Overview

Tackling poor outcomes, health inequalities and patient safety

Trans people experience worse physical and mental health than the general population. This is likely to be substantially due to the direct and indirect effects of the inequality which trans people experience. This results in multiple admissions across health and wellbeing services. Whilst the numbers of trans patients is small they are rapidly increasing. Local engagement clearly highlighted poor patient experience in relation to the two to three year waiting lists to access national gender identity clinics and the lack of understanding of by health professionals in meeting the clinical and health and wellbeing needs of this population.   

Current health inequalities include:

• Trans patients are disproportionality more likely to experience poor mental health in comparison to any other population cohort - 59 % of trans people under the age of 26 years have considered suicide and have self-harmed , compared to 8.9 % of all 16 to 24 year olds (Pace research – Brunel, Worcester and London South Bank Universities 2015).
• Trans patients are disproportionality more likely to take their own life than any other population cohort. 48% of Trans patients under the age of 26 years have attempted suicide. (Patient safety issue).
• Evidence also strongly indicates that poor patient experience and lack of confidence in GPs means it is more likely to delay in visiting their GP, meaning holistic health needs of trans patients are not being met effectively and routine screening not accessed

How we responded

With our partner CCG in Sefton, we established a collaborative group made up of members of In Trust Merseyside, expert patients, expert clinicians and other key stakeholders. The aim was to genuinely co-produce a unified pathway for the transgender community to enable holistic support across primary care, secondary care and across voluntary, community and faith sector to address entrenched health inequalities and discrimination.

Our Trans Health Sefton service was launched November 2017 providing timely and holistic support for transgender patients and their families to improve their experience and health outcomes and giving them access to the right local services at the right time.

Our approach developed into CMAGIC, the Cheshire and Merseyside Area Gender Identity Collaborative. CMAGIC is a multifaceted collaboration between trans patients and organisations  and clinicians across the Merseyside area. 

The collaborative aims to improve the care of transgender people through:

• Support and education of the clinicians who provide care for trans people
• Distribution of information relating to transgender health care
• Coordination of services and sharing of resources
• Development of clinical pathways clinical evidence and best practice guidance
• Develop and disseminate new ways of service provision, e.g. tele-consultation.
• Assist commissioners in identification and support of clinicians willing to assist in the care of Trans patients across the area
• Explore development of a provider network capable of being commissioned as gender identity Centre.

As a result, our co-produced and innovative Trans Health Sefton pathway was adopted by CCGs across Merseyside. The collaborative is currently hosted by Mersey Care NHS Foundation Trust and co-production remains central to CMAGICs approach.

The outcome

In 2019-2020, the work of Trans Health Sefton and CMAGIC has gone from strength to strength and their approach and success have been recognised nationally. 

Trans Health Sefton was the winner in the Primary Care Innovation category of the national Healthcare Transformation Awards, hosted by NHS Clinical Commissioners and Health + Care in June 2019. The pathway is also being adopted in 2020 as a national pilot for gender identity clinics, part of NHS England’s specialised commissioning for transgender services.

This year our CCGs have supported expert patient and community representatives with regular information sessions to further strengthen their understanding of their roles of chair and vice chair of the core group. This has included training on conflicts of interest and how chair meetings. Other capacity building initiatives for core members has included briefing on understanding legal duties such as the Equality Act 2010, duty to involve, human rights and common law requirements to consult (Gunning principles). This has empowered community representatives to access and chair meetings, as well as improving their ability to challenge public authority representatives and clinicians who attend the meetings.

Importantly, patient experience has improved as part of this unified approach, equality of opportunity has been advanced and health inequalities reduced amongst our trans residents.