Following an awareness event early this month, to bring people up-to-speed on the new local care pathway for trans and non-binary people, we spoke to CMAGIC chair, Tony Griffin about his personal journey and how the CMAGIC pilot came to be established.
First of all, can you share an overview of the new local pilot for trans and gender non-binary people?
The new service is a partnership between Cheshire and Merseyside Adult Gender Identity Collaborative or ‘CMAGIC’ and Merseycare NHS Trust. The CMAGIC pilot will provide a local care pathway for trans and non-binary people wishing to transition and brings together specialist multi-disciplinary teams. CMAGIC has already been delivering award-winning services for trans and gender non-binary people in Sefton for many years. As it was chosen by NHS England to be one of three pilots; CMAGIC will now provide a new unique care pathway to the Cheshire and Merseyside area.
You are well known by many for your commitment to the field of equality and diversity, particularly in healthcare settings, both public and private. How has your own journey influenced your work?
My personal experience has influenced a great deal of the work I do. I have worked in and out of the public and third sectors all my life and including the NHS. I am a trans man and socially transitioned, female to male, many years go. I have been very fortunate, unlike other trans people I have always been in employment. I was surrounded by supportive people and able to be who I was.
For a long time, I shied away from transitioning medically. I had campaigned for many years for the rights of trans and intersex communities and had seen how difficult it was. However, when the GRA came in, in 2004, it gave my now-wife the opportunity to make an honest man out of me, so I decided to do it. I wanted to get married and I could only get my Gender Recognition Certificate with a medical transition. I had to go to London for my appointments and the process was the most humiliating and inhumane experience I had ever been through. Like myself, my partner had also worked in the NHS for decades, but the treatment I received at the GIC bore no resemblance to the care in the NHS that we had both come to know. My partner made the observation that this will be viewed in years to come as barbaric, just as we now view the treatment of Gay men and reparative therapy.
I faced similar issues with my top surgery, which was a disaster. The surgeon was a breast surgery specialist but wasn’t skilled in reconstructing a male chest. At the time, I knew less about the process and was just delighted to have my surgery booked in. Now I realise there were so many red flags about their attitude towards me and there are so many questions I should have asked. In the end it took five years to sort out the mess that was made and I still have pain from it now.
So is this where the seeds were sown for the idea of a better care pathway for trans people?
In part, yes. There were such low levels of trans awareness in the NHS, even among people who genuinely wanted to deliver good care. It was clear that education was a problem. As someone working in training, I could see many opportunities for improvement.
I think the seeds were really sown when I moved to work in Sefton. I saw, even in my own local hospital, the barriers trans people faced. For example, when I sent my bloods the records would come with no male pronoun and my old name. Trans people were being told they could only change these with the GRC, but that had never been the intention of the document. I had lots of ideas of ways that trans, intersex and non-binary people could be better supported and Angela White, from Sefton CVS, was tireless in her support for those ideas. We established a local support group, In-Trust Merseyside and Cheshire, which saw people coming from all over the region. So I heard so many different stories about different treatment, I decided I wanted to track down the actual NHS care pathway that the North West was working to. It took a FOI request for a copy of the North West care pathway for trans people to be obtained, no one could seem to find an approved version.
It meant that everyone was doing things slightly differently and all of it was dependant upon the views and knowledge of GP’s and the local PCT’s. There was a huge gap. Eventually, in 2007, someone turned something up, but you could tell it had been found at the back of a draw somewhere. It was covered in tea stains and still had query notes scribbled on it, like it had never quite been finished. The task had been given to someone who had little or no knowledge of the process.
To be honest, I laughed at it. It was all wrong and had clearly never been implemented. It became clear why everyone was being treated differently. There was no guidance. It was clear the national service wasn’t working, so I decided to design a local service that was needed for many reasons and certainly aside from raising quality would save money for both the patients and the NHS itself.
At the time, trans patients could only be seen by the GIC if they were in paid employment. The GIC is obviously a key part of that care pathway, how did you tackle that?
In 2006, the Royal College of Psychiatrists re-drafted the guidelines for the treatment of trans patients. At that time you could only start your medical transition if you were in paid employment, which you had to prove. The draft new protocol changed that to ‘being in employment paid and unpaid’.
What that allowed us to do was establish a trans volunteer project, which would enable trans people who were out of work to take on volunteer roles and get their GIC appointments. We explained to Sefton organisations why we were doing it and asked them to help us source volunteer roles and Sefton PCT actually were our first employer to offer places. It worked and it allowed many of our members to not only start their medical journey but to gain valuable new skills and especially gain confidence to be out and about as themselves.
We were recognised at the HSJ awards for this, in the innovative practice category and I think this was something that made Sefton PCT more understanding as to why we needed to create a better care pathway.
How did this local care pathway develop from there?
When we shared the document we had received with Sefton PCT and explained about the non-existent care pathway, they were shocked. I think Fiona Clarke’s reaction was “Is this it?”. There were so many misconceptions about the process even among clinicians, such as the assumption that because you go to a GIC you get counselling, which isn’t the case. This led – in 2013 – to the funding of a trans specific counselling service called Transgender Support Service (TSS) for Sefton and Liverpool. Later, further funding was obtained to test another part of the model and we called it Trans Health Merseyside (THM), with Sahir House as delivery partner.
THM is the part that provided things like peer mentoring which was much needed amongst other key areas of personal development to help get back into employment or education, or simply to be able to get out of the house especially if you have transphobic neighbours. Mersey Care took over TSS in 2017 from LCH and they are now of course our valued partners for the CMAGIC pilot. The pilot is also funded by NHS England.
Why is CMAGIC so important to the trans and non-binary community in the region?
One of the most important things is that this is a local service, which means people can be seen locally, without having to travel hundreds of miles for care.
The CMAGIC team will be providing diagnosis and it will ensure that trans people are supported by committed clinicians who are knowledgeable of barriers and attitudes that trans people face.
With the pandemic putting an additional strain on the mental health of TGNB people, particularly those on waiting lists whose first appointment dates keep being pushed further and further back, this service has never been more vital. Some people are waiting an average of 30 months and over and still not had their first appointment at the GIC.
To give you some understanding of how desperate the situation is; our trans support group has run a crisis line over Christmas and Easter for the last 15 years. This Christmas was the worst we’d experienced since 2008/9 when we lost 15 of our community to suicide. To further illustrate, I received a call from an individual who – after waiting 18 months for their first GIC appointment – had received a letter saying it would be another 30 months before they would be seen. They were at crisis point, but they had a referral in for CMAGIC. I was able to tell them “Wait, hold on – CMAGIC is almost here” and encourage them to hang on, be patient. We came off the phone laughing and filled with hope. That’s why it’s so important. It saves lives.
With the service now launched, what are the next steps for it and further plans for 2021?
Really, we’re focused on getting the clinical pilot formally launched and patients in for their appointments. After the delays caused by COVID-19 we are finally up and running and the recent event has given us the chance to engage people and bring them up to speed. Delivery and awareness-raising will be the key focus for a while. In the long term we do want to also integrate the community support services we have into the pathway as well.
This year our theme is ‘Young At Heart’, which promotes the right for LGBT+ people to live happy, healthy and carefree lives, regardless of how they identify. What does this statement mean to you and the team at CMAGIC?
I turned 60 last year, but I hope I’m still young at heart! Being able to celebrate being young at heart should be something we can all do and celebration comes from the freedom to be yourself and that is what I hope CMAGIC can offer to people.
Who is eligible for CMAGIC and how can people find out more about the service?
We are contacting eligible people directly and invite them to transfer to CMAGIC as a service user. There are instances where we may not have been in contact as we are not aware that someone is on the waiting list or details may not be up-to-date with NHS GPs.
The pilot scheme is initially set to run for two years and will be available to individuals living in Liverpool, South Sefton, Halton, Knowsley, Southport and Formby, St Helens, Cheshire, Vale Royal, Warrington and Wirral.
To be eligible for the service, individuals must be aged 17+ and registered with a GP in England, on a waiting list for an established NHS gender incongruence service and must not yet have attended their first appointment.
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