Sunday, 1 March 2009

My final thoughts on transition..

I've been doing at lot of thinking and soul searching over the past week or so.

I'm now "retired" having been put in the Support Group at the Department of Work and Pensions, my Ankylosing Spondylitis (AS) having reached a level that effectively excludes me from the workplace.

It's a good and pragmatic decision as I'm going to be needing all my energies to recover from major surgeries soon. I have one assessment for surgery next week and the other at the end of the month. My AS is a significaant factor in both but hopefully not show stopping as I have no Plan B.

I've now got some contact lenses and a tooth in the gap that made me too self conscious to smile properly and I'm getting used to both so things are looking up.

The death of my heroine, Rachael Webb, a few weeks back has made me reevaluate my thinking on transsexual and transgender rights.She had nothing to do with LBGT in the Union but was a warrior for women's rights. It's the right position to take in the sense that as a true transsexual I have a female brain whilst transgender have a male brain and no matter how much I want to be inclusive and non discriminatory I don't feel comfortable fighting for their "rights" as I don't understand the fetish or whatever it is that drives them. I also respect everyones right to express their sexuality any way they want but it's nothing to do with being a true transsexual and the grouping of LBGT is a political one that I have never really felt comfortable with and can't advocate.

Whilst I don't feel really worthy to pick up the baton from Rachael I am going to follow her lead and put my political energies into women's rights and let the feminist in me run free.

I think I've done my bit for the true transsexual by demonstrating that you don't have to submit to the illegal and obscene methodologies of NHS Gender Identity Clinics (even the name of which is discriminatory to the true transsexual) to get NHS funded surgery with the surgeon of your choice at the hospital of your choice once you have a gender recognition certificate.

It's now up to another true transsexual to either follow my method or get the whole process declared illegal.

My message is simple though don't wait for the likes of Press For Change to achieve fundamental change because they won't as they support the role of the psychiatrist in the bogus mental illness classification.

The DSM revision will probably declare true transsexuals as people with a morbid mutilation fetish and reaffirm transgender as a sexual fetish but my argument is that it doesn't matter as they never understood and they just make themselves look ridiculous.

Those born with a female brain in an externally male body will always know the truth and know that the ultimate choice is transition or die. It matters far less what the world thinks you are than you knowing what you are. That is what transition is letting go of the male construct that society has foisted on you and releasing the woman inside.

To set yourself free you have to take control and responsibility not hand it to someone else.

So it's time to let go of everything LBGT and let the feminist run free. When I set out to transition it was to live as a women in society not as a trans ghetto member.

I've achieved that here in Manchester so this blog has run it's course. I'll leave it up as it contains a lot of useful information for someone transitioning under today's NHS "rules".

I'm taking a small break from blogging though I expect I'll return to it from a female & human rights perspective. I'll post the URL on here when I start again as I'm not ashamed of my past.

God Bless you all.

This was the most important part of this blog:

This article is for anyone In England who knows they were born with a female brain in a male body and by definition is not mentally ill but has to jump through the hoops in the bogus treatment paths invented by charlatan psychiatrists who make a living out of punishing & persecuting people they consider sexual deviants with a mutilation fetish.

So if you are gender confused, gender queer, a cross dresser, a transvestite or anyone who falls under the transgender label go away this is not for you.

Lets start at the beginning:

In England your sex at birth is determined (not unreasonably) by the presence or otherwise of a penis so if you have one you are male and you stay male on English birth records forever.

However if your brain sex is female no matter how hard you try to suppress it eventually you will get to the point where you either change your sex or die. There is no escape from this decision and genital surgery is essential not an option.

Notice that up to this point I’ve not used the word gender because it is a concept of sexuality invented to appease the Establishment who can’t grasp the simplicity of the condition and see sex as a binary anatomical issue that cannot be changed.

So in England we have the Gender Recognition Act to appease the Religious Establishment but grant most of the fundamental Human Rights enjoyed by people born with congruent brain & body sex to those that do not.

HM Government was let off the hook of being in breach of European Human Rights Legislation of the legitimacy of sex change by giving a few honours to a self appointed group of Transgender activists that wanted to create a law to reflect their Queer based politics and that preserved the earnings potential of the Gender Industry. It is bad law mixing bogus medical practice with historical legal concepts.

It can however be used to absolutely guarantee that the National Health Service funds what is known as gender reassignment surgery with the surgeon of your choice at the hospital of your choice.

Remember in the eyes of the law you are male until you have a gender recognition certificate but are female once you have one.

The general public is not generally aware that you can get a new female birth certificate without having genital surgery and it is in the Establishment’s interest to minimise this occurrence. It was not the Establishment's intention to recognise women with penises and this has only occurred because of European Law.

So no National Health Service Primary Care Trust can refuse to fund surgery or delay it once you have the magic bullet of a Gender Recognition Certificate.

There are two other legal magic bullets to kill off any possibility of some bigoted administrator trying to deny you your right to NHS funded surgery and choice.

They are the Sex Discrimination Act and the Mental Capacity Act. Essentially the first guarantees your absolute right to be treated in the same way as any other woman with a life threatening birth defect or simply a genital deformity and the second absolutely guarantees your right to make the decision on surgery without requiring permission from for example multiple charlatan psychiatrists at a Gender Recognition Clinic.

Now the trick is to achieve your objective of State funded surgery without compromising the integrity of the Health Professionals who can make this a relatively short easy journey for you.

No surgeon will operate without two referrals from appropriately qualified people and no gender recognition certificate can be issued without one report from an appropriately qualified person.

Gender psychiatrists working in the NHS Gender Identity Clinics want you to believe that only they can issue the report to obtain a Gender Recognition Certificate and only they are the gatekeepers (backed by a willing PCT administrators) to NHS funded surgery. Their arrogance on this issue remains astonishing.

The truth is that anyone on the list of approved Gender Specialists can issue the report and most importantly they are not all psychiatrists. So pick one and agree a fee for the report.

Aside from the one specialist medical report the Gender Recognition Act requires proof of living in your true gender for a period of two years based on a recognisable start date for example when you change your name or first see your General Practitioner if you have a name that is used by both sexes.

To totally avoid giving your local Primary Care Trust any ammunition to delay your application for funding for surgery and have the reassurance of NHS monitored prescription hormones you might want to adopt a sequence similar to the one detailed below.

#1 Change your name by statutory declaration immediately you transition. This is vital as it is the start date to get a gender recognition certificate.

#2 See your General Practitioner on the same day who must confirm an initial diagnosis of “gender dysphoria” and arrange an appointment with a local psychiatrist.

#3 One and only one single hour appointment is all that is required with a general clinical psychiatrist to establish proof that you have no mental illnesses. Get yourself discharged back to GP care not an NHS Gender Clinic.

#4 Via your GP ask your PCT to fund your referral to the Gender Specialist you chose from the official Gender Recognition Act list on their web site if they refuse then fund this yourself.

#5 Obtain NHS prescription for hormone and anti-androgen therapy from your GP on a joint care basis with your chosen Gender Specialist.

#6 As soon as it is 24 months from your statutory declaration of change of name apply for a gender recognition certificate.

#7 As soon as you have a gender recognition certificate and a new birth certificate in your true gender apply for NHS funding for surgery for correction of birth defect by a surgeon of your choice in a hospital of your choice.

Warning do not pick Charing Cross as they will insist on you going to their Gender Identity Clinic who ignore #1 to #6.

#8 Be prepared to use the law to get your funding. The Sex Discrimination Act, The Gender Recognition Act, The Mental Capacity Act and the Human Rights Act are now in your favour as you are legally of the gender that you have transitioned to and the NHS cannot apply their arbitrary unscientific prejudiced rules that they get away with those who accept referral to the Gender Identity Clinics prior to transition.

It is important to understand that your application for funding will be made outside of any Gender Dysphoria pathway, adopted or invented by local administrators, on the grounds of exceptionality. The exceptionality being that you have already legally changed sex to female as opposed to someone who is male and may be considering it.

I have to avoid at this stage digression into the numerous illegalities of current National Health Service policy adopted by Primary Care Trusts but suffice to say I have yet to read one that does not conflict with the three magic bullet Acts that I have referred to earlier.

Here is the legal argument for a woman with a Gender Recognition Certificate claiming exceptionality compared to a man applying for a sex change at some future date.

This is an edited version of the one I used to obtain funding from the Exceptionality Panel at my local PCT so some points may be specific to their particular perverse views.

N.B. If a local criteria is in excess of the criteria in the Gender Recognition Act and you don’t meet that particular bogus criteria then point out that it is illegal to insist on any criteria beyond those required for a legal sex change in the Act.

1.1          Treatment Option Unlawful

The proposed treatment for psychiatric assessment at Charing Cross Hospital gender clinic prior to GRS is considered unlawful under the Mental Capacity Act 2004 and the amended Sex Discrimination Act 1975.

1.1.1          Mental Capacity Act 2004

The Mental Capacity Act 2005 covers this issue. A person cannot be forced to accept a treatment if the patient’s mental disorder does not justify detention in hospital, or the patient needs treatment only for a physical illness or disability.

The successful treatment of gender dysphoria requires a surgical intervention (GRS) so must relate to a physical disability. Psychiatric interventions have never been successful on their own in addressing gender dysphoria.

Alternatively, it cannot be claimed that a psychiatric evaluation is required to have GRS.

The Mental Capacity Act 2005 affirms that a person must be assumed to have the capacity to make a decision about their life/treatment unless there is evidence that they do not have such capacity. That a decision may appear to be foolish or unwise to someone, such as the PCT, is not evidence of this.

Any Department of Health or PCT policy that contradicts the Mental Capacity Act 2005 is unlawful and invalid.

1.1.2          Sex Discrimination Act

The decision to refuse treatment at the preferred hospital appears to be due, at least in part, to sex discrimination by reason of gender reassignment contrary to the Sex Discrimination Act 1975 as modified by The Sex Discrimination Act 1975 (Amendment) Regulations 2008 No 963.         Gender Certificate

 XXX is legally female and has a gender certificate and a female birth certificate. 

The requirement for XXX to attend psychological evaluation will require duplication of the criteria for which she was issued with a gender certificate. To require this is sex discrimination by reason of gender reassignment contrary to the Sex Discrimination Act 1975 as modified by The Sex Discrimination Act 1975 (Amendment) Regulations 2008 No 963.

Most patients in XXX’s peer group are presenting as males considering future GRS at the beginning of their treatment and are legally male. In these circumstances, a psychological assessment may be appropriate. However, this situation where a patient is legally female at the time of their referral for GRS represents a new circumstance that has not been addressed.         Illogical Arguments\

The arguments presented by the PCT are so illogical that it is difficult to see that there is a coherent argument behind them and if pursued one would be led to conclude that it is an attempt to justify prejudice. Such dogmatic prejudice would be unlawful discrimination against XXX by reason of her gender reassignment.

The PCT has proposed that XXX be referred for psychiatric assessment at Charing Cross when her GP referred her to have GRS with Mr YYY at ZZZ Hospital.

A psychiatric assessment as part of the treatment is to lead the patient into making a decision as to whether they wish to make a permanent change of gender to their preferred gender. XXX has already made such a commitment and has acquired a gender certificate and a female birth certificate. This makes any psychiatric assessment redundant as well as illogical.

Finally, XXX appears to meet the PCT’s criteria for GRS as described in section 2.3.         Mental Health

From April 2008 Primary Care Trusts are expected to offer a free choice of where to go for hospital treatment.  Exceptions are for mental health services and maternity services. Patients referred by their GP for hospital treatment can now choose to be treated in any hospital anywhere in the country, which meets the standards set by the NHS.

The DoH document Choice of Hospital: Guidance for PCTs, NHS Trusts and SHAs on offering patients choice of where they are treated published in July 2003 states that all patients who have to wait more than 6 months for a surgical intervention should be offered choice. Further, the document states: “The Department of Health does not believe there is any justification for the blanket exclusion of any category of patient.” Individual PCTs were to have implemented surgery choice with up to 5 hospitals by 2004.

Typical waiting times after a referral to an NHS Gender Identity Clinic have been typically 6 months but there is pressure to reduce this to 18 weeks as required for psychiatric services (NHS funding processes and waiting times for adult service-users: Trans wellbeing and healthcare GIRES for DH Feb 2008).  Referral for surgery is a separate referral process and again an 18 week response time applies.

This can be contrasted with the current time to wait for surgery with Mr YY at ZZZ Hospital of 13 weeks. Thus the referral for surgery via a referral to Charing Cross GIC will lead to a delay in surgery. This delay is unfavourable treatment and is thus sex discrimination by reason of gender reassignment.

2         MRSA Rates

No specific rates are available for Charing Cross so we have to infer from PCT rates. The DH published statistics for Imperial College Healthcare was for 967 reported episodes of MRSA at hospitals in the group, including Charing Cross, in the period April 2001 to Mar 2008. This represents an average rate of 2.68 MRSA episodes per 10,000 bed days with the minimum half year rate of 1.46.

Applying these rates to the 433 GRC patients, for an average 5 bed days at Charing Cross the MSRA incidence would, for example, generate 0.32 to 0.58 occurrences. Therefore, it is not surprising that there were no reported incidents of MRSA in the Charing Cross GRC patients but there remains a significant risk of infection. This compares unfavourably with the ZZZ Hospital rate of zero episodes of MRSA.
2.1.1          Choice of Surgeon

Charing Cross hospital does not allow external selection of the surgeon for this procedure as the surgeon is assigned to perform the procedure by hospital administration.

2.1.2          Specialised Service and the Choice agenda

“Choose & Book” – Patient’s Choice of Hospital and Booked Appointment Policy Framework for Choice and Booking at the Point of Referral (DH ref 3467 23 August 2004) identifies the exclusions referred to above in paragraph 19:

“19. Choice of hospital may not be appropriate for all services. The services that will not be required to offer a choice of 4-5 hospitals (or suitable alternative providers) by December 2005 are:

”Services where other choices are more likely to improve the patient experience:
o        maternity services
o        mental health”

The GP referral was for GRS which although more commonly following a mental health element is a surgical procedure and does not fall within either excluded category.

GRS has a near 100% success rate in relieving gender dysphoria.

Gender Identity Disorder is recognised as a specialised service in Specialised Mental Health Services (adult) - Definition No 22 (DH 2nd edition). This states that:

“The programme requires patients to complete a minimum of two years of real life tests before they are accepted for transgender surgery. For men seeking female identity, this includes exclusive adoption of female dress, a female name, and full-time employment as a female. Initial treatment is with hormone therapy, usually for a period of two years.

The principal reasons for patients leaving the programme are psychiatric disorders, personality disorder and dysmorphophobia. The drop out rate is less than 1%.

After this period of real life testing and treatment with hormone therapy (which averages 3-4 years) a proportion of the patients still in the programme are assessed as appropriate for surgical therapy.

Patients will not be accepted for surgery unless at least 2 specialist consultant psychiatrists support the referral. Once the surgical option has been agreed, the patient is referred to one of the very few surgical units that provide this highly specialised service.”

XXX meets all these criteria and will have achieved “K” years living as a woman so there is no requirement for further psychiatric assessment.

The PCT is insisting that the referral should be to Charing Cross GIC for a psychiatric assessment. Presumably this is the PCT’s justification for pretending that a surgical intervention might fall under mental health services.

The Mental Capacity Act 2005 (see legal section below) covers this issue. A person cannot be forced to accept a treatment if the patient’s mental disorder does not justify detention in hospital, or the patient needs treatment only for a physical illness or disability. The successful treatment of gender dysphoria requires a surgical intervention (GRS) so this relates to a physical disability. Psychiatric interventions have never been successful on their own.

Alternatively, it cannot be claimed that a psychiatric evaluation is required to have GRS.

The Mental Capacity Act 2005 affirms that a person must be assumed to have the capacity to make a decision about their life/treatment unless there is evidence that they do not have such capacity. That a decision may appear to be foolish or unwise to someone (the PCT?) is not evidence of this. The PCT have not offered any such evidence.

Any DH or PCT policy that contradicts the Mental Capacity Act 2005 is unlawful and invalid.

From April 2008 patient choice of hospital should be implemented by GP referral, as in this case. 

2.1.3          Quality of Clinical Care:         Is the intervention offered effective? Evidence to be put forward to support the intervention.

The request was to use Mr YYY, one of 2 surgeons at Charing Cross, who also works at Nuffield Sussex. The other surgeon, Mr UUU, uses a different technique.

GRS is well established as being nearly 100% effective in relieving gender dysphoria and was not disputed by the PCT.         Is the intervention being undertaken by a known provider with an established reputation for treatment i.e. is the provider competent or there other potential providers?

Mr YYY is one of two surgeons at Charing Cross that would undertake surgery via the PCT preferred treatment pathway. Therefore there is no dispute that he is competent.

2.1.4          Quality of Life:         What is the patient’s quality of life? E.g. is the condition life threatening/is the patient in permanent chronic pain?

The patient’s gender dysphoria represents a disabling condition that can be remedied by GRS.

2.1.5          Health Gain:         What is the extent of the health gain?

There is no difference in the health gain from GRS with either path. However, psychiatric assessment at Charing Cross will only extend the delay until GRS.         Is the treatment meeting the patient’s needs?

The GRS will relieve her gender dysphoria. The patient does not want, and there is no evidence that she needs, psychiatric assessment at Charing Cross (ref Mental Capacity Act 2005).

2.1.6          View of Stakeholders:         Has appropriate clinical advice been taken?

There is no disagreement with all involved that GRS is the correct end result. The dispute has been on choice of hospital for GRS and a PCT insistence on a psychiatric assessment.         Are the patient’s requirement’s reasonable?

No party has disputed that GRS is a reasonable end result. This appeal document addresses whether the treatment path constraints the PCT has tried to impose are reasonable or even lawful.         GP approval sought.

The patient has the full support of her GP.

2.1.7          Equity:         Does the patient fit the agreed patient selection criteria e.g. NICE guidance? If not, what is the case for expanding the selection criteria?

NICE guidance is not available. Not applicable as the dispute is in respect of patient choice in the treatment pathway.         What is the priority of this in relation to potential opportunity costs? i.e. is funding the intervention reasonable in relation to the needs of the overall population?

Not applicable as the dispute is in respect of patient choice in the treatment pathway.         What precedence for funding is there?

The PCT have offered XXX a treatment path at Charing Cross hospital which includes the same surgical procedure as a treatment component.

2.1.8          Cost Effectiveness and Affordability         Are alternative treatments available?

There are no effective alternatives to GRS in relieving gender dysphoria.         Are there comparable less expensive alternative and comparable interventions available?

XXX’s efforts to get visibility or clarification for cost comparisons have not succeeded due to the PCT’s failure to disclose cost information.

The PCT are proposing a treatment path of psychiatric assessment with Charing Cross GIC prior to GRS at Charing Cross Hospital, XXX’s GP requested she have GRS with the same surgeon at ZZZ Hospital.          Is the intervention currently available under contract?

Yes, at Charing Cross Hospital but it appears that this contract requires GIC psychiatric assessment prior to surgery.         Is this good use of public funds?

This is not disputed. The dispute is in respect of the treatment path.         Can the PCT afford this treatment?

Yes, in that the PCT are insisting that XXX must undertake treatment at Charing Cross if she is to receive PCT funding.

2.1.9          Human Rights         Is there a victim?

Yes, it is claimed that XXX has been the subject of sex discrimination by the PCT – see section below.         Is the PCT pursuing a legitimate aim?

No, it is claimed that XXX has been the subject of sex discrimination by the PCT – see section below.         Is the request/decision proportionate?

No, significant PCT resources appear to have been used to try to force XXX to submit to the PCT’s preferred treatment path.         Are there relevant and sufficient reasons for the decision?

No, the arguments presented in the letter in favour of the decision are flawed, see section 2.1.

2.2          PCT Criteria for GRS

The criteria for accepting a patient referral for GRS is stated in the PCT’s Policy Statement No. 1 – Commissioning Policy and Referral Guidelines for Gender Dysphoria Services and Gender Reassignment Surgery in Adults.

The relevant section is 6.3 which list the criteria for the PCT commissioning GRS. The criteria (annotated with whether criteria is met) are:

·         Patient aged 18 or over;

Yes, XXX is over 18

·         The patient must be registered on the list of NHS patients of a GP practise with which SSPCT holds a contract or, where the patient is not registered with a GP practise, he or she must be “usually resident” in the geographic area covered by SSPCT, except where paragraph 80 of the Department of Health guidance “Who Pays Establishing the Responsible Commissioner” (September 2007) applies

Yes, XXX is registered with Dr LLL

·         The transsexual identity must have persisted for at least two years.

Yes, XXX has proof of this is in having a gender certificate.

·         The disorder must not be a symptom of any other mental disorder or chromosomal disorder

Yes, Dr RRR, a consultant psychiatrist who assessed XXX confirmed that XXX did not have any other mental disorder. There is no suggestion that XXX has a genetic disorder.

·         Patients should complete two years’ successful continuous full-time real life experience in their chosen gender role. Periods of returning to their original gender may indicate ambivalence about proceeding and should be excluded when calculating the two year continuum.

Yes, XXX has lived exclusively as a female since she changed her name to XXX and this is proved by her gender certificate.

·         Patients should have found employment, or have been in education or training, in their desired gender role for a minimum period of one year, including employment in the voluntary sector.

Yes, XXX has been continuously employed by GGG in a female role since her transition on dd/mm/yyyy.

·         Patients should have continued with an established course of hormone reassignment therapy.

Yes, XXX is continuing her hormone reassignment therapy prescribed by her GP.

·         Patients should have changed their name legally to one appropriate to the transgendered self.

Yes, ‘XXX’ changed her name to XXX on dd/mm/yyyy. 

·         Patients should have a demonstrable knowledge of the cost, required length of hospitalisations, likely complications and post surgical rehabilitation requirements of the various surgical interventions.

Yes, XXX has shown her understanding in correspondence with the PCT and is willing to have a short ( 1 hour) assessment by a psychiatrist to confirm that she is giving informed consent to the GRS procedure.

Thus, XXX meets the PCT criteria for referral for GRS which makes the PCT decision to refer her for psychiatric assessment under a claimed standard treatment both illogical and a misuse of clinical resources in offering unnecessary and unlawful (psychiatric) assessment or treatment.

What I am saying in this article as legal fact is true as I know I did it and in the process got two Primary Care Trusts to acknowledge it.

The sequence I describe can be done at minimal cost I managed it on a net income of £200 a week and my total cost was under £800 spread over 3 years.

I write this article for the benefit of someone who does not have the funds to go private on every aspect of confirming their true sex.

If it saves one life then it is greater payment than any financial reward.

Here are the legal references:

Mental Capacity Act 2005

The five statutory principles are:

1. A person must be assumed to have capacity unless it is established that they lack capacity.

2.A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

3.A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

4.An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

5.Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

In particular regarding XXX, she must be assumed to have the capacity to make the decision to have GRS unless there is medical evidence that she does not [MCA 2005 Section 1 (3) below]

A lack of capacity cannot be established merely by reference to—

(a) a person’s age or appearance, or

(b) a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity.
Compulsory treatment under the MHA is not an option if: the patient’s mental disorder does not justify detention in hospital, or the patient needs treatment only for a physical illness or disability MCA 2005 Section 3.2         

Sex Discrimination Act 1975

A section of the notes from the “EXPLANATORY MEMORANDUM TO THE SEX DISCRIMINATION (AMENDMENT OF LEGISLATION) REGULATIONS 2008” 2008 No. 963 are presented below.

Section 1 SDA, (direct and indirect discrimination against women)

Schedule 1, paragraph 2 of the 2008 Regulations amends section 2A SDA (discrimination on the grounds of gender reassignment) to extend protection from direct discrimination on grounds of gender reassignment in the provision of goods, facilities, services or premises.

Schedule 1, paragraph 13 of the 2008 Regulations provides how the SDA operates in relation to gender reassignment discrimination in respect of contracts entered into which relates to differences in premiums and benefits.

Article 3 SDO, (direct and indirect discrimination against women)

Schedule 2, paragraph 2 of the 2008 Regulations amends Article 4A of the SDO (discrimination on the grounds of gender reassignment) to extend protection from direct discrimination on grounds of gender reassignment in the provision of goods, facilities, services or premises.

Schedule 2, paragraph 13 of the 2008 Regulations provides how the SDO operates in relation to gender reassignment discrimination in respect of contracts entered into which relates to differences in premiums and benefits.

Section 1(2) SDA.
Schedule 1, paragraph 1 of the 2008 Regulations applies the Directive-based definition of indirect discrimination in section 1(2) SDA to those areas of the SDA with which the Directive is concerned, namely sections 29-31, except in so far as they relate to an excluded matter.

Article 3(2) of the SDO.

Schedule 2, paragraph 1 of the 2008 Regulations applies the Directive-based definition of indirect discrimination in Article 3(2) of the SDO to those areas of the SDO with which the Directive is concerned, namely Article 30-32, except in so far as they relate to an excluded matter.

R v North West Lancashire HA ex p A, D and G (1999) 53 BMLR 148, [2000] 1 WLR 977

This precedent appears relevant to XXX’s case.

The Court of Appeal said that a decision regarding the provision of treatment must be taken within a proper framework.

Although it is appropriate for a Health Authority to have a policy for establishing certain priorities in funding different treatments, in establishing priorities - comparing the respective needs of patients suffering from different illnesses and determining the respective strengths of their claims to treatment - it is vital for the Health Authority to:

·  accurately assess the nature and seriousness of each type of illness

·  determine the effectiveness of various forms of treatment for it, AND
  give proper effect to that assessment and that determination in the formulation and individual application of its policy

Saturday, 14 February 2009

Time to say "No more"...

I have never believed in violence to achieve legitimate aims but this belief is being pushed to the limit by the fascist state I live in. HM Government is institutionally prejudiced against disabled and transsexual people so if you are both you simply get twice the discrimination.

Occasionally you find someone, like my GP who is without prejudice and prepared to help but the overwhelming majority of the establishment do everything they can to destroy you. Worst of all are the smiling bigots feigning concern and understanding whilst in reality they treat you with utter contempt.

This all starts with HM Government’s attitude to true transsexual people who they now gleefully call transgender or Trans a meaningless grouping invented by their lackeys Press for Change that equates a neurological condition with some sort of sexual preference.

HM Government bigots constantly sell the propaganda that being transsexual or disabled is some sort of lifestyle choice made by the work-shy to enjoy a life of luxury on benefits. This is the propaganda of the capitalist state that wants a low wage global economy playing off one set of subsistence wage worker against another.

Meanwhile the fat cat bankers pay themselves huge bonuses as a reward for their greed secure in the knowledge that HM Government will continue to fund their excesses through increased taxation of the workers, well those that are left after the mass layoffs, to ensure the capitalist shareholders maintain their dividends and increase their wealth at the expense of the majority.

This is medieval feudalism brought up to date and held in place by fear and force. Whatever woes befall the common people the establishment continues and flourishes but this must change. I’ve always been an anarchist but held back from violent protest as it’s never directed well enough against the establishment hierarchy and it is the innocent protester that gets hurt. That is the lesson of the Peterloo massacre and should not be forgotten.

Targeted non-violent direct action can however produce fundamental change in this bankrupt state and the time is right to start it…

Saturday, 7 February 2009

Please sign up to this petition…

I don’t think this petition is particularly well worded and I’m not convinced such petitions make a real difference but none the less it deserves support.

HM Government proposals for transsexual and transgender people in terms of ID cards are a sick joke though the way the Government is diluting transsexual rights in the Single Equality Bill is far more serious.

I don’t think ID cards will become law as the Labour party is going to get beaten at the next election but I could be wrong though as the majority of the population are pretty easily manipulated by Government propaganda.

This is the link:

Thank you for signing.

Wednesday, 4 February 2009

Tribute to Rachael Webb…

Today Rachael’s daughter Leila telephoned me to tell me that Rachael had taken her own life last week. To say I was upset by this news is a bit of an understatement.

Rachael Webb was one of my heroines, a comrade and a friend. She described herself as a Marxist Atheist so with me as a Christian Anarchist we had plenty to talk about and we did. I have a series of emails, that I treasure, that passed between us that make me smile now I’ve reread them as we had a lot of intellectual differences but then again so much in common.

That she chose the time and manner of her death was not a sign of weakness but of great strength. Rachael like myself believed in the importance of control of your own destiny and she did that in situations way beyond those that I have had to face and I respected her greatly for that ability. She was an inspiration to me.

Rachael spoke her mind and told the truth something that those she crossed swords with had to recognise though often begrudgingly. She was a true revolutionary that stuck to her principles and beliefs and I was proud that we were on the same side.

My only regret is that I didn’t know her better or spend more time with her as every time we spoke I learnt from her wisdom. She rang me at Christmas and again just a few weeks ago and yes she told me that she was contemplating her demise but I never thought she’d do it and now having reflected on it I know that once she’d decided that was what was going to happen no one on this Earth could have stopped her.

I don’t want to dwell on her death though she lived an amazing life and I’m going to carry a great memory of someone it was a privilege to call a friend.

Her daughter Leila is going to organise a Tribute Meeting in Brixton, sometime in May as Rachael being Rachael left strict instructions regarding no memorial services. Rachael is not dead, in my mind, as I know her soul survives though she’d hate me writing that. But anyway Rachael I raise my glass to you and say I told you so! LOL It was a pleasure to meet and get to know the spirit that inhabited the body. Rachael Webb was a very special lady.

I’ll end this tribute by reprinting an unedited email from Rachael to me in which she talks about her life and times. It is so typical of her and for those who didn’t know her it might shed some light on why this lady was one of my heroines…

Hi Maggie

There is so much in your email that I want to hold a dialogue on:

You say "not sure why I am telling you all this". Well as far as I am concerned ideas are what people are all about, I know I was labelled a lot of rather insulting things by psychiatrists and psychologists over this, I must admit I could never understand why Albert Camus's anti-hero in "The Outsider" was labelled a psychopath? Very significant and the reason why ... Oh best forget all about the psychologists and psychiatrists for my own peace of mind and almost all are more than average boring?

"Gender Identity Clinic" staff/psychiatrists as Charlatans?

Yes, I get quite angry about this, you are right I am sure. Maybe we should pathologise* them for a change? unless they do what they do because they can't earn a living doing anything else, (could any of them drive a 40 tone truck between here and Alicante without looking at a map? or make biscuits?), I think they must be on a power trip?

*(Ronnie Laing who I was a patient of, (Politics of Experience and the Bird of Paradise) for a time when I lived in Brixton once said something about, "Saints may still be kissing lepers, it's about time lepers started kissing saints".

Of course I "transitioned", (don't like the word but I can't think of another), in 1981/2, over a quarter of a Centurary ago and assume I am older than you? (dob 1940), and I didn't have to go through the so called "real life test", but the idea that they have control over who and when has female hormones, (or male hormones), appals me. Why? what does it achieve? Who are they "protecting" from what? Just who is going to take female hormones if they were available over the counter at Boots? (You can get them on the internet anyway).

Which man is going to take female hormones unless they are transsexual? I can remember a truck driver who I was in bed with, (that's enough of the salacious stuff), and my hormone patch became dislodged and stuck on him, I laughed when I saw it and just for fun told him what it might do to him, he became quite agitated, either unfortunately or fortunately almost all other men would have a similar reaction? No "normal" (I don't think there is such a beast) man would even dream of taking hormones like hrt so what do psychiatrists achieve by playing god and deciding who should and should not get them?

Nietzsche once said, (bearing in mind he was brilliant and also a self centred egotistical male), "there is no such thing as knowledge only power, no such thing as truth only will". Of course he was speaking objectively, he wasn't saying "this is how I want it to be", he was only saying "this is how it is"; and psychiatrists at gic's are a very good example. I do sometimes wonder whether they get off on tranvestic fantasies? Maybe they lack the imagination to know what being transsexual could be like, but as the numbers of men who practise some sort of transvestism is quite large, (apparently), maybe they assume that all transsexual people are tranvestic and try to make their patients conform with their own limited imaginations?

When I confronted my basic transsexuality I didn't have to jump through those ridiculous hoops because gic's hadn't been invented, I just went along to my GP and obtained hormone prescriptions. I won't bore you with my life history but they produced changes in my body, if I had not been tsp then I would have found those changes uncomfortable and stopped taking them, as it was I knew it was "for me" and persevered.

In the 1980's talking things over with a friend we decided that a tsp from our early times when we were still young, (I didn't approve of the person concerned, she was a leading member of a NAZI organisation), but it doesn't alter what she said which was that really being tsp meant you had to do 4 things:

1) Alter your body shape (by taking hormones)
2) Alter your body hair from male type to female type (by electrolysis or laser or what ever)
3) Alter your voice (speech therapy)
4) Alter you genitals from male to female (with surgery)

Of course I object totally to this persons politics but cannot fault her observation on what is involve in being ts? It is only psychiatrists and other prejudiced people who make so much of it? What do you think of the "four points"?

At my age I can't help but observe that generally things are better now, when I was a teenager, (London 1950's), and spent my youth in Soho in various clubs and bars on the existential and gay scenes, (we took drugs, made love and listened to Edith Piaff and also west coast jazz and we discussed Sartre, Camus, Kafka, Simone de Beauvoir etc), we could get put in prison for gay sex, in some ways there wasn't even a word for "transsexual" so I was totally excluded, even from the society in which I mixed, as for the suburb in which I grew up in, I may as well have come from Mars I suppose. Well, things are better now, I must face up to that and be glad for it.

I knew I was transsexual when I was six years old, my experiences are more normal amongst tsp's than I ever thought. I'm not rambling back in time for the sake of it, I want to establish what is and what is not so we can try to grasp the right questions about the political tasks we approach, even if we cannot think of the right answers.

One thing strikes me is that we mustn't assume progress is inevitable, it isn't. I don't know a lot about it but for example, I understand that the Weimer Republic was tolerant towards the lesbian and gay scene, then thousands or more people like you and me were killed in concentration camps by the third Reich, we can go backwards and we could well do so, we can also go forwards, the marxist in me says that the only thing we cannot do is stay in the same situation we are in now?

I might have been able to get hormones on demand but the rest was often unpleasant due to there being far more prejudice. Of course I was involved in politics, I was a member of Militant, (the RSL), and an active member of the Labour Party and the T&G. I had some positions in the labour Movement where I lived in King's Lynn and am afraid I had to put up with a hell of a lot of prejudice, particularly from some people in the T&G. In some ways I want to put that to one side, I moved to Brixton as "Rachael Webb" in 1983 and took part in Peter Tatchell's election campaign in Bermondsey, Simon Hughes played a disgraceful role in whiping up prejudice against Peter Tatchell, I knew him slightly at the time, and he has since said "that's history" so if he can say that then so can I.

I'll always remember one leading T&G member in King's Lynn who was supportative of me, (there were quite a few), Bill Davidson, who was an ex Durham Coal Miner and former squaddie, he had trade unionism in his guts and he stood by me as a true friend and Comrade, I'll always be grateful to him and to others.

The reason I'm going into this is about the situation of tsp's and how it has developed over the last 25 years. I made the mistake of joining the only available tsp organisation which was called the Self Help Association For Transsexuals, (think of the initials and cringe), it was as reactionary and right wing as the initials suggest, the leading member was a former wealthy business person and Senior Army Officer called Judy Cousins. They expelled me for my left wing feminist views.

I think that both Christine Burns and Stephen Whittle will agree that I was the principle person who stood up for a position of transsexual people within a position which accounted for both feminism and the emerging lesbian and gay political scene, including "sexual politics" etc. I was elected as a Councillor in Lambeth and had a job as a Housing Officer in Southwark and of course the media looked on me as some sort of gift from Sun/Mail heaven, they did me over when ever there wasn't much on the news. I developed media skills, I remember a media course I went on with Diane Abbot and Scarlet McGuire, the lessons I learnt are ones the Press Office of the T&G still tell me to observe: only ever say 3 things when you give a radio or tv interview, keep the three things simple because listeners/viewers can't absorb anything more, say them over and over again what ever questions you are asked - end of lesson. It works, just look at the next tv interview of any politician you see and you will see that that is the ABC of media relations, even after all these years.

Anyway, I became drained by fighting and fighting and by always being sort of available for public inspection. I will never ever forget the first time I was "doorsteped" by a Fleet Street photographer, I could have grabbed his camera and thrown it over a hedge but I knew I had to "grin and bear it", it gets to you in the end.

In some ways I was glad when Christine Burns, who was a member of the Conservative Party stood up at a Tory Party Conference, and for no reason that she can think of, as far as I know, talked about her being tsp, (everyone else in the Tatton Conservative Party Business women's group, of which she was Chair) thought she was a "normal" Tory business woman, so I will always be grateful to her. Stephen Whittle was as far as I know what used to be called a "Euro-Com" after Gramcsci et al. He and Christine and other, fortunately, left wing younger people than me took up the challenge.

They worked with Dr Lynn Jones MP, (I know her now through the LRC, why don't you contact her, she is from your part of the world - details ) and so the GRC was duly passed on my 64th birthday I think it was.

IN 1994 I had become, as I said, fed up with local government and all that went with it, I became nostalgic about my life as a truck driver so I moved to Brighton, bought a 38 tonne truck and went trucking in Europe. What a culture shock, the world of Inner City London Labour Parties to being an international freight driver, it was bad enough being a woman in a man's world, I never breathed a word about being transsexual, the blokes had problems with accepting the few women doing international trucking, let alone being a tsp. Tell you more about it sometime. Well just one thing:

When you look at my photo on "page 3" you will see I am behind Maureen Byrne who was Equalities Officer for Region 1 of the T&G. She gave a talk on Equality issues to our RTC Committee which consists of 17 male truckers and me, a number of them never knew, and in arrangement with her I talked about being tsp, she said afterwards that she studied their faces and said that some of them obviously had difficulty in taking it in but that most of them came round to a reasonable position. Interesting. Glad things have improved and they have, but as I said above we cannot assume they will carry on doing so.

Anyway, yes, I agree with you on a lot of points and disagree with you on some, but on the important issues we are totally together and have everything to gain and nothing to lose by organising together.


Rachael Webb

Tuesday, 3 February 2009

It just keeps getting better…

I’ve had a couple of days on medical matters well in the sense I got my free NHS eye sight test and I’m delighted with the result. My last test was in 2003 and six years later and having had three major Iritis attacks amazingly my prescription is no different now compared to 2003. Next week I have a contact lens test but I have to pay for that. It’ll be great to go back to contact lenses particularly now there are gas permeable varifocal contact lens options. The NHS contributes to the cost of the lenses as well which is a bonus.

So on a bit of a roll I went to see my GP with my list; sick note, prescription etc. and to say a big thank you for giving me real hope of putting my Ankylosing Spondylitis into permanent remission once my major surgery is out of the way. I decided to ask about rhinoplasty as whilst this was approved by South Staffordshire PCT they instead on one of their hospitals. I had asked for the top maxillofacial surgeon in the UK who also coincidentally (of course) is the top private facial feminisation plastic surgeon. I don’t think I have to explain why South Staffordshire said no to me.

Anyway I gave all the details to my GP as this particular surgeon is based in Manchester in the forlorn hope he might do some NHS work. Later today I got a text back saying he’s based at the Manchester Royal Infirmary and yes I can have my rhinoplasty there with him. I must say there is a genuine reason for my requiring surgery in that when my nose was reset after my accident the internal & external damage could not be corrected without an operation.

I must admit I spent a good hour laughing after the news came through as I think I’m becoming the Bionic Woman (we have the technology we can rebuild her). LOL Lets see so far Manchester NHS has agreed to my major surgery, agreed to put me on the expensive TNF alpha treatment, and now agreed to rhinoplasty that will dramatically improve my appearance.

I owe this City so much, for taking me in when I was near total physical and mental collapse and giving me renewed faith in the future. I am determined to find a way of paying back this investment in my health.

I owe (and love) Manchester big time…

Thursday, 29 January 2009

Pot calls kettle black…

I received an email from Press For Change publicising Christine Burns’s rant against the Equalities and Human Rights Commission asking if it was trying to forget “trans” people?

I think the answer should be Yes for a lot of the “Trans” community as I can’t quite see how the Human Rights or Equalities are compromised for drag queens, hairy panty wearers, cross dressers or transvestites. These are all men who are free to indulge their fantasies if they so wish.

Of course no man should be subject to violence or abuse for any temporary change in gender presentation but I’ve yet to hear or see a list of issues that go outside existing legislation’s ability to protect the individual. I say that as someone who has been directly involved with LBGT. My experience there was that “Trans” is generally misunderstood or defined incorrectly to be true transsexual.

What I do know is whether we are talking “Trans”, transgender or true transsexual none of people assigned the label are mentally ill and it is the psychiatric community that is guilty of an abuse of human rights by treating them as such.

The mess of NHS treatment and the mess of the law itself continue because of this unscientific bogus classification that none of the high profile champions of trans ever challenge. It is total hypocrisy to avoid the confrontation that is needed to effect real and permanent change for both transgender and true transsexual people.

This is Ms Burn’s list of issues and some comments from me.

# set yourself the goals that trans people in Britain should no longer suffer a postcode lottery for funding of the most basic health care provision

Nice but same is true for every other NHS treatment

# commission the most basic of all research – to find out, with a degree of certainty, (a) how many transsexual, transgender and other gender variant people live in the UK; (b) how many require care relating to their gender issues (not just those who present seeking surgery); and (c) how many are not getting that care or suffer unreasonable waiting times or denial of service choice

This looks like a pitch for some work.

# quiz the Royal Colleges on why they have dragged their feet for seven years and have still not published basic standards of care for the UK (they're afraid their discriminatory protocols are unlawful)

Here is a blind acceptance of transgender and transsexual people being mentally ill. All the current NHS policies are unlawful so it would be more beneficial to insist they are all revised against the Mental Capacity Act, Sex Discrimination Act and Gender Recognition Act but starting from the position of declaring what is referred to as true transsexual is an irreversible neurological condition.

# demand to know why there is no published, peer reviewed research on the outcomes of trans care in the UK (and why less than 0.098% of articles recently searched in the Cochrane Library, MEDLINE, EMBASE and PsychINFO relate to UK research on LGB&T health as a whole.)

NIce to know but so what.

# Proactively audit EIA's on PCT commissioning policies at random and use judicial review to overturn cynical discriminatory practice predicated on the above lack of data – a locked in form of institutional discrimination if ever there was a case

I think we agree on this subject to the prior removal of the mental illness classification.

# Take up the case of the UK's backward practice on prescription of hormone blocking treatment of teenage trans people as the travesty of ethics and the Human Rights abuse that it represents

Now this I totally agree with providing it doesn’t enhance the role of the psychiatrist or psychologist or psychosexual therapists.

# Ensure that all police forces are monitoring transphobic hate crime.


# Put transphobic bullying in schools into the educational vocabulary


# Actively investigate the reasons why trans people are living on benefits and why those in work are known to be paid several grades below their capability.


# Criticise media organisations when their editors still persist in allowing transphobic language to air (especially from comics of dubious talent).

Hummmm censorship?

# Investigate and report on why the trans community's tiny support and advocacy organisations are close to collapse – their leaders physically and spiritually exhausted after nearly 20 years of voluntary work.

Well actually I think it’s time for a change of the guard as they say. A lot of the problems transgender and transsexual people face are a direct result of bad law and misrepresentation influenced by Press For Change and others who make a living from Trans politics.

You can read Ms Burn’s article at:

I predict no real change but possibly some nice expenses or a research commission to keep the Trans activists happy meanwhile the NHS and others will continue their abusive ways unless they are confronted by other gender guerrillas like myself who are prepared to use the law to achieve their aims.

Now here is the Equalities Human Rights Commission response to Ms Burns.

I¹m sorry to hear that there has sometimes been a delay in your being reimbursed for travel expenses incurred when contributing to Commission consultations. The Commission strives to provide genuine opportunities for stakeholders to engage with us on our developing strategies and policies. We recognise that many of our stakeholders are not well funded, so we try and balance that with our duty to consult. We are currently developing our policy on paying expenses for attending Commission events, which will be designed to ensure that people aren¹t excluded from contributing to the Commission¹s work on the grounds of cost. However, as a publicly funded organisation with limited resources, we unfortunately do not have the scope to offer payments for people¹s time.

Oh dear poor old Ms Burns isn't going to get paid for her support of the mental illness classification of transgender and transsexual people though she'll still get her expenses as an unaccountable self interest lobbyist.