FOI – 000051 Gender reassignment (HTML)

Date received 8 Mar 2022 – Date responded 25 Mar 2022

Request

Good morning,

1. I have been trying unsuccessfully to obtain the following information from NHS Scotland, who referred me to the individual regional health boards and they, in turn, are referring me to National Services Scotland.

2. I’ve heard of pass the parcel but this is ridiculous. There must be official records on the costs etc to the NHS in the terms I am asking for information on.

3. Thus am submitting the following questions under Freedom of Information legislation and understand you have 20 days in which to provide me with a response:

4. How many under 18 year old biological males and females have been funded gender reassignment surgery in Scotland over the past five years? Please break the numbers down according to sex.

5. How many under 18 year old biological males and females has your health board funded to have gender reassignment surgery in England in the last five years? Please break the numbers down in terms of males and females.

6. How many transgender people in Scotland have detransitioned in the past five years and how many are currently in the process of detransitioning?

7. How much has Scotland spent on funding gender reassignment surgeries and all associated treatment costs for under 18 year olds in the last five years?

8. Has any health boards settled any claims from transgender people contending that they should not have been given gender reassignment surgery in the last five years?

9. What is the total average cost to the NHS of gender reassignment treatment and surgery for a biological male and female, including associated treatments such as referrals to endocrinologists for hormone treatment and monitoring; referral for facial feminisation and tracheal shave; referral for breast augmentation; referral to speech therapy for help in projecting a more female or male sounding voice and referral for hair and tattoo removal by laser or electrolysis to help with body/hair beard; facial surgery; breast implants?

10. Do you keep a record of the numbers of detranisitioners and if so what percentage of those who have undergone GR surgery go on to detransition?

Are under 16s ever referred for gender reassignment surgery? If so have any been referred without parental consent?

What is the average waiting time for gender reassignment surgery?

How many teenagers aged 16-17 have been sent to hospitals in England to undergo further assessment for specialist chest reconstruction over the past five years?

Response

Freedom of Information Reference: FOI-2022-000051 Gender reassignment surgery

I refer to your freedom of information request which we received on 8 March 2022 requesting the following information.

I can advise you that we have now completed the search of our records and can provide you with the following information:

1. How many under 18-year-old biological males and females have been funded gender reassignment surgery in Scotland over the past five years? Please break the numbers down according to sex. No under 18 year old people have been funded gender reassignment surgery in or from Scotland over the past five years. NHS National Services Scotland does not fund any elements of Gender Reassignment Surgery which are undertaken in Scotland (e.g. facial feminisation or breast augmentation). In conjunction with NHS England we only commission the provision of male to female and female to male genital surgery and male to female specialist chest reconstructive surgery from providers within England.

2. How many under 18-year-old biological males and females has your health board funded to have gender reassignment surgery in England in the last five years? Please break the numbers down in terms of males and females. For five-year period, 2016/17 to 2020/21 National Services Division (NSD) authorised 46 patients under the age of 18. This was their age at point of requesting funding with a view to being assessed by the surgical service. Whilst those under the age of 18 can be referred to surgical providers in England for consultation with a view to surgery, this surgery is not undertaken until the individual has had their 18th birthday. Therefore, no patients under the age of 18 have had their surgery funded by NHS Scotland or NSS prior to them being 18 years of age.

3. How many transgender people in Scotland have detransitioned in the past five years and how many are currently in the process of detransitioning?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold this information. There are no records held which detail how many individuals have chosen to detransition.

4. How much has Scotland spent on funding gender reassignment surgeries and all associated treatment costs for under 18 year olds in the last five years?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold this information. NHS Scotland and NSS has not funded any gender reassignment surgery for people under the age of 18. There are no records available which detail the total costs to the NHS in Scotland for gender reassignment surgery, provision of gender identity clinics, therapeutic services and prescribed medications which are made available to those undergoing the process of transition.

5. Has any health boards settled any claims from transgender people contending that they should not have been given gender reassignment surgery in the last five years?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold information concerning legal claims from those contending that they should not have undergone gender reassignment surgery.

6. What is the total average cost to the NHS of gender reassignment treatment and surgery for a biological male and female, including associated treatments such as referrals to endocrinologists for hormone treatment and monitoring; referral for facial feminisation and tracheal shave; referral for breast augmentation; referral to speech therapy for help in projecting a more female or male sounding voice and referral for hair and tattoo removal by laser or electrolysis to help with body/hair beard; facial surgery; breast implants?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold this information. There are no records available that detail the inclusive costs to the NHS in Scotland for gender reassignment surgery, provision of gender identity clinics, therapeutic services and prescribed medications which are made available to those undergoing the process of transition. Each individual is unique and will undergo different elements of care depending on their own individual needs. Several of the treatments referred to in the question are part of core clinical services provided by NHS providers which are not identified separately or are unique to gender reassignment treatments. It is therefore impossible to determine an average or total cost.

7. Do you keep a record of the numbers of detranisitioners and if so what percentage of those who have undergone GR surgery go on to detransition? Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold this information. There are no records held which detail how many individuals have chosen to detransition.

8. Are under 16s ever referred for gender reassignment surgery? If so have any been referred without parental consent?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold any details as to the process of consent in individual cases. It is not current normal clinical practice to refer those under the age of 16 for gender reassignment surgery.

9. What is the average waiting time for gender reassignment surgery? As a result of the Covid-19 pandemic, surgery is being clinically prioritised in line with the agreed clinical prioritisation framework with priority being given to surgery that is essential to save life or deal with life limiting conditions. Gender reassignment surgery is considered as an elective, planned procedure and at the present time waiting times have increased. The management of waiting times for the highly specialist chest and genital surgery is managed by NHS England and such data would require to be obtained for them.

10. How many teenagers aged 16-17 have been sent to hospitals in England to undergo further assessment for specialist chest reconstruction over the past five years?

Under Section 17 of the Freedom of Information Scotland Act an organisation does not require to provide information if it does not hold that information. NHS National Services Scotland does not hold the information on how many individuals have been sent to hospitals in England. As described in question 2 we can advise that for the total number of all gender reassignment related surgery cases we authorised funding: Over the five period year period 2016/17 to 2020/21 this was 46 patients under the age of 18.

I trust you will find the information of assistance and if you require any further information please do not hesitate to contact us.

If you are unhappy with any aspect of how we have dealt with your request you can make representations to us asking us to review the handling of your request.

If you require any further information please contact Associate Director Information Security & Governance, within 40 working days of the date of this correspondence.

Contact

Address

If after a review you are still unhappy, you also have the right to apply to the Scottish Information Commissioner, who can be contacted at Kinburn Castle, St Andrews, Fife, KY16 9DS, or via their application form.

National Services Scotland (NSS) is committed to publishing all information released in response to Freedom of Information requests. You can view all FOI responses within our FOI Publications repository.