Miss Marie Griffiths,
40 Baronsdale Close
Ipswich, Suffolk.
IP1 4JX.
Tel. No (01473) 464757
Dear Sir,
I am currently receiving treatment for my transsexual condition via the care of my GP Doctor Susan Smith at The Norwich Rd. Surgery, 199 Norwich Road, Ipswich, Suffolk, IP1 4BX. I first came to her a couple of years ago asking for her help after trying to fight the condition I knew I had for many painful years. I was referred to Charing Cross Hospital where I received very limited help. I received psychiatric counseling firstly from a Doctor Stevens who was sure that I was transsexual but wanted another opinion before prescribing treatment. This session lasted a full hour. When I returned for my second visit I only received a 20 minute appointment with a Dr. Jabuni who had a very interrogative and impersonal style. My next appointment was with a Dr. Montgomery. I had confirmed my appointment in the morning and was told that it had been canceled after arriving at Charing Cross. After some negotiation I received an interview. The interview lasted a mere 15 minutes. During this appointment he examined my breasts with out the presence of a nurse. He then proceeded to make a telephone call whilst I had my top removed. Upon completion of the call he did not proceed with any further examination. He then proceeded to give a diagnosis based on things I had said. Perhaps he had confused me with a previous patient. I found his style very offensive and expressed my disappointment at the length of the interview, I also asked about whether I could receive more lengthy attention if I went to the private sector. He said that if I went private then I could never return to the clinic. Surely this is beyond his powers and against his professionalism. I was then given a place on a group therapy session that consisted of around 40 people. Such numbers I considered too large for any therapeutic help.
I was disappointed at my treatment at Charing Cross as it was causing more depression and anxiety than not going at all. I then henceforth decided to seek Private help with guaranteed treatment times with a Dr. Russell Reid. The London Institute, 10 Warwick Rd., London SW5 9UH. Dr. Reid being a respected and qualified consultant psychiatrist specialising in the condition of Gender Dysphoria. He diagnose me as a Primary Transsexual and prescribed i.e. female hormones to enable me to transition to the female role. I have been under his supervision for the last 12 months and have progressed immensely. I look convincingly female to most people and have little problem living and working as a women full time for the last 3 months. I am totally as ease with myself mentally and live a truthful existence with everyone now. My friends, family, work colleagues have been told and have not deserted me. I am in full time employment in role. I have had straight boyfriends who have treated me as any other young girl. Unfortunately they have left me due to my incompleteness leaving me very upset. However in most aspects I can now enjoy a life as the normal woman that I am.
I hope that I have explained my case appropriately. I know that you have a difficult job balancing resources. I know that sometimes political pressure can bear upon decisions that should be entirely medical. This is not a perfect world which I why I have already resorted to private medicine. I just need some help for you as all of the financial burden so far has laid upon me. I deserve greater help from my Health Authority and hope that with the help of the Community Health Committee I can receive that help in order to life a decent life. I have read the purchasing conditions from your report to the Suffolk Health Authority. The rules are well drafted but unnecessarily restrictive. I would hope that you would accept the opinion of Dr. Reid plus a second independent opinion of some other experienced psychiatrist.
Yours sincerely.
Miss Griffiths
Here is a copy of your purchasing condition together with my comments.
Transsexuals are seen at the Gender Clinic based at the Charing Cross Hospital. This Clinic has adopted the guidelines produced by the Harry Benjamin International Gender Dysphoria u association Inc.
Transsexuals are also seen at the other GICs around the country. There are NHS GICs in Leicester and now locally in Norwich. The later clinic was set up but Norfolk Health Authority to reduce the high costs charged by Charing Cross Hospital to provide a better, cheaper service. There are also private GICs. The Portland Clinic in Manchester and The London Institute run by Dr. Russell Reid. I attend the London institute as it provides an efficient service at a reasonable cost. All these clinic adopt the standards of the Harry Benjamin International Gender Dysphoria Association inc. All referrals to this Gender Identity Clinic are made by a local consultant psychiatrist (under existing contracts) as tertiary referral This would allow clearly unsuitable candidates to be screened out early on. GP should be notified of this decision. It should be possible to come to an agreement with the Gender Identity Clinic such that direct referrals to the clinic are identified and the GP asked to re-refer to a local consultant psychiatrist.
I have received local counseling paid for by myself by a counselor who has experience the with cases of Gender Dysphoria. My GP referred me directly to Charing Cross as she did it not know of anyone with expertise in the local area for this condition. I was clearly at that stage a suitable candidate having no psychological conditions. I do not see the point of re-referrals for suitable candidates to a local psychiatrist. The local psychiatrist would not have the expertise of a psychiatrist at the GIC and this would have no benefit to the patient and be a waste of health authority.
In order to limit the possibility that people may have moved into Suffolk in order to take advantage of the health authority purchasing policy, a residency condition may be applied. People pay the same taxes in this country for the same health service their location should have no difference on the treatment they receive. Making medical decisions on the basis of a person residency is unethical. I have lived in Suffolk for 3 years. I have paid my taxes, national insurance, poll tax and council tax. I have not drawn benefits from Suffolk County Council. I have had to pay for my psychiatric treatment, my electrolygy and prescriptions from my own resources. I am also having to save for my corrective plastic surgery. I know of transsexuals in other councils that have received psychiatric treatment, electrolygy, extensive corrective plastic surgery and Gender reassignment surgery all paid for by their Health Authority. I am not being greedy, I have paid for most of my surgery .myself leaving me in financial trouble I just need the health authorities help to spare me from substantial debt and the ensuing worry at this already stressful time for me. With your help I will be able to keep up a decent stand of living and be able to concentrate on my job. In a couple of years time I will be little burden upon the health authority, my mental health will be fine and I will be able to contribute as a respectable citizen. I should be in good health, I do not drink or smoke. There are many lies spread about transsexual by the media. The East Anglian Daily Times quoted a figure of 50,000 to treat a transsexual on the NHS, any health authority that does spend this amount must have serious financial mismanagement. The cost of Gender reassignment privately is 6,000, I know that the internal costs for such a procedure are much less. There is also the lie that transsexuals I will chose to have the treatment. This is as ridiculous as someone having voluntary open heart surgery. Surgery is a risk but in 95% of cases the results are a happy and satisfied patient. Compare this statistic to other procedures are regularly done by the NHS.
The patient should undergo a period of assessment, psychiatric care and counseling as recommended by the Gender Identity Clinic. If felt appropriate, this may involve some therapy undertaken locally under existing contracts.
This is a very reasonable statement and one which I have undertaken. The GIC in my case being The London Institute.
Hormone therapy should be prescribed only on the recommendation of the Gender Identity Clinic.
This is a very reasonable statement and one which I have undertaken. The GIC in my
case being The London Institute.
If sex-reassignment surgery is recommended by the Gender Identity Clinic, the Director of Public Health should be sent - early -on a full clinical progress report. This will assist in the evaluation of the ECR request and the scheduling of surgery within the limits of the ECR budget.
This is a very reasonable statement but too much of a delay in treatment has it medical dangers. The longer that a patient is on a high oestrogen high anti-androgen pre-operative dose the greater are the risks of deep vein thrombosis. A health authority that delays the operation on the purely the grounds of a limited ECR budget would be putting patients life at risk.
Each recommended episode of surgery should generate a new ECR request. Each ECR request will be considered in the usual manner taking into consideration the current financial status of the ECR budget. The surgery would normally be expected to be undertaken by units experienced in the specialised nature of sex-reassignment surgery. However, if felt appropriate, certain operations may be performed locally under existing contracts.
The same answer to the above condition applies here. plus there are few centres that have experience in gender-reassignment surgery. There have been cases where local authorities have used inexperience local surgeons to perform the operation leading to numerous and serious complications that have had to be paid for by the Health Authority at great cost. On the other hand there are health authorities that have given contracts to private hospitals with expertise to perform such operations to great success often at a lower cost that using experienced NHS centres.
Patients currently undergoing assessment, receiving psychiatric care or hormone treatment at the Gender Identity Clinic funded by the health authority, should continue to have their treatment funded by the health authority.
This need not be said. Suspension of treatment abruptly on non-medical ground is unethical in any condition. In the treatment of Gender Dysphoria there are risks of health and temporary psychiatric conditions caused by coming off and going onto hormones and anti-androgens.
Patients part-way through -reassignment surgery funded by the health authority, should continue to have their surgery funded by the health authority, subject to each episode of surgery generating fresh ECR request which will be considered in the usual manner taking into consideration the current financial status of the ECR budget.
The same response to the above condition applies here.
Patients with unusual circumstances will have their case reviewed by the Director of Public Health who may wish to take into consideration an assessment by the Gender Identity Clinic.
This is a very valid point. Every patient differs in their needs and need to be assessed independently.