Treatment Funding Refused

Your Health Authority has Refused to Fund Your Gender Reassignment Treatment - What Next?

Firstly - the decision to provide any medical treatment or not is a clinical decision - i.e. it is the role of the doctor involved to decide your medical needs - it is not the role of an administrator.

So - in effect, in the case of trans men, if a psychiatrist and a surgeon think that hormones, a mastectomy or a metoidioplasty or phalloplasty is the correct treatment for you, then it is simply up to the health authority to fund it. They cannot refuse that funding, and if they do so, then you have a right to have the decision reviewed by the courts - only that can be a long and costly process.

In effect you need to tell them that you will seek a judicial review of their decision on the basis that they do not have the power to make such a decision. That sometimes works - but it is hard work, and not something to be taken up lightly.

Secondly in the case of Reg v North West Lancashire Health Authority, Ex p A and others CA: Auld, Buxton and May LJJ: 29 July 1999, said

“Although a health authority had acknowledged that transsexualism was an illness, the policy it had adopted in relation to the allocation of resources for dealing with people with the condition treated it as an attitude or state of mind which did not warrant medical treatment. The ostensible provision that the policy made for exceptions in individual cases amounted effectively to the operation of a blanket policy against funding treatment for the condition because it did not believe in such treatment.

…… Regional health authorities had to establish priorities. It made sense to have a policy for the purpose, and might be irrational not to have one. In his Lordship’s view a policy towards transsexualism low in an order of priorities of illnesses for treatment was not in principle irrational, provided it genuinely recognised the possibility of overriding clinical need and required each request for treatment to be considered on its individual merits.

The authority’s recognition that transsexualism was an illness was at best oblique and lacked conviction. Its policies should, but did not, properly reflect the medical judgment that it was an illness. The failure properly to evaluate it as an illness was not mitigated by the allowance for the possibility of exception in case of overriding clinical need. The authority’s stance was not a genuine application of a policy subject to individually determined exceptions. It was similar to a blanket policy.”

So your health authority must look at your individual case. Undoubtedly they will argue here that they have, but they must assess your clinical need based on whether or not you are transsexual, not on some completely unrelated matter e.g. are you in a stable relationship.

What To Do Next

1. Ensure you have the full support of your GP and of any other specialists you have been seeing. If your GP is unwilling or unsure about prescribing hormones or referring you for surgery, consider changing your GP. You can do this through your local Family Practitioner Committee (look in the phone book) who should be able to find you a sympathetic GP in your area. Remember that a fund-holding practice can decide for itself whether to pay for gender reassignment for a patient. If it’s sympathetic, you are home and dry; if unsympathetic you have little chance, unless you can persuade them to change their minds - it’s probably easier to change your GP.
2. Go and see your MP. MPs can have enormous influence in individual cases like this, and are often successful on their own in getting a decision not to fund reversed. Don’t write - go to his or her surgery and talk to them face to face to ask for their support.
3. Contact your local Community Health Council (in the phone book). Explain the situation and ask for their support.
4. Make sure you or your GP has received the refusal to fund in writing from the Health Authority. If the reason given is not clear, write again asking them why. Once you have established their reason for not funding, you may find useful any or all of the information/arguments given below. You or your GP can write stating that you wish to appeal against their decision and explaining why you think it is wrong. At this point supporting letters would be useful from your MP, Community Health Council and any health specialists who have seen you in connection with your transsexualism.
5. If your appeal is unsuccessful and you feel you are not getting anywhere, contact Press For Change at BM Network, London, WC1N 3XX. Press For Change can put you in touch with one of the solicitors who are representing people in such cases. You have a good chance of winning a case against a HA if it proves necessary to go to court. Two similar cases have already been settled out of court.

If you are unemployed or on a reduced level of income, you may be eligible for Legal Aid which means that the legal action will cost you nothing. It will also be possible to protect your identity so that if you go to court and the case is reported in the newspapers, your name will not appear.

Remember although these setbacks may be very irritating or depressing, your aim is to get your treatment on the NHS in the end and if you follow these steps, it is highly likely that you will be successful. So, even it is very understandable that you may feel very depressed or suicidal it is important to stay calm and to appear to be in control. It will definitely not help your case if it possible to argue that you are mentally unstable.