en English

The last of the ‘expert witnesses’ to testify against Dr Helen Webberley in her tribunal this month is Dr John Dean. Dr Dean, a former GP and current clinical lead for the Exeter Gender Identity Clinic (GIC, also known as ‘The Laurels’), has been invited by the GMC because of the expertise and experience he has gained from his career managing gender identity services. On the surface this makes sense – one of the allegations against Dr Webberley is that she doesn’t have the right experience or qualifications to treat young trans people – but what kind of expertise does Dr Dean provide, and how has it affected the service he manages?

Besides his role as clinical lead for The Laurels, Dr Dean has also been chair of the NHS Clinical Reference Group (CRG) for Gender Identity Services since 2013 and clinical lead of the Welsh Gender Service at Cardiff since 2019. It’s easy to understand why, during their 2015 consultation on transgender equality, he was invited to give oral testimony for the Women and Equalities Committee. In the report he is quoted as saying: “Not treating people is not a neutral act – it will do harm”.

This is a sentiment with which many trans people and their allies will agree. Transgender healthcare isn’t just about who is providing what treatments, it’s about reducing the barriers that are stopping people from getting access to those treatments. If the best quality trans healthcare in the world were available in the UK, it would do no good if the people who needed to gain access to it were barred from doing so. As Dr Dean says, it would do harm.

And yet, despite Dr Dean’s apparent commitment to improving the provision of trans healthcare, just five years later The Laurels has become an infamous bottleneck. Indeed, in 2020 the service saw just two new patients. As of April 2021 there are 2,702 people on the waiting list, with personal accounts online revealing patients often waiting upwards of four years. In January 2021 the longest single wait for a patient on the Laurels was 2,092 days – five years and eight months without a first appointment.

But it wasn’t always this way. In 2014, 280 patients had an initial assessment at the Laurels – but by 2020 this had fallen to 12 (or about 0.004% of the current waiting list). As recently as six years ago The Laurels was favourably reviewed online as one of the best GICs in the UK, but now patients are waiting so long with so little contact that they don’t even know if they’re on the list.

And while we don’t know what exactly is causing such a stranglehold on care provision, it’s clear that the management of the service is at least partially responsible. It appears that poor funding, poor staffing, and a model of care that drags patients through redundant assessments to ‘prove’ their identities have all contributed to the decline of this service. It’s true that referrals to gender identity services have increased year-on-year – but that’s not an excuse for failure to then provide those services. It’s not reasonable to tell transgender people to stop being transgender, but it is reasonable to demand that services are developed and devolved in response to a very real need.

Perhaps the problem relates to the fact that Dr Dean is too many degrees removed from the actual care of the transgender people that his services were created to support. He hasn’t practiced as a GP since 1999, and he personally doesn’t have any experience of providing gender-affirming care to trans children and adolescents. Complaints online have suggested that the service is tied up in bureaucracy, and has lost sight of the people it’s supposed to help.

It’s easy to talk about these wait times as if they’re a fact of life – a problem without a solution – but GenderGP has shown that there is another way. Since its formation in 2015, GenderGP has provided private treatment to more than 8,000 people. Some of these individuals have been on the waiting list for the Laurels since this company was founded, and they’re still waiting.

And all the while people are suffering very real and grave consequences. In May of this year the musician Sophie Gwen Williams took her own life after waiting five and a half years without a first assessment at a GIC, then transferring after a move to London and being told it would be a further four years. Almost a decade for a single appointment. Her friends and supporters were vocal in the press and at London Trans Pride: “how is any trans* person supposed to survive nearly A DECADE amid a maelstrom of gender dysphoria and the repeated mental health crises that it brings on?” Beneath the culture war that so often characterises trans issues in the UK, people are struggling to stay alive for treatments that get slower and further away each year.

So when Dr Dean takes the stand, we must consider his testimony in the context of the waiting times at The Laurels – and the tragic death of Sophie Gwen Williams. Two factors which emphasise the very real consequences of the endless checks, balances and red tape favoured by the NHS when it comes to treating transgender patients.