Written evidence submitted by UK Trans Info to the Transgender Equality Inquiry

1. This response is from UK Trans Info, a national organisation focused on improving the lives of trans and non-binary people in the UK.

Executive Summary

2. Although UK Trans Info’s remit is wide, most of our work focuses on legal issues and adult trans-specific healthcare so our submission will focus on these areas. This is not intended to suggest that these are the only important areas of concern and we refer you to the Trans Organisation Network’s submission for a broad overview of other concerns.
3. UK Trans Info welcomes this inquiry and hopes that it will achieve positive changes for trans and non-binary people, but we also urge the Committee to hold an inquiry into intersex equality as the protections and rights of intersex people have been long overlooked.
4. Our key recommendations are:

• Reform gender recognition legislation to be a simple, cheap administrative procedure based on self-determination of gender
• Allow people to opt out of having a legal gender
• Add gender identity as a new protected characteristic under equalities legislation
• Remove exceptions that allow legal discrimination against trans and non-binary people
• Remove requirement to prove existence of a gender recognition certificate before enhanced privacy is granted
• Provide guidance for both individuals and organisations on changing name, titles and gender
• Create gender neutral marriage vows
• Create alternative format birth certificates which refer to parent 1 and parent 2 rather than mother and father/parent
• Remove requirement for doctor’s letter to change gender on passports
• Introduce passports with unspecified gender
• Ensure access to gender identity services are fully covered by Referral to Treatment targets and ensure these targets are met
• Produce clear guidance for GPs on issuing bridging prescriptions
• Commission an independent study into the possibility of moving to a system of providing treatment by informed consent

Legal Gender Recognition

5. In January 2015 the World Professional Association of Transgender Health issued a statement (henceforth “the WPATH statement”) regarding gender recognition[1] grounded in their clinical experience as health and legal professionals. They urged governments to “institute simple and accessible administrative procedures for transgender people to obtain legal recognition of gender.” The Gender Recognition Act 2004 (GRA) does not meet their recommendations.
6. In April 2015 the Parliamentary Assembly of the Council of Europe adopted with large majority a resolution (“the CoE resolution”) on Discrimination against transgender people in Europe[2]. They called on member states to “develop quick, transparent and accessible procedures, based on self-determination, for changing the name and registered sex of transgender people.” The GRA does not meet their recommendations.
7. The GRA is outdated and in urgent need of revision. We recommend the following changes, which are largely in line with the WPATH statement and the CoE resolution:
1. Remove the requirements for medical evidence and evidence of living ‘in the acquired gender’ and replace with a simple administrative system that only requires a statutory declaration as evidence. The UK would then join Argentina, Denmark, Ireland and Malta as world leaders by allowing self-determination of legal gender.
2. Remove the two-year waiting period before gender recognition can be obtained.
3. Reduce the age requirement for obtaining gender recognition through the standard route to at least 16.
4. Provide a method for children and teenagers who are below the usual age requirement to obtain gender recognition with the consent of their parents or guardians, or without their consent through the courts where it is in their best interests.
5. Remove the requirement introduced in the Marriage (Same Sex Couples) Act 2013 for people to provide a statutory declaration of consent (known as the ‘spousal veto’) from their spouse before they can obtain full gender recognition. This requirement can delay gender recognition for years if the divorce is a difficult one, and delay it forever if the spouse is in a coma or otherwise unable to consent. The spouse’s rights can be protected by preventing the reregistration of the marriage unless both spouses agree and by giving them an uncontestable grounds for annulment. Full details on problems caused by this requirement and our proposed solution can be found in our previous submission to the Ministry of Justice[3].
6. Allow those who are in a civil partnership to obtain gender recognition without having to first convert it into a marriage. This requirement causes similar issues to the spousal veto, as it requires the partner to consent to the conversion before recognition can be acquired. If the relationship is a happy one but the partner does not agree with marriage then this can cause the couple to have to choose which partner’s needs are met.
7. End the situation where those who are in a Northern Irish marriage or civil partnership must end that legal relationship before gender recognition can be obtained, even if this means the marriage cannot be reregistered due to the lack of legally same-sex marriage in that country. If this cannot be accomplished by keeping the marriage or civil partnership fully intact then instead create a procedure that allows an interim Gender Recognition Certificate to be used to convert a Northern Irish marriage into a civil partnership (or vice versa) without affecting the continuity of the legal relationship.
8. Allow people to opt out of having a legal gender. This will allow the many people who do not identify as entirely male nor as entirely female (0.4% of the population according to some accounts[4]) to obtain birth certificates and other documentation that does not incorrectly gender.
9. Remove the requirement to be or have been in a marriage or civil partnership in order to use the Alternative Track procedure for gender recognition, and change the requirement to have transitioned six years before the provisions were brought into place to instead be six years (or preferably less) before the date of application (this only applies if the procedure is not removed due to other recommendations)
10. Allow automatic recognition of overseas gender recognition.
11. Reduce or remove the cost of gender recognition applications.
8. We note that these changes would also be a cost-saving measure as it would end the need for the Gender Recognition Panel.
9. We also recommend updating the gov.uk website which still says that it is necessary to end an existing marriage or civil partnership before gender recognition can be obtained.

Equalities Legislation

10. The Equality Act 2010 does not fully protect all trans and non-binary people, nor does equality legislation in Northern Ireland. We recommend the following changes:
1. Create a new protected characteristic of Gender Identity based upon the definition in The Yogyakarta Principles[5] as the current definition of Gender Reassignment doesn’t clearly encompass all trans and non-binary people. A similar recommendation was also included in the CoE resolution.
2. Reverse the situation where a Genuine Occupational Requirement to specify that someone must not be a trans person is legal, but one to specify that they must be a trans person is illegal.
3. Remove the exception allowing providers of single-sex services to legally discriminate against trans and non-binary people which in particular can sometimes make it impossible to access crisis services.

Privacy, Records and Changing Details

11. Remove the exemption in 22(4)(c) of the GRA which forces people to prove that they have a full GRC before their protected information is actually covered by the enhanced privacy granted by that section. This will force organisations to assume that all trans and non-binary people have gender recognition and treat their gender history with the care that it requires.
12. Trans and non-binary people routinely have difficulty getting organisations to update their name, title (Mr, Miss, etc) and gender on their records. Even large chains such as high street banks have discrepancies from branch to branch or even employee to employee with unreasonable and unlawful demands such as a Gender Recognition Certificate, doctor’s notes or even proof of surgery. We recommend producing clear guidance for organisations on how name, title and gender changes should be responded to and in which circumstances a Gender Recognition Certificate should or should not be requested.
13. The gov.uk website’s information on changing name is inadequate and does not give sufficient information on the many options available. We recommend updating to the level of detail found UK Trans Info’s guide to Changing My Name and Title[6].

Marriage

14. Marriage vows in England, Northern Ireland and Wales require the use of the word husband and/or wife. Some registrars insist that this must relate to legal gender, meaning trans women without a GRC who get married have to be referred to as ‘husband’ in their vows and trans men without a GRC have to be referred to as ‘wife’ in their vows. As these vows are heard by everybody who attends the ceremony this can be a significant problem if some friends or family are unaware that they are a trans person. The gendered language is also a problem for some non-binary people and we are aware of several couples who have felt unable to marry because of this. We recommend allowing a gender neutral set of vows as is available in Scotland.

Children of Trans and Non-binary People

15. Birth certificates in the UK always list the parent who gave birth as the mother, and where there is a second parent they are listed as either father or parent depending on the circumstances surrounding the conception. This can lead to trans men being listed as mother, and trans women being listed as father, even when their name, legal gender and/or role in the family don’t match these descriptions. This can cause problems when the birth certificate has to be produced, especially outside the UK.
16. We recommend creating an alternative format for birth certificates which lists both of the parents as just “parent 1” and “parent 2” instead of mother and father/parent. The first parent listed would be the one whose name is first alphabetically. This format would be available for all birth certificates, including historical ones, as an option alongside the usual format. The decision of which format to use would be made each time a copy of the birth certificate was ordered, meaning that the usual format would always be available if it was needed to verify the exact legal parental status that applies.

Passports

17. Trans and non-binary people currently require a letter from a doctor before they can alter the gender marker on their passport. This is not in keeping with the Equality Act which does not require medical intervention, and in many cases the doctor is only basing their letter on the applicant’s word. We recommend that this requirement is removed.
18. For those who do not identify solely as either a man or a woman, gender markers in passports can be distressing. We recommend introducing passports that do not specify the holder’s gender. This would be signified by an X, meaning ‘not specified’. This is fully compliant with international guidelines and the UK is already used to handling such passports as they are available in several countries including Australia and New Zealand.

Access to Gender Identity Services

19. Accessing specialised Gender Identity Services (SGIS) is a difficult and lengthy process in most of the UK, and it is absolutely vital that it becomes a quick and easy process. The point in a trans and/or non-binary person’s life when they first ask their GP for a referral to a gender identity clinic (GIC) can for many be a crisis point where they realise that they cannot continue to live their life as they  have been doing and must make changes. The feeling of urgency to get things started once that point is reached cannot be overstated, and this can lead to a very vulnerable situation.
20. Although we often hear from the uninformed that access to SGIS should be low priority for the NHS, there is clear evidence to suggest that the opposite is true. The Trans Mental Health Study 2012[7] found that 84% of trans people had considered ending their lives and that 35% had attempted suicide at least once. In addition 53% of the participants had self-harmed at some point, and 20% of respondents had wanted to harm themselves because of involvement with a GIC or health service due to problems such as long waiting times and delays to treatment. They also found that for the majority of participants both suicidal thoughts and self harm was drastically reduced after transition was complete, with 63% feeling that they harmed themselves less after transition.
21. We regularly speak to people that are currently on the waiting list who are actively self harming or considering suicide due to the delays and length of waiting lists for gender surgery. Importantly, many of them will not seek help because they believe it may put their treatment at risk if they show any signs of instability. The delays and barriers to accessing treatment are putting lives at risk.
22. SGIS in Wales are currently outsourced entirely to England. We recommend:
1. Create a GIC in Wales to allow trans and non-binary people there to access trans-specific healthcare without needing to travel to England.
2. As an interim measure allow people to choose between any of the GICs in England rather than being forced to go to the clinic in London.
3. Allow direct referral to a GIC as in the rest of the UK rather than requiring an assessment from local mental health services.
4. Remove the exemption for SGIS from 26 week Referral to Treatment standards and then ensure this target is adhered to.
23. SGIS in England are currently completely overwhelmed. We recommend:
1. Urgently remedy the breach of legal rights and the NHS Constitution caused by referrals to GICs exceeding 18 weeks Referral to Treatment standards in almost all cases, exceeding 52 weeks in many cases and in some cases exceeding 104 weeks[8].
2. Remove the cap on the number of patients that can be seen per year at certain gender clinics. Review the contracts held with each clinic to ensure that patients are not unfairly disadvantaged by attending a clinic that is not funded as well as others.
3. Ensure that NHS England meets its commitment[9] to bring waiting lists for genital surgery down to 18 weeks by March 2017.
24. SGIS in Scotland are also overwhelmed. We recommend:
1. Urgently remedy the situation where referrals to GICs are in some cases reaching 52 weeks.
2. Ensure that the 18 week Referral to Treatment standard is applied to access to GICs and that this standard is adhered to.
3. Resolve the situation at Aberdeen GIC where patients have had their treatment indefinitely delayed due to long-term absence of the clinics only doctor.
25. SGIS in Northern Ireland have much shorter waiting lists than the rest of the UK (8 to 10 weeks) but there are still some access issues. We recommend:
1. Ensuring that there is action taken to deal with the rapid increase in referral rates and ensure that waiting lists are kept well within the 18 week limit.
2. End the practice requiring existing mental health issues (including depression) be “dealt with” before attending the GIC. Mental health issues should be dealt with concurrently as in the rest of the UK and recommended by the Royal College of Psychiatrists.
3. Stop requiring patients to prove they are ordinarily resident in Northern Ireland before they can be seen at the Belfast GIC. The evidence required can be impossible for some people to obtain especially if they are homeless or living with family. Being registered with a Northern Ireland GP should be evidence enough.
4. Ensure that trans and non-binary people who have children are not automatically assumed to be bad parents or forced to send their children to weekly sessions with children’s social services as a requirement of their transition. One trans person recently told us that the clinic said refusal could lead to the child being taken out of her custody, and that if she didn’t agree to it then she should delay her transition until after the child left school.

Treatment for Gender Dysphoria

26. Access to hormone treatment is usually initiated by a GIC, yet due to excessive waiting lists and lengthy assessment procedures many patients turn to self-medication which can be unsafe especially with inadequate supervision. The Good Practice Guidelines[10], endorsed by 13 organisations including the Royal College of GPs, suggests that GPs give patients bridging prescriptions on a harm as part of a holding and harm reduction strategy, however due to unclear guidance most refuse. We recommend producing clear guidance for GPs on the issuing of bridging prescriptions for those who are waiting for treatment at a GIC.
27. Access to treatment is currently provided under a gatekeeping system. Patients have to go through an often distressing assessment process which can take as many as six appointments before treatment is even considered. In some cases patients are forced to bring certain friends or family members to assessment sessions against their wishes and with no regard to their right to privacy. Patients are often denied or delayed treatment for a variety of discriminatory reasons including because their name or clothes are not considered to be acceptable for their gender, because they do not have enough social interaction or because they refuse to tell everyone they know that they are trans. Non-binary people in particular are often told that because their gender is not entirely male nor entirely female they are a ‘complex case’ and treatment is often delayed or denied for this reason. We recommend commissioning an independent study into the possibility of moving to a system of providing treatment by informed consent.
28. The Good Practice Guidelines state that trans and non-binary people “have a right to counselling and psychotherapeutic practice as part of the overall package of care” which should be provided by therapists and counsellors with specialist knowledge of gender issues. While some people don’t need it, this should be available for those who do yet funding for this is often unavailable especially when commissioned locally. We recommend guidance be issued to commissioners to ensure they are aware how vital it is that specialised counselling be provided for these issues and asking them to ensure that it is always funded.

20 August 2015