Information as regards transgender patients, costs, and healthcare

Summary

A request for data on transgender healthcare services, costs, and patient numbers on the Isle of Man was partially fulfilled, with the Department of Health and Social Care disclosing that no on-island treatment is currently available while citing exemptions for missing data on specific costs and historical records.

Key Facts

• No patients are currently receiving treatment for gender dysphoria on the Isle of Man.
• Fewer than 12 residents are currently receiving assessments off-island.
• Fewer than 6 patients are on the waiting list for the Tavistock and Portman NHS Foundation Trust.
• The Department does not hold information regarding patients who have undergone or are awaiting surgery or endocrinology.
• Specific cost data for surgeries, therapy, and assessments could not be provided due to lack of held information.

Data Disclosed

• less than twelve (12)
• less than six (6)
• 2000 through to the year 2020
• 14th September 2020
• 9th October 2020

Exemptions Cited

• Section 11(3)a of the Act (practical refusal reason: information not held or cannot be found after reasonable steps)

Original Request

Regarding a proposal to improve the healthcare services of transgender individuals on the island, to be presented to the Health Minster and other relevant bodies. Please provide the following information. Question 1. How many of the islands residents are currently being treated under the IOM Health Service for any type of gender dysphoria? Question 2. From the year 2000 through to the year 2020, what is the total number of residents, per year, that have been treated for Gender Dysphoria in the last twenty years? Question 3. How many residents are registered in any way, under the IOM Health Service, as being classed as "Transgender", "Gender Identity Disorder", "Gender Dysphoric", "Transsexual" or similar? Question 4. What number of these residents have undergone sexual re-assignment surgery? Question 5. What number of these residents are having to engage in treatment in the U.K as opposed to receiving treatment on the island? e.g. attending appointments at the London Gender Clinic etc. Question 6. What is the approximate or average cost to the IOM Health Service for:- 5a. Sexual Reassignment Surgery? 5b. Hormone Replacement Therapy for both Testosterone and Oestrogen therapy? 5c. On island therapy appointments? 5d. Off island therapy appointments 5e. Current cost of one appointment/ on island with a psychiatrist or mental health professional of the same level? 5f. Current cost of one appointment on island with a psychotherapist or mental health professional of the same level? 5g. Current cost of the assessment process in diagnosing Gender Identity Dysphoria? Question 7. What training or information does the government provide for healthcare practitioners to learn and understand more about Gender Identity Dysphoria? Question 8. If known, how many on island health care practitioners are trained on a reasonable level in Gender Identity Disorder or Gender Dysphoria?

Data Tables (1)

Full Response Text

Interim Chief Executive: Kathryn Magson Freedom of Information Team Crookall House Demesne Road Douglas Isle of Man IM1 3QA

Tel: (01624) 642621 Email: dhsc@foi.gov.im Website: www.gov.im/dhsc Our ref: 1468473 9th October 2020

Dear ###

We write further to your request which was received on the 14th September 2020 and states:

“Regarding a proposal to improve the healthcare services of transgender individuals on the island, to be presented to the Health Minster and other relevant bodies. Please provide the following information. Question 1. How many of the islands residents are currently being treated under the IOM Health Service for any type of gender dysphoria? Question 2. From the year 2000 through to the year 2020, what is the total number of residents, per year, that have been treated for Gender Dysphoria in the last twenty years? Question 3. How many residents are registered in any way, under the IOM Health Service, as being classed as "Transgender", "Gender Identity Disorder", "Gender Dysphoric", "Transsexual" or similar? Question 4. What number of these residents have undergone sexual re-assignment surgery? Question 5. What number of these residents are having to engage in treatment in the U.K as opposed to receiving treatment on the island? e.g. attending appointments at the London Gender Clinic etc. Question 6. What is the approximate or average cost to the IOM Health Service for:- 5a. Sexual Reassignment Surgery?

5b. Hormone Replacement Therapy for both Testosterone and Oestrogen therapy? 5c. On island therapy appointments? 5d. Off island therapy appointments 5e. Current cost of one appointment/ on island with a psychiatrist or mental health professional of the same level? 5f. Current cost of one appointment on island with a psychotherapist or mental health professional of the same level? 5g. Current cost of the assessment process in diagnosing Gender Identity Dysphoria? Question 7. What training or information does the government provide for healthcare practitioners to learn and understand more about Gender Identity Dysphoria? Question 8. If known, how many on island health care practitioners are trained on a reasonable level in Gender Identity Disorder or Gender Dysphoria?”. Our Response: While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested. The statutory exemption sections are shown as part of the corresponding answers below. Question 1. How many of the islands residents are currently being treated under the IOM Health Service for any type of gender dysphoria? While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. No patients are receiving treatment on island, there are currently less than twelve (12) receiving assessments off island. We have less than six (6) patients on the Tavistock and Portman NHS Foundation Trust’s (a specialist mental health trust based in north London) waiting list for an appointment date, to start their assessments. The Department does not hold any information for those who have undergone or awaiting surgery or endocrinology (the study of hormones). Question 2. From the year 2000 through to the year 2020, what is the total number of residents, per year, that have been treated for Gender Dysphoria in the last twenty years? While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you

have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. The Department only has figures available from April 2013 - August 2020 inclusive and there were 38 individuals in total during this period. Assessments usually go on for longer than one year. Question 3. How many residents are registered in any way, under the IOM Health Service, as being classed as "Transgender", "Gender Identity Disorder", "Gender Dysphoric", "Transsexual" or similar? While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. The Department’s current databases do not record a patient as being "Transgender", "Gender Identity Disorder", "Gender Dysphoric" or "Transsexual. Question 4. What number of these residents have undergone sexual re-assignment surgery? Complying with the request for information would require the public authority to do one or more of the matters mentioned in section 8(3) (things a public authority is not required to do by the Act S11(3)(b). While our aim is to provide information whenever possible, in this instance, complying with your request for information would require us to create or derive information from information that we hold. This would require the Department to undertake an excessive piece of work to retrieve relevant data from our systems in order to disclose. The Department does not hold these figures; surgery in the UK is paid for through Nobles Hospital. Nobles Hospital is billed for such work along with all other non-contracted invoices by the UK trusts and, therefore, this data unfortunately is not collated or readily available. Question 5. What number of these residents are having to engage in treatment in the U.K as opposed to receiving treatment on the island? e.g. attending appointments at the London Gender Clinic etc. All Gender Identity Disorder patients are referred to the NHS Tavistock & Portman Clinic in the UK for specialist off island intervention, as this service is not currently available in the Isle of Man. During COVID, appointments are facilitated virtually.

Question 6. What is the approximate or average cost to the IOM Health Service for:- 5a. Sexual Reassignment Surgery? The IoM pay national tariff for sexual reassignment surgery on an activity basis in the UK. The UK national tariff information is available on the internet using this link https://www.england.nhs.uk/pay-syst/national-tariff/

5b. Hormone Replacement Therapy for both Testosterone and Oestrogen therapy? The cost to the IOM Health Service for Endocrinology is £726.95 for appointments in UK and £519.25 per treatment also in the UK. The UK national tariff information is available on the internet using this link: https://www.england.nhs.uk/pay- syst/national-tariff/2019-20-payment-reform-proposals/ 5c. On island therapy appointments? The UK national tariff information is available on the internet using this link: https://www.england.nhs.uk/pay-syst/national-tariff/2019-20-payment-reform- proposals/ 5d. Off island therapy appointments The cost is £778.88 per appointment, the figure is higher for Child Adolescent Mental Health Service (CAMHS) approximately £1,600. 5e. Current cost of one appointment/ on island with a psychiatrist or mental health professional of the same level? The UK national tariff information is available on the internet using this link: https://www.england.nhs.uk/pay-syst/national-tariff/2019-20-payment-reform- proposals/ 5f. Current cost of one appointment on island with a psychotherapist or mental health professional of the same level? The UK national tariff information is available on the internet using this link: https://www.england.nhs.uk/pay-syst/national-tariff/2019-20-payment-reform- proposals/ 5g. Current cost of the assessment process in diagnosing Gender Identity Dysphoria? While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal

reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. Patients receive 2 – 3 appointments per year and usually continue for longer than 1 year. Each patient’s assessment process is different so the Department cannot provide an exact figure. Question 7. What training or information does the government provide for healthcare practitioners to learn and understand more about Gender Identity Dysphoria? A mandatory online learning package, entitled Equality and Diversity Essentials, is provided to all Isle of Man Government staff within Department of Health and Social Care – this training covers Protected Characteristics.
Question 8. If known, how many on island health care practitioners are trained on a reasonable level in Gender Identity Disorder or Gender Dysphoria? While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. This information is not held by the Department.

Please quote the reference number 1468473 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.

In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely