Sunday, 6 April 2008

"Our policy has been to create the context for change, then to apply changes within that context."

That quote is from The Head of Change and People at Terminal 5 but it could have come from anyone in Government or the Department of Health.

Completely meaningless and irrelevant it neatly sums up my Primary care Trust who after two years of painstaking research have yet to decide on the clinical pathway for transsexual people. In other words they are trying to hide an illegal blanket ban on surgery by procrastination.

I’ve now got a copy of the reply to my GP to my request for funding for surgery. Here is my reply for your entertainment…

FROM: Maggie Fiona Fox
08 April 2007

To: Mr XXX XXX Director of Commissioning South Staffordshire PCT Anglesey House Towers Business Park Rugely Staffordshire WF15 1UL

Dear Mr XXX,

I am now in receipt of a copy of the response to my GP, Dr ZZZ, by your assistant planning manager and I am most concerned by the response that seems to indicate that the request for funding by Dr ZZZ has not been understood.

The request was for funding to be referred for surgery to Mr Phil Thomas based on the advice of my gender specialist Dr Richard Curtis.

After nearly two years of consideration that you still have to decide on “gender dysphoria services” is of no relevance other than if of course it were a disguised blanket ban on surgery it would be illegal. (Appeals Court Ruling N-W Lancashire Health Authority vs. A, D and G.)

The request for funding to a specific surgeon is due the complications of my underlying medical condition of severe Ankylosing Spondylitis that means I am significantly different from the general population (for example 50% lung capacity and no spinal rotation) to warrant individual recommendation for treatment as I will require intensive post operative care and minimal time in surgery.

The significant benefits being that I will stand a better chance of surviving the operation, minimise the risk of requiring additional correctional procedures and optimise after care recovery (including pain control) from the surgery being carried out by the UK’s leading surgeon in this field together with the specialist nursing facility that is in place at the Sussex Nuffield Hospital.

I think the problem may be that the Individual Treatment Panel could be confused by the misinformation on my condition regrettably permeating the NHS.

Gender dysphoria or gender identity disorder or transsexualism is a recognised medical condition for which the treatment sequence is simply assessment to eliminate any possibility of mental illness, provision of hormones under the care of a gender specialist and then surgery.

I have been assessed by one of your own psychiatrists and I have a HM Government approved gender specialist Dr Richard Curtis so there is no question regarding diagnosis and treatment.

I am on hormone therapy and have now completed two and half years living in my true gender and been awarded a gender recognition certificate on the grounds that this is a permanent change.

I do not require any “services”. I just naturally require surgery to complete the physical change. Risk now to my mental health is related to the chance of denial of surgery. I am fully aware of the consequences and risks of surgery and under the Mental Capacity Act of 2005 there is no basis to assume I am not competent to realise the consequences and make this decision.

In view of this I would therefore ask that you personally present my case directly to the Individual Treatment Panel as I have already provided more than adequate evidential documentation via Dr ZZZ.

I look forward to your response,

Yours sincerely,



Maggie Fiona Fox

Copy to Dr ZZZ & Dr R Curtis

Summary of my clinical case:

I have a HM Government recognised Gender Specialist that has recommended me for surgery with a UK surgeon.

The recommendation is due to my underlying medical condition.

I already have a totally effective hormone and anti-androgen regime that has dramatically increased my “acceptability” to the general public.

I exceed all the internationally accepted criteria for readiness for surgery.

I have a Gender Recognition Certificate and a female birth certificate.

My gender specialist is an approved NHS contractor to other PCT.

The surgeon I want operates within the NHS.

Finally may I commend that the PCT operates a policy that “funding for surgery will be provided to anyone who obtains a gender recognition certificate” as to get one you have to prove you are committed to a permanent lifelong change and exceed the criteria for surgery. If you haven’t already had surgery you have to explain why not!

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