Posts tagged GIC

Prescribing practice…

Can’t/won’t say much more right now. However, i am in conversation with one Health Authority about current prescribing practice and there is likely also to be a story or a development of great interest to the trans community in the not too distant. Read the rest of this entry »

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And on to the discrimination case…

Here goes.a copy of what i have now sent to the EHRC to see if they’ll give me “strategic support”. If they won’t, that’s OK…i’ll just head off to county court to take the case forward separately.

Meanwhile, any thoughts anyone has in respect of the argument. Also, anyone else who has suffered from GIC’s in this way, please let me know. All cases gratefully received.

jane
xx

The grounds for claiming discrimination are as follows:

1. I am transgendered. I was diagnosed as gender dysphoric earlier this year, and am pursuing a course of treatment that will lead, in time, to full gender re-assignment following.
2. I have been living full time “in role” since January 2010, including dressing, and as far as possible living as female. I have amended my name in respect of all significant services (including tax, voting and VAT) to be consistent with my personal identity.
3. It has been my experience that the majority of organisations with whom I have dealt – including the Inland Revenue, NHS, Customs and Excise, Utilities, Electoral Registration, the Registrar of Births Deaths and Marriages and many more besides – have been happy to change my name details on the basis that I prove my entitlement to services or privileges under guise of my old name and then simply to switch to my new name version.
4. A Home Office legal adviser has confirmed to myself that there is no such thing as a “legal name” in UK law: this has been further confirmed by a number of legal experts.
5. Earlier this year, I was referred to the NHS Gender Identity Clinic at Charing Cross in London for treatment in respect of gender dysphoria. They have stated both verbally and on the record that they will not recognise a change of name without production of a deed poll (or possibly statutory declaration).
6. This practice is at variance with the practice of all other government departments that I have dealt with (see 3. above), including the NHS own guidelines on the subject, which urge medical staff to deal with an individual according to the gender in which they present and as they would wish to be identified – and which permits individuals to change their name within the NHS own computer system on the basis of a simple verbal request for same.
7. I have been informed by management at the Gender Identity Clinic that even where an individual’s name has been changed within the NHS system, they will continue to use that individual’s previous name unless a deed poll is produced.
8. It is my understanding that the GIC do not apply the deed poll requirement to their own cis members of staff: this is therefore directly discriminatory, as the organisation applies different standards to cis and trans persons.
9. On visiting the GIC, my previous name was called out in public, by a consultant, in front of other members of the public even after I made it known to a member of staff at the GIC that I no longer used that name. This was both humiliating and acutely embarrassing.

It is my contention that this treatment is discriminatory in respect of transgendered individuals because it is applying a test to such individuals that is not applied to others. Specifically,

10. The GIC requires that individuals demonstrate “proof” of living in role. In fact, the effort required to obtain a deed poll is minimal: a cost of £5-£10 and a simple form that can be filled and obtained in an hour or less. The real effort to living in role is demonstrated by actually changing one’s name across a large number of bureaucratic systems: being known by that name in everyday life, to friends, family and work colleagues; and, more seriously, enduring the everyday burden of on-street transphobia that is the lot of most early days trans men and women.
11. In the case of the GIC, the fact that they appear not to require documentation to show staff members have changed names is an instance of direct discrimination in the way that they treat trans and cis individuals.
12. Varying explanations may be put forward around either security or computer integrity. These may be complex but in most cases resolve either to poor system design or organisational fossilisation: the view that because this is how the system works, it is how it should work. In fact, there are very few places where systems could not be amended very easily and very quickly to take account of changing names, with no loss of integrity or security. In no case does documentation of any sort help to make the case more strongly.
13. Although the demand for a deed poll is a small request, it is part of a wider pattern, which sees organisations continuing to place requirements for documentation on the transgendered and on women that tend not to be encountered by men. This is therefore an instance of sex discrimination in its purest form.
14. It is further humiliating, since it constitutes a social statement that an individual’s identity is not affirmed unless they pay for a piece of paper to confirm that identity: the GIC has also threatened that where an individual fails to obtain a deed poll, hormone treatment may be withheld or even withdrawn. This has such significant consequences for trans individuals that it cannot be seen as anything except the most egregious form of social control.

In addition to the above, it may be helpful to bear in mind that I am in the process of preparing a paper on behalf of to submit to the Equalities Minister, Lynne Featherstone, that argues that the demand by many organisations for documentation before they will recognise a change of name (deed poll for transgendered individuals: marriage or divorce certificate for women) is in most cases discriminatory on grounds of gender.

I believe that this case is worthy of support by the EHRC because there is an important point of principle at stake here that affects the lives of almost half the adult population in the UK – transgendered and women alike. The demand for proof of identity has become entangled with a non-concept – the “legal name” – and it is time that the two ideas were disentangled once more.

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The fightback begins…

Today’s first phone calls have proven positive. However, these were just the first echelon response, so I guess I should be prepared for a few knock-backs before I arrive.

First to my GP practice, where I am starting to put in hand a) name change (without deed poll, naturally!) and b) shifting to a female GP. It was difficult enough to cope with a bloke before Friday: now it is impossible, which is a shame, because the GP I DO have right now has never done anything but his best for me, is a very gentle caring bloke, and tries his best.

Its just…well, he can’t help being a bloke!

Next to the GIC, where I spoke to a very nice lady – Linda – who did her best to persuade me to give them another chance. Detail? Well, I actually started out by giving her something of a hard time. Sublimated a little bit of anger but…it wasn’t her fault, and just venting at her wasn’t going to get me anywhere much.

On the other hand, I did obtain one or two answers to questions which are both instructive and possibly useful for follow-up around official complaints.

Basically, they are NOT meant to call you out in reception with your previous name. So someone may speak to their consultant.

They DO continue to insist on deed polls…which means that whilst Inland Revenue, HM Customs and Excise, the Home Office, the Registrar of Births Deaths and Marriages, the Electoral Registration Officer and all of the NHS (apart from GIC’s) – to name but a few! – are happy to take a name change without a deed poll, Charing Cross says not.

That leaves them in a select group of a very few institutions that includes nPower, Tescos Clubcard, and most major banks.

I asked about whether they insisted on proof of name change for their staff – and she couldn’t confirm or deny: interesting, since at least one member of the GIC staff has changed her (first) name in the last few years and I’d bet no proof was required. That, in case anyone is wondering, is almost certainly discriminatory – as too is the claim that failure to provide documentation means that they can’t link old and new records.

Er, no. When I change my name in the NHS system, they will have to deal with that issue like every other bit of the NHS in the land. Presence or absence of deed poll makes no difference whatsoever to that issue.

Some difference between her view of whether a helpline number should have been dished out or not. My inside tracker says to me that it should: Linda says not, although literature is available in reception.

Also started to get to the heart of other technical issues, like: what the hell was the status of the consultation I just had. Did it make me a patient, even?

We sort of agreed it didn’t. Because, basically, if it did, then I would have to stop seeing my private consultant and, since I need to continue treatment for the time being (not least to monitor any side-effects of the hormones I am taking) that relationship needs to continue until it stops.

Her understanding – to be confirmed – was that following a second assessment, which would have been in February, they would possibly offer to take me on as a patient, at which point I would have to choose. Perfectly reasonable – and a million miles from the bowdlerised version offered me on Friday.

So. I need to write back to her.

Next: I spoke to the pct and have asked them to refuse to shell out for the consult I just had. I suggested that they should not pay a) because I would be taking this forward as an instance of discriminatory and abusive behaviour, and b) because it felt very much like “make-work”. I raised with both the pct and Charing Cross the refusal of their consultant even to look at the blood work done to date and insistence I re-do it…as well as the fact that instead of acknowledging where I was now, I got treated as though this was day one of my transition.

But someone needs to pick this up. If Charing Cross are to be believed, the only trustworthy phlebotomy departtment in the UK (that’s bloods, that is!) is situated in Charing Cross hospital. If true, this is a national disgrace and something must be done. Alternatively, it is more of the money-grubbing culture that seems to surround this whole business.

On the positive side, I told the pct that legal precedent granted me the right to seek treatment for gender dysphoria. That following my abusive treatment at the hands of Charing Cross, I could not be expected to go back there. And that I would ask them to consider paying for an alternative private provider.

No promises…but they seem likely to be able to get an answer back to me on that one in the next week or so.

Of course, if the answer is no, then legal fall-out will follow. But still, it could go some way to establishing an important point of principle for trans men and women everywhere (or if its already been established, please let me know and I’ll feed it into my case).

More news soon.

jane
xx

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The control freaks have taken over the asylum

So what’s my take on what just happened? I think there’s a much bigger political dimension – which I will write up later over on the political blog.

However, this feels like an obsession by some parts of the medical (psych?) profession with control and dogma: prescribing according to guidelines and not the needs of the patient. Sure: I see the need for a lead consultant, and therefore would not mind losing my private specialist.

But this prescriptive, inflexible approach to history-taking and rule-setting? Let’s NLP some of this. First off., I arrive looking good, wearing some of my nicer clothes . Hair is neat and tidy. Make-up is good. Nail polish, sadly, not quite up to scratch (sic!) – but it will do.

All this takes time and effort. Did he notice? Nope. No pleasantries. No “hair looks good”. Nothing. Would a female consultant have done better – or not? Because there is a double point to this. I’m being assessed and one of the things being thrown into the scales is one tiny trivial item legislatively – the deed poll. Whereas the fact that I took time to dress, to look good, is not commented, not recognised.

(Also unrecognised: the fact that i walk through london this way!)

Instead, its quickly on to the verbal history-taking which, let’s be honest, if I wanted to screw with their system, I could have learnt by rote.

The clothes? The look? The work that goes daily into my self-presentation? The fact that, because I am still some way from that Holy Grail of “passing”, all of the above means I walk through life now the centre of comments, sniggers, and occasionally far far worse…no comment.

But if – perish the thought – I prove “resistant” to some petty abstract little legalistic rule that they have made up for purposes of back-covering, why: that might be enough to bar me from hormones.

Well, bully for them – and I do mean bully.

I come away with my faith in the system (and my belief in all the re-assurances that the system has improved) quite shattered. I am dealing with a bunch of control freaks who either have no comprehension of what they are dealing with or…and I sincerely hpe this is not the case…know all too well.

Because if they understand what it is to be trans, then they would understand that the line is being drawn in the wrong place. Hormones should be, need to be, easy. The cost is not great. There’s a long run-in before effects become irreversible. They minimise distress.

Sure: I’ll go along with surgery being harder to access on the NHS, given the step-change in resource and consequence that it entails. But not hormones.

No. In a sane and idealised world, we would get beyond this psychiatric nonsense for the early stages. I should be assessed on basis of my understanding of the issues and ability to take responsibility for my decisions. There shouldn’t even be a question mark over hormones.

The fact that there is suggests that much of this process is about control – and little else.

jane
xx

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Charing X: the uncontained country

So. Was this all planned? Is there a chapter somewhere in the Handbook of Psychiatric Charlatanry that underscores how its not a good session unless you provoke your patient to tears or anger or both?

Receding now… I’m still putting it all together…and the further it gets, the angrier I feel about the consultant’s utter failure to contain issues: his apparent complete and total disregard for any emotional downside to the session.

We ended with me not understanding next steps. Can they block treatment? He says not: but he doesn’t explain what they can or will do.

Confused. Angry. And a black hole opening up. Panic. Close to panic attack in Hammersmith tube. Desire to hurt. Someone else? Me? This can’t be any sort of sane or rational service.

Good thing I am mostly rational. I can feel the darkness clawing out to claim me and if I weren’t so darn rational …if I were depressed…down…we’d be looking at overdose territory right now. Damn him!

Because here’s the thing that I’m guessing you lucky cis people reading my blog don’t know. Which is how it feels to get on to hormones…and how it feels to even imagine losing them. Am I alone in this? I don’t think so. I know others who have transitioned before me who have been treated similarly…and been just as upset.

This is why some of us suicide…because we CAN’T transition when we need. FFS: I thought Charing X knew that.

Still, for now I carry on. I detach. I watch myself going into panic. A PCSO approaches me. I’m now on Kings X station. I appear to be in tears. How did that happen? I glare at him. He backs off.

So what did this consultant think he was doing? Did he really intend to provoke this? I have no idea. How does one separate deliberate cruelty from sheer carelessness.

As I put things back together, I realise it is all about containment – or rather non-containment. He’s hurt me. A lot. And then just shoved me out on to the street in a rush, because he’s on to his next patient. Brilliant.

Care by rote and by the carefully-timed therapy period. On the train, other stuff bubbles up…we picked over relationships. Lightly I passed over abusive relationships I had suffered. Like: guess what…in THIS particular relationship, some nights I just lay awake too scared to go to sleep. Many years ago. But that fear is suddenly back.

Is this how the NHS tends to cover such issues? You got abused? You got hit? You feel bad about it? OK: let’s tick the box and move on.

Boundaries. What boundaries?

jane
xx

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Charing Cross narrative

Rushed. 11am appointment, which is never good for me. The vagaries of modern rail mean I can get to London after 10am for £28 – or before for the best part of £100. I needn’t have worried: made Charing Cross GIC with about 15 minutes to spare…and then waited an extra ten minutes for my appointment.

We opened on a slightly sour note. He – the consultant – called me in by THAT name…the old one…the one I’d rather not use any more. I handled it well – I thought. I was assertive. I explained my dislike of it. Told him my name.

I explained my dislike of deed polls as bureaucratic nonsense and an imposition. I explained I was taking that matter up at Ministerial level. I kept it all light.

So we started with history-taking: the usual charlatanry. Childhood. Relations with school. Relations with friends. Relations with relations. It wasn’t exactly threatening – wasn’t exactly anything much at all.

Til the end – and a provocation. How did I feel at the start? Huh? Did he think I was cross or something? The whole point was for me NOT to get wound up: to state, to assert and not have a go. Is he looking to start something?

He insists. Honest reaction, I say? I was terrified at the idea this might get in the way of my transition. I still don’t feel altogether safe.

He falls back – but only for a moment. Let’s cut to the chase. I can’t go private and be treated at Charing X. That’s fair. I’m happy with that.

But…we wouldn’t prescribe hormones til a second appointment (which has now moved out to February) or later: might need me to COME OFF hormones until I satisfy their criteria.

Oh? Wary, now. Hasn’t he heard a word I’ve said? A black hole starts to open: I can’t contemplate that.

And they may need a deed poll. What! Yes: some consultants won’t prescribe hormones until I’ve got a deed poll. Bastards! Fucking control freak bastards!!! This is beyond madness and I kick off.

I explain again why I object to the stupid things: why I can’t see the point of making life-changing drugs dependent on something I can obtain in ten minutes for a fiver. Explain, again, that his lot are medics – not lawyers – and they appear seriously to be misrepresenting the law on this front.

He scribbles furiously. Did he deliberately set out to provoke this, to see where I would go? Stupid man. He adds another twist. My dislike of deed polls shows “resistance”.

To whom? To what? I’ve changed my name already with Inland Revenue, VAT, NHS next week. The council. My video shop. But no: I need to go buy that stupid bit of paper.

But time is pressing. The issue is still whirling round as I find the session finished and myself back out at reception…then out on to the street. I am a total wreck. Plans for a quick dash up to Camden for some clothes shopping are trashed.

The hole opens up and panic sets in.

Jane
xx

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Charing Cross…make that VERY cross

Angry.

Upset.

Tearful.

Furious.

Cross. At him – for provoking this. At him – for not containing it. At me – for feeling this way.

Day ruined.

One mad tranny on the warpath.

Mild to militant in 60 seconds flat.

Sick to death of formal, male, patronising, arrogant, controlling gits.

Jane
xx

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