Ry has heard nothing since their initial referral confirmation, Tom had long periods of silence from the clinic when waiting for their first appointment. The clinic said that they were sending letters but Tom never received them.

“It's not just me,” Tom says, “I've heard it from a few people, I genuinely think they've got a shredder in there, and they don't know it's a shredder. I don't want to be horrible to the people who work there, I know they're massively understaffed and I get that, but something isn’t right.”

Tom says they would get a text “reminding” them of an appointment the following day, but that this was the first they had heard of it. These appointments were frequently unsuitable due to work commitments.

Ry and Del, like Tom, understand that the clinic is under immense pressure and that gender identity clinics across the country are struggling to cope with high numbers of referrals and inadequate resources. Each was sympathetic, especially to the disruption that Covid had caused to an already strained service.

But these waits can have dangerous consequences. Ry got more desperate the longer their needs were not being met.

“It led to my [gender] dysphoria being a lot worse. And I looked into self-medicating hormones. I found a [hormone] blocker online from an online pharmacy and ended up taking that for three weeks, and then I started having really bad side effects so I had to stop. I'm still living with those side effects now.”

They knew that it was risky to take these medications unprescribed. “I guess I'm paying the price. I know I shouldn’t have self-medicated but at the same time I was desperate.”

Stock photograph of a genderqueer person sitting on a therapist's couch, listening.

Stock photograph of a genderqueer person sitting on a therapist's couch, listening.

The Gender Spectrum Collection

The alternative to black market medication is to pay for private healthcare, which is unaffordable to many, though Tom and Ry have both considered it as a way to get the ball rolling and get an initial prescription.

Asked how can gender identity clinic waiting times could be improved, Tom, Del and Ry all cite improvements to communication as a key way to make the patient pathway less dehumanising.

Tom suggests a range of support options that somebody could access while waiting to see a medic as a potential area for improvement. “I would say that there needs to be a quick chat about what the plan is, right off the bat. Offer counselling during that time, I think that’s the main thing. Whatever the time period is, there needs to be a chance to talk it through with somebody.

“I had had a naive and fond hope of some, like, psychological support while I was on that waiting list.”

Ry believes that it is the issues surrounding the wait, such as the “lack of communication, lack of respect and lack of acknowledgement” that make it especially difficult to deal with. GPs refusing to offer bridging prescriptions or to engage with the process following an initial referral can also be a barrier.

“It just seems unnecessarily brutal, and it might sound dramatic but I think when you've experienced dysphoria for so long as a child and you're entering services as an adult, the very least you'd expect is a bit of compassion and understanding. And just to be notified of where you are in the process.”

Del just wants his first appointment with a medic to materialise. “I just wish there was more doctors and nurses out there to say, ‘Come and see me and we'll go through this’. That's my big thing that I wish we could get help with.”

Katie Roe, Operational Manager at Sheffield’s gender identity clinic, said: “Unfortunately, all NHS England commissioned Gender services have the similar waiting times and it is a national issue.

“We appreciate how difficult and frustrating it is for those waiting to be seen. Our clinical team spend time discussing this as part of the initial appointment with anyone who seeks help and support from us.

“Occasionally we talk to GPs if there are particularly distressed people whilst on waiting list. We also signpost to local support and have partnered with Gendered Intelligence, a trans-led service which can provide help, support and reassurance to anybody waiting for their first appointment with us.

“Most people who get help and treatment from the Gender Identity Clinic are very pleased to be seen and they are understanding of the delays. They realise that the clinicians are seeing them as quickly as possible.”

*Tom chose to use a pseudonym for this article

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