What to do if refused funding for gender reassignment

PFC briefing, 1998

Action | Arguments

What to do if your GP or Health Authority refuses to fund gender reassignment treatment: (briefing note from Press For Change, 1998)

STOP PRESS: Following the High Court’s ruling in the North-West Lancashire Health Authority case, this information is somewhat outdated.  The ruling in that case is being appealed, but in the meantime we have produced some supplementrary guidance notes, which you should also read.
CMcN, 1998-04-29

Part One: Action

1. Ensure you have the full support of your GP and of any other specialists you have been seeing.  If your GP is unwilling or unsure about prescribing hormones or referring you for surgery, consider changing your GP.  You can do this through your local Family Practitioner Committee (look in the phone book) who should be able to find you a sympathetic GP in your area.

Remember that a fund-holding practice can decide for itself whether to pay for gender reassignment for a patient.  If it’s sympathetic, you are home and dry; if unsympathetic you have little chance, unless you can persuade them to change their minds - it’s probably easier to change your GP.

2. Go and see your MP.  MPs can have enormous influence in individual cases like this, and are often successful on their own in getting a decision not to fund reversed.  Don’t write - go to his or her surgery and talk to them face to face to ask for their support.

3. Contact your local Community Health Council (in the phone book).  Explain the situation and ask for their support.

4. Make sure you or your GP has received the refusal to fund in writing from the Health Authority.  If the reason given is not clear, write again asking them why.  Once you have established their reason for not funding, you may find useful any or all of the information/arguments given below.  You or your GP can write stating that you wish to appeal against their decision and explaining why you think it is wrong.  At this point supporting letters would be useful from your MP, Community Health Council and any health specialists who have seen you in connection with your transsexualism.

5. If your appeal is unsuccessful and you feel you are not getting anywhere, please contact Press for Change again.  We can put you in touch with one of the solicitors who are representing people in such cases.  You have a good chance of winning a case against a HA if it proves necessary to go to court.  Several similar cases have already been settled out of court.

6. Although these kind of setbacks may provide very understandable reasons for being extremely depressed or suicidal, it is important to stay calm and to appear to be in control.  It will not help you if it is possible to argue that you are mentally unstable.

Part Two: The Arguments

Reasons why a Health Authority should fund gender reassignment treatment

1. Ensure the person in the HA responsible for making the funding decision is fully informed about transsexualism - they may not be.

2. If you have already begun hormone therapy, point out that to refuse surgery will leave your treatment unfinished - an unusual and unethical way to treat a patient!

3. If you have been assessed by a specialist, point this out and ask him/her to write in your support.

4. If your GP is supportive point this out.

5. If you have been refused funding because of what appears to be a blanket policy tell them that most HAs at least look at each case on its merits.  (Press for Change made a study of this).  Some have positive policies towards funding gender reassignment (see the Nottingham Guidelines).  Note that a blanket policy of never funding a specific medical procedure is illegal.

6. Gender reassignment surgery is a one-off expense, enormously cheaper than the alternative…The alternative for transsexual people who are not treated is likely to be that (if they do not kill themselves) they become a lifelong burden on the psychiatric and/or social services, unable to lead a normal life, unable to work (and pay taxes) or to make a contribution to society.

7. On the other hand, transsexual people after reassignment treatment rarely use psychiatric or social services ever again.  They nearly always go on to lead full, healthy, independent and productive lives and make a positive contribution to society - successful transsexual people are even now working in every walk of life.

8. Gender reassignment is the only known effective treatment for transsexualism and is in 98% of cases completely successful (a far better success rate than most other treatments carried out on the NHS).

9. Gender reassignment surgery is carried out on healthy people, often relatively young people, who therefore generally recover quickly - this fact adds to its success and economy.

10. As there are very few transsexual people around (perhaps 10,000 throughout the UK), it is unlikely that any one HA would have to fund many such treatments - i.e. the cost will be a drop in the ocean of their budget.

11. Gender dysphoria is a recognised medical condition which is now thought to be inborn.  (See PFC publication “Transsexualism: the current medical viewpoint”.) Transsexual people should therefore be treated equally to any other person born with a correctable inborn disability.

12. Transsexualism, if left untreated, is a fatal disorder i.e. people really do kill or mutilate themselves.  It cannot for this reason be fairly compared to many other types of plastic surgery.  Where an individual is suffering debilitating psychological distress, most HAs would consider funding plastic surgery even if it is not usually their policy e.g. even nose jobs and bat ears move up the funding agenda when the owner is incapable of leading a normal life because of them.