Mentions Wes Streeting

A typically incandescently brilliant barnstormer from Abigail.

There is a clash going on in Britain between two fundamentally irreconcilable ideologies.

The NHS, DHSC, and many other official institutions like courts view transition as a response to a medical problem they call ‘gender dysphoria’ or ‘gender incongruence.’ From this starting point it seems appropriate that trans people have to get permission to transition: transness is a medical matter with inherent risks that ought to be controlled by “specialists.” Sometimes those specialists delay or deny permission, but that’s just part of the job. It also makes sense to ask which treatments are “most effective at treating dysphoria” and explore alternative treatments through trials, reviews, consultations, etc. I call this view ‘Pathologization.’

According to Pathologization, past treatments like electric shocks simply failed to alleviate patients’ dysphoria. These days we have more effective methods, and one day we might discover a cheap way of treating it without transition- a silver bullet conversion therapy. Doctors and managers will determine when and whether adjustments to the system are needed. Ideally they’ll engage with trans people in “stakeholder groups” but if those groups don’t get what they want that’s not a dealbreaker. Patients who suffer or die waiting are unfortunate but hey, the NHS can’t save everyone.

On the other hand, the view of an increasing number- especially young people and trans people ourselves- is that transition is a bit like pregnancy. It’s a process that may require professional assistance to bring to the happiest possible conclusion (whether completion or termination), and for this reason it is appropriate and necessary that the NHS is involved. But whether, how, and when to do it should be up to you. From this starting point there should be as few obstacles as possible: the role of doctors and managers is to facilitate and advise but never delay or deny. Prompt, reliable access to transition is a civil rights matter.

[…]

It is vital to realise that organisations can embody an ideology even if nobody working in them believes it. I think sometimes when people hear “Organisation X is institutionally discriminatory” they interpret that as “The leaders of Organisation X are bad people.” For example;

“The Metropolitan police are institutionally racist.”

“I’ve met some police officers and they’re lovely!”

This is a mistake. To say that an organisation is institutionally discriminatory makes no comment on the character of its employees, merely the pattern of its outputs. Not everyone who controls trans healthcare is a frothing bigot; again, I have no animosity towards Colonel Korn or his colleagues. My issue is with the outputs of the system they manage.

One of the principles upon which provision of puberty blockers to young trans people was made was Gillick competence – the law that says that young people over the age of 12 can be individually assessed by medical professionals to determine whether or not they’re competent to make medical decisions for themselves. This was hard fought for by feminist campaigners back in the 1980s and it led to the passing of the Age Of Legal Capacity Act in Scotland in 1991. It’s a principle of particular importance when it comes to reproductive healthcare, as it helps young people to access the services they need even if, for instance, they feel unsafe discussing them with their parents. As such, it helps to protect them from abuse and to get used to the idea that they have ownership of their bodies, which is important as they grow up and negotiate boundaries in romantic and social relationships.

By overriding Gillick competence where trans people are concerned, Streeting has created a risk that it will be ignored in other cases too. Perhaps we shouldn’t be surprised. He seems shaky on the concept of medical consent more generally, as demonstrated by his suggestion that obese unemployed people should be given the weight loss drug Ozempic to improve their health and get them back into work. Although his initial comments on this, which provoked a public outcry, were quickly followed by assurances that it would not be compulsory, concern remains about the vulnerability of people who depend on the state for support, especially those who are disabled, who make up a significant part of the obese population. Like most drugs, Ozempic has side effects and is not appropriate for everyone.

Slimy git.

Streeting acknowledged that the decision would not be welcomed by everyone but sought to reassure young trans people. He had met many of them since taking up his post in July, he said, and listened to their concerns, fears and anxieties.

In a message directly to them, and referencing having come out as gay, he said: “I know it’s not easy being a trans kid in our country today, the trans community is at the wrong end of all of the statistics for mental ill health, self-harm and suicide.

“I can’t pretend to know what that’s like, but I do know what it’s like to feel you have to bury a secret about yourself, to be afraid of who you are, to be bullied for it and then to experience the liberating experience of coming out.

“I know it won’t feel like it based on the decisions I’m taking today, but I really do care about this and so does this government. I am determined to improve the quality of care and access to healthcare for all trans people.”

Decisions were being taken “based on the evidence and advice of clinicians, not politics or political pressure”, he added.