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Commissioned by NHS England Specialised Commissioning team in July 2024, this operational review of NHS adult gender dysphoria clinics (GDCs) in England was led by Dr David Levy, with the support of a panel of clinicians and other key stakeholders. The aim was to determine whether the operation and delivery of the GDCs meet the requirements of the non-surgical interventions service specification and consider the safety and effectiveness of the GDC service. The report sets out its key findings as follows: Access A majority of these clinics have exceptionally long waiting times for NHS services, with patients often waiting for many years to be assessed. This can be distressing for patients, place undue pressure on staff and contribute to patient safety risks. As the GDCs maintain separate waiting lists, the true size of the waiting list is unclear, as some patients may be referred to 1 or more GDC through self-referral or GP referral. The current referral process means the majority of GDCs need to manage relationships with GPs and other services outside their region or ICB area. This places additional demands on resources. Quality (including safety) The absence of any patient outcomes data, alongside limited and inconsistent quality data reporting, and minimal clinical audit makes it impossible to properly understand patient outcomes and the safety of these services. These gaps place these clinics outside standard NHS quality assurance expectations. In addition, existing patient demographic data and clinic feedback indicate that there has been a shift in patient demographics in recent years to a younger cohort with reported additional conditions. Yet, this has not always been met with corresponding changes in how some clinics identify and address patients’ potential additional biopsychosocial needs. Productivity There is currently a wide variation in service provision across the country. This includes differences in the number of appointments per GDC clinician and consultation length. These variations need to be considered both in terms of improving access and ensuring high-quality services and patient safety. Additional financial resources have been made available to each GDC to expand its staffing in recent years. However, workforce data has not always reflected an expansion in staff numbers in some GDCs. Culture, leadership and governance Some clinics undertake little or no quality improvement work or knowledge-sharing between services. The senior clinical leadership approach at some clinics also limits staff’s clinical curiosity and the opportunities to identify ways to improve patient outcomes. The review also found that oversight by some trust boards and by NHS England regional specialised commissioning teams has not consistently identified these concerns, sought any mitigating actions or supported improvements. This contributes to concerns that these services carry a high level of risk. Commissioners and host organisation oversight, governance and supportive leadership need to be strengthened to manage this risk. This will be critical to delivering improvements. Next steps Based on these findings, the review panel has set out twenty recommendations to improve patient care which are included in this report. The report calls for a wider healthcare response from national and local commissioning teams, adult gender dysphoria clinics, NHS trusts, ICBs, primary care, and other healthcare constituents. This joint approach will be driven by the proposed National Quality Improvement Programme for Adult Gender Services and a new National GDC Oversight Board.

On this page from Medecins Sans Frontieres, you can find resources intended for educational and training purposes on various subjects: inclusive language, healthcare disparities, sexual orientation and gender identity, and more.

Health disparities are systemic and deeply rooted in social and economic inequities. Patients living in deprived areas, from racially minoritised communities, or facing additional challenges such as homelessness or intellectual disabilities experience worse health outcomes. These disparities are compounded by mistrust in healthcare, low health literacy, cultural barriers, and discrimination.  This report focuses on patients with blood disorders and/or cancers who experience health inequalities, and therefore have worse outcomes and experiences of care than patients who don’t. We looked at how social and economic factors affect the health of people living with blood disorders and cancer.  Report key findings: Patients living with cancer and/or blood disorders experience significant barriers to care including delays in diagnosis, unequal access to services, and systemic discrimination, These patients also reported challenges navigating healthcare, a lack of communication, and economic burdens such as high transportation and medication costs, Social determinants of health like inadequate housing and living in deprived areas further worsened outcomes, Participants emphasised mistrust in the healthcare system, particularly among racially minoritised and LGBTQ+ communities, and highlighted the need for better coordination, cultural sensitivity training, and localised services. The project involved a literature review on health disparities and social determinants affecting patients with cancer and blood disorders. Discussions were held with local and condition-specific charities, and we conducted focus groups and a case study interview with patients and carers. These efforts aimed to gather diverse perspectives and first-hand accounts of lived experiences.

There is a well-established case for involving communities and people with lived experience in health and care policy, service design and delivery. NHS England guidance on working in partnership with communities highlights the financial benefits and improvements to quality and health outcomes that working with local communities brings. But could this involvement go further? In this article, Loreen Chikwira, Researcher at The King's Fund looks at the arguments for the use of intersectional approaches in understanding people’s lived experience of care in tackling ethnic health inequalities. These intersectional approaches help health and care providers shift their focus from people’s behaviours to also identifying and addressing ways of working that create and reinforce inequalities and poor experiences of care.

In April 2023, National Voices held a workshop with members, supported by The Disrupt Foundation, on the unequal impact of the Covid-19 pandemic. It explored how communities and groups were affected differently by both the virus itself and the measures brought in to control it.   It painted a grim picture of the ways in which the pandemic response exacerbated existing, deep-rooted inequalities across the UK and compounded the disadvantages experienced by people from minoritised communities, by disabled people and by people living with long term conditions.  Just some examples include people who are immunocompromised, who were asked to go into isolation for huge periods of time and still feel completely overlooked as control measures have been lifted. Or the use of DNRs (Do Not Resuscitate orders) which were disproportionately applied to people with learning disabilities.  With the Covid-19 Inquiry underway, it is imperative that we capture the lessons learnt from the pandemic, and use them to suggest action for the future.