Sunday, 26 September 2010

Unemployed? Sod off!

    I posted a couple of days ago about my appointment with the psychiatrist on Friday, and my referral to the GIC. What happened not long afterwards has troubled me slightly over the weekend and I think I'd better write about it here.
    On Friday evening I happened to meet a friend from another town in passing. She's like me, bloke on the outside at the moment, at the start of the NHS system. She's in a more perilous state than me though and unlike me she's wanting to go the whole way, hormones and GRS where I'm seeking a way to avoid them without going insane. She is also unemployed at the moment, as I understand it on medical grounds.
    I've been referred to the GIC. She hasn't. She's had her first appointment with the gatekeeper psychiatrist in her area, but unlike me she has been unable to secure a second appointment. The reason? She's unemployed and I'm not.
    Now I understand all about Real Life Experience. How in the NHS interpretation of the Standards of Care you have to prove you are able to live in your target gender role in the real world before being prescribed any hormones. And how that has to include employment, voluntary work or education. I have seen many different views on RLE, but they have a reason for it and that's the way they do it.
    I do not however understand how the employment requirement for RLE can be applied to an appointment with the gatekeeper. At the gatekeeper level you are several steps and a lot of time away from even thinking about RLE and there should be no employment requirement for psychiatric counseling alone.
    I am unaware of any other condition covered by the NHS for which there is a requirement to be employed before they'll even see you. Forget about the RLE requirement for a minute, that's about one treatment choice not the diagnosis. Maybe I'm missing something, but wasn't the NHS supposed to be about equal access to treatment for all regardless of their means? Or indeed what they are suffering from. I understand this may be a local policy from my friend's area rather than national NHS policy, but someone needs reminding of what it says on the NHS charter.


  1. NICE was set up to ensure that the same standards for all treatments were utilised throughout the whole country.

    Well that does not work does it? Our treatment is arbitrary and completely lacking in common sense or logic. It verges on the criminal how we are often mistreated and they wonder why so many give up and die!

    Caroline xxx

  2. I don't understand either how an employment requirement can or should be applied in this case. I hope she is challenging the decision?

  3. Don't worry, she's kicking up a fuss about it. And I'm sure they'll give in to her. I feel rather bad because I was full of "My referral's been confirmed!", not knowing of course that she's had this roadblock placed in front of her.

    The postcode lottery is all too real I'm afraid. My letter from the GIC is a case in point, it confirms my referral but states that it's my PCT they're waiting for to say they'll pay rather than a simple waiting list. So I'll have to wait a few months, hassle the PCT a bit and only then will I get on the very long waiting list for an appointment.

  4. If nothing else, this pathway teaches assertiveness and develops an ability to negotiate bureaucracy... my PCT stalled for three years, but that was because they were in dire financial straits after paying out loads of compensation over the baby deaths scandal. So I didn't press the case until I learned that they were in funds again, and then dealt with the Special Funding person at the PCT. Good luck with your case, and to your friend too.

  5. To quote surgeon James Bellringer: If you don't offer anorexics treatment one fifth die; if you don't offer transsexuals treatment one fifth commit suicide. Now you wouldn't seriously suggest that you don't try treating anorexia.

  6. Alas, this just illustrates how the rules are seemingly made up as they go along.

    This is cruel, very cruel. I wish your friend well.

  7. Do they just make this up as they go along? It's unreal.

    I hope that your friend gets them to move soon (and that your PCT gets it's act together!)

    @Cathy: That's a very good quote...


  8. Having come surprisingly close to being one of those fifth not that long ago I can certainly appreciate the truth in that quote.

    Don't anyone worry on my behalf, my GIC appointment will come, it just won't come that quickly. I have the resources to kick some butts. My friend on the other hand does worry me, she's not having an easy time of it.

  9. Sad the way some rules are followed to the letter rather than the spirit.

  10. "...prove you are able to live in your target gender role in the real world before being prescribed any hormones."

    This is all very confusing. A friend of mine has been prescribed hormones even though she's still working in male mode as a teacher. Sounds like they really do make up the rules as they go along.

    I'm just about to arrive at the start line and begin the process. It'll be interesting to see what advice I get as there's no way I can give up my male job for a couple of years.


  11. @Lucy, I don't think those rules even apply to that particular stage!

    @Angie, there is more than one path. For instance I have a friend who was referred direct to her endocrinologist and never saw a GIC, she was on hormones for a year before going f/t. Mind you, she's retired so the employment requirement didn't make complete sense