I received a letter from the Director of Commissioning & Redesign at South Staffordshire NHS Primary Care Trust. I won't bother reproducing it here as it was designed to soften me up, for a refusal of funding.
Here is my response, if they are wise they will show it to their legal advisers and then approve funding for my surgery.
Dear Mr QQQ,
Thank you for your letter dated 30 April 2008.
I found this letter to be even more confusing than your treatment policy and I wish to clarify many issues arising out of it. However, rather than go through each point of your letter, I will address it as a whole.
My perception is that your letter is preparing the PCT’s position for a rejection of my request for exceptional status.
I refer to the legal framework for the commissioning responsibilities of PCTs which is set out in regulations 3(7)-(10) of the National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Regulations 2002.
An aspect of this is whether a PCT provides a treatment for a particular health condition for which the PCT must give due consideration to the Human Rights Act (1998). However, this does not apply in this instance, as the PCT has made clear that it provides gender reassignment surgery and the only issue in contention is where this may be commissioned.
The allocation of resources and the determination of the processes to prioritise resources is a matter for each PCT. I am not aware under the legal framework of any other issues that may determine treatment options.
Your policy states that gender reassignment surgery is a funded treatment so there is no resource issue.
There is no additional financial burden to the PCT in referring me to the Sussex Nuffield in that the Nuffield Hospital Brighton not only has a lower treatment cost but also has zero incidence of MRSA, DVT and pulmonary embolus and thus significantly reduces the risk of my requiring further treatment for these (to me) life threatening conditions.
The process of identifying exceptional cases is to deal with areas where resources have to prioritised and ethical issues of patient care come to the fore. The process is not intended to deal with contentions of patient choice.
This is further emphasised in your strategic plan “STRATEGIC DIRECTION 2007-2012: To prevent ill-health, and to promote long life and well-being for all” (Draft version 12) which states your approach to healthcare is (applicable points in italic):
The PCT’s approach to providing health care is based on the following:
· Focus on prevention
· Target resource where need is greatest in the PCT
· Put clinical decision-making at the heart of service change
· Work with partners on other factors which impact on ill-health
· Where treatment is needed, offer choice and commission high-quality services with no delays
· Provide leadership to the local health community
· Develop and design services based on the most appropriate fit for patients
I have tried to accommodate your process to allow your staff to deal efficiently and effectively with my treatment. However, my patience is becoming exhausted.
Your policy of using the Gender Identity Clinic based at Charing Cross hospital will probably require review in the future as the protocols used by this unit may be shown to be unlawful under the Gender Recognition Act (2004) and also under the Mental Capacity Act (2005).
With respect to this, whilst I have written to Mr Thomas’s Office to tell him that I will accept a single one off assessment by a further psychiatrist as part of his existing protocols, I have also registered my disagreement regarding the legality of such an additional assessment.
Finally, your comment that you cannot commission Nuffield Hospital Brighton because they are not on your database is particularly baffling. Are you claiming that you do not have competent administration staff to undertake this, thus forming an insurmountable barrier to any change in commissioning practise?
I look forward to receiving a more understandable reply.
Maggie Fiona Fox
Copy to Janet Dean MP & Dr SSS
I sent this covering letter to my MP. Should do the job!
South Staffordshire NHS Primary Care Trust
Since our recent meeting I have received a letter from QQQ Director of Commissioning & Redesign that causes me great concern as I am trying to avoid legal conflict with South Staffordshire NHS Primary Care Trust.
I am becoming convinced that the PCT will dispute the strict medical criteria laid down by Parliament that were incorporated into the Gender Recognition Act of 2004 thereby wasting public funds.
The exceptionality arguments in my GP’s submission are both that I have a female birth certificate so the PCT gender dysphoria services policy does not apply and that my Ankylosing Spondylitis makes me higher risk and requires dedicated specialist post operative nursing care.
The other arguments are in the copy of my response to QQQ that is attached.
I do hope you can help me convince this PCT to move away from such an extreme position.
Maggie Fiona Fox