Read standard 8: Specialist gender identity healthcare

Gender identity healthcare: Adults and young people
Healthcare Improvement Scotland

Standard statement

People have access to safe, high-quality specialist gender identity healthcare.

Rationale

People should have access to safe, high-quality specialist gender identity healthcare, including non-surgical, surgical and pharmaceutical interventions and treatment. This should follow national clinical protocols, guidance and pathways.1 Specialist gender identity healthcare should be based on robust holistic clinical assessment, evidence based clinical protocols, best practice and with appropriate governance processes in place.

Services should ensure they support people to make informed decisions and should follow relevant capacity and consent protocols. Referrals to gender identity services, including surgical and non-surgical care, should be appropriate and timely for the person.29 Staff should be trained and knowledgeable about relevant national clinical pathways and regulatory and competency frameworks.

Discussions about specialist healthcare should include risk and benefits of any treatment, continuity of care and safe administration of medications, as appropriate. Policies and protocols to support decision making relating to medication should be developed. All staff who prescribe or administer medication should have appropriate qualifications and competencies and do so in line with regulatory requirements.43 Specialist pharmacy advice should be integral to multidisciplinary discussions. The monitoring and review of medications should be embedded in practice. Where appropriate, repeat and bridging prescriptions should be considered, with decisions recorded appropriately.

Evidence highlights that some people may self-source medication without input from a regulated professional such as a pharmacist. Policies and protocols should include providing support and non-judgemental advice from relevant qualified staff for people self-sourcing.

Organisations should ensure the appropriate governance arrangements are in place to support continuity of care and support throughout the pathway, in line with national and local protocols. For example, when people have moved between NHS boards, UK NHS services or other providers.

Who is responsible for meeting this standard?

All organisations and staff providing specialist gender identity healthcare.

Criteria

8.1

Organisations have systems and processes in place in line with national protocols for non-surgical, surgical and pharmaceutical treatment that:

  • support informed choice and decision making
  • covers referral, assessment and treatment across the patient pathway.
8.2

Organisations have protocols in place for non-surgical, surgical and pharmaceutical treatment by trained, competent and registered staff, which includes:

  • criteria for accessing treatment in line with relevant guidelines
  • baseline and ongoing monitoring and review requirements by appropriately trained staff, including primary care and pharmacy staff
  • any additional monitoring requirements, for example blood sampling, and who is responsible for these
  • who to contact to discuss any concerns or if the person wishes to change or discontinue treatment or medication
  • information sharing protocols across multidisciplinary teams and services.
8.3

Organisations provide clinical advice and information on non-surgical interventions from trained, competent and registered staff, which includes:

  • benefits and risks of interventions
  • capacity and consent in line with national guidance
  • pre-assessment for intervention
  • discharge planning
  • aftercare and support protocols where required, including a point of contact for the person.
8.4

Organisations have protocols in place for the provision of non-surgical interventions, which include:

  • access to locally provided services including voice support, mental health support, fertility preservation, and facial hair removal and wigs
  • referral process with clear roles and responsibilities
  • alignment with national guidance and policy.1
8.5

Organisations provide clinical advice and information on surgical interventions from trained, competent and registered staff including:

  • benefits and risks of interventions
  • capacity and consent in line with national guidance
  • pre-assessment for surgery
  • discharge planning
  • aftercare and support protocols where required, including a point of contact for the person.
8.6

Organisations have protocols in place for the provision of surgical interventions, which includes:

  • access to locally provided surgery or nationally commissioned surgery
  • availability of locally provided surgery
  • referral process with clear roles and responsibilities
  • alignment with national guidance and policy.1
8.7

Organisations provide clinical advice and information on medications from trained, competent and registered staff including:

  • the benefits and risks associated with commencing or discontinuing medication
  • instructions for taking medications including self-administration
  • the purpose of their medication and importance of taking it as prescribed
  • the importance of medications monitoring and review by regulated health professionals.
8.8

Organisations have protocols for medication and prescribing that are developed with specialist pharmacy input which cover:

  • repeat and ongoing prescriptions
  • bridging prescriptions
  • monitoring and review of all prescriptions including dose and duration
  • prescribed medications and/or those not prescribed
  • advice and support from an appropriate specialist
  • the maintenance of prescriptions when the person moves, where possible and clinically appropriate.
8.9

Medications are:

  • prescribed by staff with an independent prescribing qualification and competency in this clinical area or based upon the specialist recommendation of a prescriber in this clinical area, in line with regulatory requirements
  • dispensed and/or administered by staff with the relevant professional qualifications and competencies
  • regularly reviewed.
8.10

Healthcare professionals work together to ensure safe transfer of care between:

  • providers including between NHS/independent provider
  • sectors including between NHS/social care such as care homes
  • settings including between primary/secondary
  • countries including between Scotland and other UK countries/overseas.
8.11

Where appropriate, with consent and in line with national guidance, families/representatives:

  • receive information about interventions including potential side effects
  • information and guidance to support the person
  • are informed about any changes to treatment or intervention and the reason for change.

What does this standard mean for...

What does the standard mean for people?

  • You will be provided with the opportunity to discuss, consider and decide on the best course of treatment at the time that is right for you.
  • You will receive information and guidance to support your decision making.
  • You will be supported to understand the risks and benefits of any treatment or interventions.
  • If you take medication, you will be able to review this with trained staff at agreed timeframes.

What does the standard mean for staff?

Staff in line with roles, responsibilities and workplace setting:

  • provide treatment and interventions in line with best practice and current evidence and guidelines
  • support people to make informed choices about their treatment including medicines
  • conduct regular treatment reviews using a structured approach
  • are able to explain the risks and benefits of any non-surgical, surgical and pharmaceutical interventions under consideration and the pathway for onward referral.

What does the standard mean for the organisation?

Organisations:

  • work in partnership with specialist services for local monitoring and management of a person’s gender identity care
  • have systems and processes in place to support the safe delivery of gender identity healthcare services including transfer of care
  • provide information for shared and supported decision making
  • ensure staff are trained and competent in the delivery of gender identity healthcare.

Examples of what meeting this standard might look like

  • Documentation in clinical notes that demonstrates supported and shared decision making.
  • Non-surgical referral pathways.
  • Electronic pharmacy records accessed across healthcare settings.
  • Clear local pathways and protocols on prescribing, medications management and review.
  • Service level agreements relating to provision of surgery.
  • Clear pathways on provision of surgery.