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Democratic Healthcare for All: #ReclaimNHS

As workers, junior doctors deserve better. As patients, carers, and service users, we deserve a NHS staffed by clinicians who are not exhausted and overworked but with the necessary space and focus to see us not as symptoms but as people. The contract is being imposed but we can fight back and #ReclaimNHS. It just so happens that NHS Employers, the people in charge of imposing the contract, have handily provided an email helpdesk over at juniordoctors@nhsemployers.org to answer questions about the new contract. We suggest that we all make use of this handy service to ask questions regarding the contract imposition. Some sample questions might include:

– How can you justify the imposition of the junior contract when 99% of British Medical Association members rejected any new contract which would extended working hours in such a way which endangered patient’s welfare?;

– The NHS has widespread staffing problems. The imposition of the junior doctor contract has had a direct impact in a reduction of applications to medical schools. Why are we stretching already overworked junior doctors instead of investing in recruitment and training to fill any shortfalls?;

– The junior doctor contract represents a de-skilling of NHS workers and a way of squeezing more work out of already over-stretched staff. Against a backdrop of privatisation, the contract seeks to make the NHS more attractive to private companies who are snapping up public assets to squeeze a profit. How can this be justified whilst still upholding the principles of a public NHS which is free at the point of access as outlined in the NHS Constitution?

Please email juniordoctors@nhsemployers.org with your questions and concerns about the junior doctor contract and privatisation before the helpline closes on the 13th April. Email the above questions, ask your own, or even send pictures of your cats. Share the facebook event. Share it on twitter. Ask your mum. Ask your gran. Together we can fight back. Together we can #ReclaimNHS.

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This open letter was written by trans artists in response to hearing that cis artist Virginia de Madieros will be given a funded residency in Manchester. As part of her residency, she will be undertaking hormone treatment with testosterone as part of an “artistic ethnography” of the Manchester transgender community. The organisers behind the open letter have asked for it to be hosted here. If you are a trans artist and wish to sign the letter, please email info[at]actionfortranshealth.org.uk

Dear Virginia de Madieros, Manchester School of Art and HOME Manchester,

We are a group of trans and gender variant artists based in the UK. It has come to our attention that the Manchester School of Art is granting a residency to Brazilian artist Virginia de Madieros which will be hosted at HOME Manchester as part the Manchester-Brazil 2016 Art Collaboration in the 20th July – 20th Oct 2016 period.
We are aware that Virginia has contacted various trans organisations in Manchester ahead of her residency here, saying:

“Virginia will be developing a new work, directed at the transgender universe – women who had assigned the female gender at birth but now are understood as men, also called FTM – female to male. The starting point of the project is her own body – a few months ago she started taking testosterone hormone as an artistic procedure… Acting as an ethnographic artist, she would be attending social spaces in Manchester which are frequented by transgenders to get into the daily lives of individuals or groups and gather personal and unobtrusive stories”

As trans artists, this raises some red flags for us.

Trans men are not “women who were assigned female at birth who go on to be understood as men”, they are men (who are also trans). We recognise that UK-based trans terms may be different from Brazilian terms, but we are also aware from looking at Virginia’s previous work around trans / transition that she is aware of the term “trans men” and how it is understood. We feel that any artistic research carried out on the trans community in Manchester should be undertaken by someone with the cultural competency to do so, including an understanding of how trans people in Manchester describe ourselves, and how the language of female-ness or male-ness as essential traits is often mobilised by transphobes to actively harm trans people.

As trans artists and activists we believe that anyone should have the right to change their body in any way they want, for any reason. However, we are concerned about the impact of a cis woman taking testosterone uncritically as an artistic endeavour in a world where trans people are literally dying through being unable to access this exact treatment. Through our engagement with some of Virginia’s previous work, we do not get as sense that her engagement with these acts are critical, however we would welcome being corrected on this front.

We are concerned about the use of ethnography within this project. Largely we see cis people studying trans bodies as an othering and objectifying process. In a recent video about her work, Virginia laughs and says:

“Oh muscles are beginning to show. I’ve been working out”

As much as muscle gain often happens when taking testosterone, we feel like the focus on certain aspects of the medical transition process is objectifying and feeds into wider tropes around trans people’s lives and bodies not being seen as a holistic whole but as disembodied parts: muscle and fat changes due to taking hormones, positioning of vocal folds, chest surgeries, and of course, genital surgeries, which are positioned by cis people as our ultimate act of transgression.

We also feel like the artist’s assumption that she, as a cis woman, could gain an “approximation” of what it is like to “become” a trans man, is somewhat misguided and plays into the pathologisation of trans-ness by positioning our “becoming” as a purely medical and biological process. This is misleading because it furthers the incorrect assumption that all trans people choose to / are able to choose to take hormones and situates our identity as part of a medical process. Her project also positions trans-ness as something that is reachable by cis people through engaging in those medical processes.

Whilst we believe that Virginia’s work genuinely has something interesting to say about gender and subjectivity, we believe that trans artists are better able to articulate work around these issues. There is a longstanding history of cis people getting funding to undertake trans art while trans artists are sidelined and their work goes unfunded and overlooked.

Virginia’s work is actively looking for trans people’s stories to tell through the ethnographic process. At the core of our concerns is the fact that as trans people, we never get to tell our own stories. Further, trans work produced by cis artists for cis audiences always ends up misrepresenting trans experiences by presenting us as dismembered body parts when in fact the reality of trans lives are so much more than our bodies. Trans art by trans artists explores this rich complexity by engaging with themes such as dysphoria, structural transphobia, gendered space, and embodiment in its most holistic sense.

We welcome a dialogue with Virginia and with the Manchester-Brazil 2016 Art Collaboration and would like to see these concerns addressed. We note that Virginia will be looking to collaborate with home grown talents and we would like to support Virginia in this endeavour and we expect that the Collaboration will ensure that trans people are appropriately remunerated for their labour.

Signed,

Jess Bradley (Queer of the Unknown art collective and Transgender Rage collective, Manchester)
Loz Webb (Queer of the Unknown art collective and Transgender Rage collective, Manchester)
Rohan Beck (Queer of the Unknown art collective and Transgender Rage collective, Manchester)
Becky Conning (musician, Manchester)
Marilyn Misandry (drag artist, Manchester)
Dennis Queen (musician, Manchester)
Daira Hopwood (poet, Manchester)
Josie Cartwright (musician, Manchester)
Ashley Reed (York)
Jake Herrett (trans activist, BUFF, Manchester)
BUFF (trans-masculine festival, Manchester)
Dean Wilson (visual artist, Newcastle)
Pazuzu Gaylord (visual artist, Sheffield)
Alexandra Greenwood (games artist, Manchester)
Jennifer Hackett (musician, Nottingham)
Mihael Jaime McAllister (writer, Chorley)
Jasper Williams (artist, Bangor)
Andy Law (musician, visual artist, film maker, York)
Sam Hope (poet and blogger, Nottingham)
Felix Henson (graphic designer and poet, Manchester)
Robbie “Weasel” Daw (artist, Manchester)
Sabah Choudrey (activist and writer)
Em Travis (writer and zine artist, Cambridge)
Rowan Davies (zine artist, Cambridge)
Fee Wood (photographer, Stoke-on-Trent)
Naomi Wilkins (musician, Manchester)
AJ McKenna (spoken word artist)
Chris Hubley (visual and performing artist, Bristol)
Adam ‘Beyonce’ Lowe (NB/femme/genderfluid writer, publisher, performer; Manchester)
Simone Conneff (musician, Manchester)
Ruth Pierce (punk musician and social researcher, Warwick)
Raf Young
Keira James (artist and author, Sheffield)
Shannan Gates (artist, author, actor)
Sam Turner (artist, Manchester)
Aimee Challenor (photographer, Chair of LGBTQ Young Greens)
Jesse Sandilands (Brighton)
Laura Allmann (writer, Manchester)
Nathan Gale (non-binary poet and musician, Edinburgh)
Lorelei Price (musician, Manchester)
Aidan C. (actor and musician)
Payton Quinn (Comedian and Writer, Cardiff)
Cheryl Morgan (writer, Trowbridge)
Kamalanandi Lyus (B.A (hons) Fine Art, Furniture Maker, Sheffield)
Stephanie McAlea (Cartographer, Chester)
Olivia Sparrow (artist, Manchester)
Lucy Attackbot Licious (musician, comedian, artist and writer, Glasgow)
ティン・ルーフ / Tin Roof
MJ Eckhouse (writer and musician)
Jessi Lloyd (photographer, Gateshead)
Liz Cooper (actress and performing artist, New Jersey)
Benjamin Marriott (musician and artist, Cardiff)
Jasper Murphy (cartoonist, other: East London)
Christopher Jane Muetz (Genderfluid Dancer and Performance Artist, Kansas USA)
Nila Kamol Krishnan Gupta (artist, independent scholar,advocate, community worker; London)

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Throughout the year, we raise money to help trans people who for whatever reason cannot access healthcare through the NHS in a reasonable amount of time. We know that the trans healthcare system is pretty broken, and that the people who need support will usually outweigh our ability to fundraise. Because of this, we use an application process to work out who faces the most barriers to getting healthcare through the regular ways.

The April 2016 Action for Trans Health solidarity fund which is open to applications from people living in the UK who are from African, Caribbean, Asian and Arab descent, including people of mixed raced backgrounds and other racialised people. We particularly welcome applications from black people, and people of colour living in Scotland, Wales, and Northern Ireland. The deadline for applications is 5pm on the 22nd April 2016.

Any money raised in membership dues or via donations between now and the application deadline will go straight into the fund. Please consider donating here:

Help us to provide access to essential healthcare today.

Action for Trans Health takes a broad view of health. We know there are a wide number of things that can effect your healthcare, and so we don’t have any rules about what the money can be used for. We do ask that if the money is being used to access medication which will be needed long-term, that the applicant has thought about how to secure the long-term supply after the grant money has been spent.

Once completed forms have been sent to us, a member of Action for Trans Health’s staff will anonymise the form by removing any information that could be identifying. Then this will be passed onto our funding panel who will decide where the funds go. We will contact you to let you know whether you have been given any money within two weeks of the funding panel meeting. If you have any questions, please email us info[at]actionfortranshealth.org.uk

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Without the advocate labour carried out by service users and their accomplices, the current crisis in trans healthcare would be far deeper, Amy Cohn writes

”Wages for Advocacy” is the acknowledgement that our labour is just as – if not more – important than the formal labour of administrators and clinicians to the provision of trans healthcare. Those systems necessitate and demand our labour, and it is those systems – not service users – that should bear the cost of it.

The caring component – that is the overwhelming part – of trans healthcare is almost exclusively underpinned by our networks and peer groups. In calling for Wages for Advocacy we recognise – and wholeheartedly echo – longstanding demands that caring labour be remunerated.

The Economics

Before you reach for your copy of Kapital, let’s clarify. A demand for wages isn’t a demand to subsume all informal labour into the wage relation – much as we might welcome its subsequent inevitable collapse. Rather, it’s an acknowledgement that we can’t eat, sleep upon, or clothe ourselves in the moral highground.

That is to say: fuck you, pay me.

If your departmental budget doesn’t have a line item for voluntary hours worked, your figures are a fantasy. If your patient pathway lacks boxes and arrows for mutual-aid, it’s pure fiction.

A demand for wages makes the value of our work legible in a form that can be understood by people whose lives don’t depend on it: cash.

And if not even a single penny changes hands, accounting for how many trans hours go into undoing the mistakes of paid staff should at least hint at where things are going wrong.

The Contradictions

Professionalisation

As the NHS concedes the importance of what it calls “voluntary sector organisations” (i.e. vehicles for advocate labour, or disingenuous imitations thereof), there’s an increasing drive to standardise and professionalise advocate labour. Resist it.

(The topic of how is another discussion entirely. But we can)

If professional choreography were going to fix the crisis, there would never have been a crisis. It’s precisely our independence from that professionalism that allows us to disrupt its operation for the better.

Advocate labour should be accountable to the people it serves. Professional regulation, by contrast, is accountability to power. Ideally those would be one and the same thing, but in such a circumstance “professionalism” (the elevation of a distinct class with unique command over the Right Way of Doing Things) would lose all meaning.

(Wages for Digression? Please)

Wages in Perpetuity

So how does power hold labour accountable? Wages! Which leaves us with a bit of a problem. While our labour is sometimes optional on an indvidual level, someone has to do it. And continuing to do it for free is crap.

But money changing hands changes the relationship between people. If one of us is getting paid for advocacy, it’s in our interest to keep getting paid. There are two main ways we do that:

1. Avoiding any action that might incline someone to sack us.
2. Avoiding entirely solving the problem so that there’s always more of the problem available to pay us for solving.

How we reconcile those points with the demand for wages is an open question – but that’s our problem to solve, and shouldn’t deter us from making the demand.

Who Blinks First?

There’s an elephant in the room whenever we discuss advocate labour – and the systems that necessitate it – with administrators and clinicians. Our lives, and the lives of our communities depend on us being in that room. Theirs don’t.

To add insult to injury, it’s they who decide who speaks, and they who are remunerated for their time.

We will never stop advocating and caring for our peers. We will continue to perform advocate labour for free for some who need it.

(The assumption that everyone who needs advocate support can or does access it is a dangerous one. It’s not accessible and we severely lack the capacity to provide it)

So how do we maintain a demand for Wages for Advocacy on that basis? They know we can’t strike, as such. Developing alternate tactics is vital in securing that demand.

The PreConditions

So what needs to be in place for our labour to be recognised? First and foremost, we ourselves must recognise and value it as such. Our advocacy is skilled, it is valuable, and it is necessary.

The confidence in that belief must be the starting point for all interactions with the systems that necessitate our labour. We are not equal partners with formal staff. (Under patient-worker control things might of course be different…)

Those of us who have secured material support for our labour – be that as wages, access to premises, whatever – need to share that knowledge. Every advocate should know (or have unmediated access to knowledge of) how to navigate these systems, from asserting the value of their labour through to filing a tax return.

Of course individual demands remain individual. Winning recognition and remuneration is a collective fight. Some of us can’t afford to give our labour freely. Some of us can. The latter must never be used as an excuse – and must never let themselves be used as an excuse. We need a collective position of negotiation, and collective red lines.

Next Steps…

This isn’t a concrete set of answers as to how, why, and in what form we should secure Wages for Advocacy, but it hopefully provides a basis for considering those questions.

Develop these ideas, rubbish them, reformulate them. You might decide not to demand wages from the systems you pay your labour into. But that should be a conscious decision – and you should support those who do.

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Transgender people face alarmingly high rates of sexual violence yet most trans victims cannot access any kind of support services in the aftermath. This post by Pazuzu Gaylord aims to outline areas where sexual violence survivor services are failing trans people and ways in which we can work to improve them.

1: Training and Advocacy

Groundbreaking research into the provision of survivor services for trans people conducted by the Survivors Network revealed that nearly all of the trans survivors who were surveyed were afraid of transphobic discrimination from the staff who were supposed to be helping them.

Action for Trans Health offer training to healthcare professionals on making services trans inclusive which could be adapted for working with survivor services. We are currently developing an advocacy service to offer individual support to trans people accessing healthcare services which will also be useful.

2: Media and Resources

Currently, most promotional media and resources produced by survivor support organisations discriminate against trans people both explicitly in the ways that they gender people’s anatomies and implicitly in how information is given and withheld based on these assumptions.

There are some examples of good trans inclusive literature, such as the LGBT Foundation’s leaflet for trans survivors of sexual violence, these can be used as a template for improving other resources. The lessons taken from trans specific literature need to be integrated into all resources, including female and male specific ones. Trans specific leaflets should be made widely, openly available without survivors having to personally ask for them.

3: Creating Specialist Trans Services

There is a desperate need for trans specific survivor services, both to deal with the total absence of services available to non-binary survivors and to provide a space for other trans survivors who are uncomfortable with using single-gender services.

4: Publicity and Locality

Where trans inclusive services exist their profile needs to be raised so that they may reach the people who need them. Action for Trans Health are working on a list of trans inclusive rape and sexual assault crisis centres, you can help us with our research here.

More outreach from survivor support organisations to trans communities is needed, forming links with organisations and individuals who are already well established in trans communities can help to build trust in services. Producing explicitly trans inclusive media and resources is another part of this.

Ideally services should be locally available but given the current rarity of trans inclusive services travel bursaries could be a small immediate way of improving access.

5: Wider Tackling of Transphobia and Rape Culture

Trans people learn to fear using public services through repeated direct experiences of discrimination from public and private sector organisations. These experiences are widespread across all kinds of services. Societal stigma towards victims of sexual violence also contributes to feelings of shame which dissuade survivors from talking about their experiences and seeking support.

Attitudes which blame trans survivors for the violence we suffer must be confronted wherever they occur and knowledge on consent and trans issues needs to be actively promoted. This education is vital not only to make survivors feel more able to access services but to reduce the prolific violence which makes survivor services necessary in the first place.

Members of Action for Trans Health are currently working with Project Salvage on research into gendered harm in activist communities and a series of workshops on how to better identify and address these problems.

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Today the Women and Equalities Select Committee released its report on its recent inquiry into transgender equality. The Inquiry heard written and oral evidence from trans individuals and organisations, including from Action for Trans Health, on various areas of life which affects trans people. Their report can be found here. Overall, we were pleasantly surprised by some of the recommendations made in the report, but feel that there are significant areas for improvement. This is our response.

[For a media contact please get in touch at jess(at)actionfortranshealth.org.uk]

Summary

Healthcare: Significant work needs to be done to engage trans people in decision making around healthcare issues beyond tightly managed consultations; education needs to be embedded in healthcare curricula and not just in continuing professional development; considerable attention needs to be placed on waiting lists and improving capacity in GICs; we are disappointed the Inquiry dismissed calls for the informed consent model be adopted

Child and Adolescent Services: We support the Inquiry’s call for shorter assessment times so hormone blockers and HRT can be provided earlier; we also discuss the problems of the Tavistock clinic having an effective monopoly on child and adolescent care.

Gender Recognition Act and Administration: we believe that the de-gendering of various forms of identification is necessary; we support the de-gendering of marriage is a neater solution to the problem of the spousal veto than two separate marriage systems.

Equality Act: We are disappointed to hear that single gender services (ie. survivors services) are to continue to be exempt from the Equality Act, this will have a disproportionate impact on the most vulnerable members of our community

Hate Crime: We are unconvinced that hate crime legislation is an appropriate tool for combating transphobia due its poor record as a deterrent and low engagement from the trans community. We believe a focus on education, awareness and combating medical neglect is more appropriate a response to transphobia.

Prisons: We welcome recommendations that policies on the management of trans prisoners be less reliant on legal definitions of gender. We believe that these policies should explicitly address the management of non-binary prisoners. We are disappointed to note the lack of discussion around trans people incarcerated in immigration detention centres. We also discuss reparative alternatives to punitive justice.

General NHS Services

We welcome the acknowledgement by the Inquiry that current practice within the NHS represents a failure to provide trans people with safe and accessible healthcare under the Equality Act (2010). It is clear that the Inquiry recognises that there is a lot of work to be done to improve NHS services in this regard.

Whilst it is right to commend NHS England’s creation of a Transgender and Nonbinary Network of consultees, the consultations themselves lead a lot to be desired. These meetings are tightly managed by NHS staff, provide little space for trans organisations to speak (nevermind being listened to) and are not very representative of the wide diversity of the trans community itself. The trans healthcare system needs to be delivered as a partnership between the trans community and medical practitioners, not solely by NHS administrators who occasionally deign to placate the trans community with a carefully managed consultation.

We welcome the recommendation for a systematic review covering transphobia in NHS services and contractors, and that the Inquiry have linked this to a lack of education on trans issues and a lack of knowledge around treatment pathways. We believe that any education efforts should go beyond Continuing Professional Development (CPD) short-courses for doctors, but should be embedded in the curriculum in all healthcare courses across the country. All NHS staff, including doctors, nurses, healthcare assistants and administrators, need to demonstrate a degree of cultural competency around trans issues.

We are happy to hear that the Inquiry calls on the General Medical Council to take complaints around transphobia in healthcare seriously. We would note in that our experience, the medical neglect of trans people is so common within the NHS that many trans people do not feel it is ‘worth it’ to complain as it is perceived to have very little impact on a system which is institutionally transphobic. We believe significant efforts to improve NHS services, through greater funding of Gender Identity Services and through education, is necessary before the trans community feels engaged enough that even the complaints procedures feel accessible to them.

Gender Identity Clinics (Adults)

We welcome the Inquiry’s recommendation to consider removing Gender Identity Services from the realm of mental health towards a different specialism (such as endocrinology) or establishing gender identity services as a specialism in and of itself. Like the Inquiry, we view this shift as potentially depathologising.

We also are glad that the Inquiry recognises the inconsistency and inaccessibility produced by gatekeeping in all areas of transition related healthcare, including with GPs, Gender Identity Clinics (GICs) and in Real Life Experience. However, we are saddened to hear that the Inquiry does not recognise the clear benefits of adopting an Informed Consent model of trans healthcare treatment which we feel would address many of the concerns witnesses had around gatekeeping and inconsistent diagnostic protocols, particular those faced by nonbinary people.

We feel that the Inquiry may misunderstand some key features of the Informed Consent model, which is used in many US-based clinics. The Inquiry seems to imply that the Informed Consent model is simply about giving surgical interventions on demand without any diagnostic evaluation. Instead, Informed Consent is based upon a genuine partnership between healthcare practitioner and patient, based around an understand of trans as an identity rather than a pathology. Further, the Inquiry seems to be under the belief that the Informed Consent model is inconsistent with the WPATH Standards of Care, which is arguably not the case. If the Inquiry wishes to see trans people have “full involvement” in their healthcare and “full personal autonomy in gender identity and presentation”, as they say in the report, then a move towards an Informed Consent model of healthcare is a necessity.

We note that the Inquiry recommends a consistent application and interpretation of guidelines between different GICs and different practitioners. It is true that inconsistent treatment between GICs, clinicians, and even between individual clinicians depending on the day of the week, is a source of confusion and anxiety for many trans people. Where guidelines are to be applied consistently, it needs to be ensured that these are interpreted in a manner which is empowering to all trans patients, including those that identify as nonbinary.

We also note that the Inquiry recommends that the requirement for Real Life Experience shift from being about conforming to potentially outdated gender norms, and more about preparing the patient for the mental, physical and social consequences of surgery. We believe this is a positive step in the right direction, but that in order to do this justice a significant investment needs to be made in mental health support for those trans patients who need it. These mental health services need to be non-pathologising.

We are glad that the Inquiry shares our concerns around waiting times for treatment and the capacity in GICs. Demand is rising 20-30% per annum and there are no clear plan to recruit the gender specialists that are needed. Waiting times already unacceptably and illegally long. We are sitting on crisis in trans healthcare. Significant financial investment is needed to meet the increasing demand. Further, recruitment and training of new specialists should happen as a matter of urgency. This should be augmented with further education work in medical schools so more young doctors are aware that specialising in trans healthcare is a career option. In the meantime, the recruitment of additional administration staff to improve the poor quality of administration and communications (alongside a review of how admin is processed) is necessary.

Children and Adolescent Trans Healthcare

We are happy to see that the Inquiry recommends a review of the Tavistock’s services with a mind to reducing the time of assessment so that hormone blockers and HRT can be provided earlier. This is an area where it has been clearly proven that failing to provide hormone blockers can cause significant harm, and compared to similar services in different countries, the UK Tavistock service is actually far behind. As the Tavistock has an effective monopoly on treatment for young trans people in the UK, this raises the issue, which we note the Inquiry has not addressed, of young UK based trans people having fewer choices of how and where to access their treatment.

Gender Recognition Act and Administration

We welcome the move away from gender recognition based on submitting medical and legal data to a panel and towards self-definition, as recommended in the report, which would see legal gender recognition move to an administrative process centred on the wishes of the individual applicant. We are glad to see the recommendation to create a legal category for nonbinary people in order to allow freer self-identification and welcome this development. However, we feel that this should be a step towards the systematic degendering birth certificates altogether. In their current form, birth certificates assign a gender to infants before they can speak, when they are unable to self-define. Degendering would be a move towards the depathologisation and destigmatisation of trans identities. The degendering of birth certificates would also be in line with recommendations from intersex rights groups, such as Intersex UK.

Degendering of birth certificates would also support young trans people who would not be benefitted by the current recommendations from this report. While the decision to reduce the age of legal gender recognition from 18 to 16 with parental permission will benefit young trans people with supportive parents, it will put in place additional barriers for children with unsupportive parents. Unfortunately, for many young trans people, parents and family members can be unsupportive and can often be sources of abuse. We believe legislation intended to support young trans people must recognise this fact. Action for Trans Health supports gender self-determination for all trans people, regardless of age, and encourages the development of legislation to allow this.

Recommendations to review the spousal veto and its harmful effects on trans people are very welcome, as are recommendations to address the problem of trans people who are victimised by spouses with malicious intent, especially given the high rates of domestic violence experienced by trans people. However we feel that the argument for the spousal veto rests on a distinction between same sex and different sex marriages and that a neater and all round better solution would be the degendering of marriage contracts. This would allow people the freedom to divorce or annul their marriage at any time but would enable trans people to have full autonomy over their identities, rather than that control being in the hands of their spouse.

We are concerned but unsurprised to hear that there have been no prosecutions under Section 22 of the Gender Recognition Act, which is intended to protect trans people’s right to privacy by preventing trans people from having their trans status unlawfully disclosed. We believe that a review of this Section is an unconvincing solution to transphobic discrimination, especially given the evidence concerning repeated instances of unlawful disclosure during court proceedings. We believe that the degendering of birth certificates and the enabling of gender self-determination regardless of age would be more effective strategies to combat transphobic discrimination on a larger scale.

Equality Act

We support the recommendation to change the wording of the protected characteristic from ‘gender reassignment’ to ‘gender identity’ in order to ensure that all trans people are clearly protected by this piece of legislation. However, while we believe that expanding the scope of this Act to cover all trans people is good in theory, given how ineffective its application often is across those protected characteristics already covered, we have concerns that it will ultimately prove confusing and difficult to apply.

We were disappointed to hear recommendations that single gender services would continue to be exempt from discrimination clauses. The suggestion of only removing exemption when the individual possesses a Gender Recognition Certificate (GRC) clearly does not go far enough, especially considering the criticisms of how GRCs function which have already been outlined in this inquiry.

It is worrying that the inquiry refers specifically to areas where vulnerable trans people are already struggling to access services, such as rape crisis centres, and sees fit to continue these exclusions. Research conducted by the Survivors Network revealed that a large majority of trans people fail to access any kind of support services following sexual violence, with most citing fears of transphobic discrimination as a reason they felt uncomfortable trying to access single gender services. Allowing discrimination against trans people in the case of single gender services legitimises the oppression of trans people and encourages transphobia amongst staff and service users.

Excluding people from work on the basis of trans status is a problem when trans people already face high rates of unemployment and trans staff could better support trans service users. Research suggests that funding is needed for the creation of trans specific services for survivors of sexual violence, which would also be inclusive of non-binary people, but this needs to be done in conjunction with and not as an alternative to making existing services inclusive of trans women in the case of women’s services and trans men in the case of men’s services. Widespread education is needed to make staff aware of the unique challenges which trans survivors face.

Hate Crime

The Trans Inquiry recommends that existing hate crime legislation be extended to bring trans in line with other protected characteristics by classifying aggravated offences and stirring up hatred against trans people as hate crimes. Whilst hate crime legislation exists, it is clear that trans people should have legal parity with other protected characteristics. We would like to see clarification as to whether Trans Exclusionary Radical Feminists (TERFs) would be able to be prosecuted for “stirring up hatred” under the new proposals. However, given low rates of prosecution for “stirring up hatred” on racial and religious grounds, we wonder whether if TERF hate-speech qualified as “stirring up hatred” it would be acted upon by the state with any degree of consistency or regularity.

However, we are concerned that the sole focus on hate crime legislation to deal with issues of transphobic violence individualises social problems of transphobia and may have some negative consequences. Hate crime legislation has not been proven to have a deterrent effect on violence borne from prejudice. Rather, hate crime legislation seeks to punish the individual perpetrator for their bias and in doing so increases the number of people in contact with the criminal justice system – mostly this will be individuals from other marginalised groups who are more unlikely to be able to afford good legal representation. Moreover, we are concerned to learn that hate crime legislation will be linked to ‘tackling extremism’, especially when the government’s flagship anti-extremism programme Prevent has been largely criticised for racial profiling and islamophobia. When marginalised groups are disproportionately negatively impacted by hate crime legislation, it is unclear how these tools are useful in bringing about a more equal society.

The reality of the situation is that most trans people do not have the ability to seek legal recourse after a hate crime incident. This is due to a number of barriers some of which are discussed in the report, including but not limited to; unwillingness to be ‘outed’, lack of energy to pursue legal recourse over incidents due to their frequency, lack of willingness to deal with the police, and lack of access to legal support (including the issue of potentially paying court fees, etc.). The inquiry recommendations encourage third party reporting to increase the number of trans related hate crime reports. However, as hate crime legislation actually gives very little in terms of protecting trans people due to it being an ineffective deterrent, it is unsurprising that trans people often do not engage with it, and will probably not do so even if the barriers above are solved. Rather, we feel that the government would do better to focus on the causes of transphobic violence through methods such as education, income equality and the reduction of medical neglect.

Recording Names and Gender Identities

We support the Inquiry’s recommendation to introduce clear and appropriate policies regarding the recording of individuals’ names and genders across public services. However, we are concerned that little guidance is given as to how this might be achieved. With widespread misinformation about the existence of ‘legal names’ in the UK, as is referenced in the report, and many trans people’s’ information currently being stored in ways that directly contravene the Data Protection Act (1998), it is difficult to see how these policies would be implemented and maintained.

We are in support of the recommendation to remove the requirement for a doctor to produce a letter enabling a trans person to apply for a passport that accurately reflects their gender and the recommendation to introduce a category on passports to include nonbinary people, such as the X category in Australia. The move towards degendering of documentation, such as passports and driving licenses, may seem an important one in ending transphobic discrimination. However, we question the necessity and impact of nationalist documents such as passports that are used to reinforce the category of citizenship and therefore cause direct harm to trans migrants and refugees. We express these concerns especially given the absence of any recommendations to support trans migrants and refugees within the Inquiry’s response.

We agree that the recording of gender should be for equalities monitoring purposes and not for identification purposes, where the recording of gender is used to uphold cissexist standards of gender. Overall, we support smarter and more comprehensive equalities monitoring that monitors gender, trans status and sexual orientation in a way that enables self-determination.

Prison and Probation

In light of the recent deaths of two trans women held in male prisons, and the high profile case of Tara Hudson hitting the media, we are glad that trans people incarcerated in prisons and in probation were discussed in the report. We note that the report acknowledges the large gap between the current guidelines for the management of trans prisoners and the reality that many trans prisoners face due to inconsistency, prejudice and bias of prison institutions. We welcome recommendations that guidelines for the management of trans prisoners be made more flexible and less reliant on legal definitions of gender, and further we support the Bent Bars Collective’s submission which recommends that any guidelines should cover the management of prisoners who identify as non-binary. We would also like to see prisons being ‘opened up’ to researchers and trans organisations so that the status of trans prisoners can be assessed more accurately.

However, we were disappointed to learn that despite evidence being presented to the inquiry about trans people incarcerated in immigration detention (by us and the UK Lesbian and Gay Immigration Group), the report did not explicitly mention immigration or issues facing trans people incarcerated in detention centres. This is a significant oversight which should be addressed immediately.

Further, we feel that any discussion of prison policy would be amiss not to discuss the very low effectiveness of the prison system in terms of reducing recidivism rates, whilst operating at high expense to the public purse. Prison is an inherently harsh environment which is not conducive to reparative forms of justice, nor is it an effective deterrent to crime. The current government has announced plans to build a £250m “mega-prison” in Wrexham, which is likely to be run by a private company. This expansion of the prison system will undoubtedly result in an expansion of the prison population as the prison estate’s capacity is increased. It is expected that this will lead to an increase in trans and gender-nonconforming people being incarcerated. In a backdrop of austerity, is likely that living conditions in prisons are likely to decrease over this period. We recommend that the government explore alternatives to the ineffective and punitive prison system which emphasise more reparative forms of justice.

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Action for Trans Health are teaming up with Sheffield IWW to hold a training day in Sheffield.

Jess Bradley from Action for Trans Health will be visiting Sheffield to deliver training for trans activists. Join us in learning about:
– Campaigns planning and training
– Setting up a group
– Training people how to give trans-friendly sexual health training to health professionals

Keira James of IWW Sheffield (UK) Branch will be talking about trans solidarity and the successful campaign against transphobic discrimination from her employers.

This event is open to all. Respectful cis people are welcome but please be aware that this is not a trans 101. If you are cis and want to come, we will be sending you homework beforehand. Please note this on your booking form.

Booking:
Places are limited so please book online here: https://docs.google.com/forms/d/111BiCNOIxjiMVN3jIuzp33Dy_EL7zU2C2YJNu3ec54g/viewform?usp=send_form

There is a travel fund available if you can’t afford to get here (this fund will prioritise trans people of colour). Get in touch at info@actionfortranshealth.org.uk

Access information: the conference room at SYAC is on the first floor, accessible via the lift, there are accessible toilets on the same floor. A quiet space will be provided on the day. If you have any additional access needs please mention this on the booking form and we will do our best to meet them.

Training is free to attend. Donations towards the Action for Trans Health solidarity fund are welcomed. The solidarity fund is used to help UK based trans and intersex people access healthcare, with priority given to those who are facing greater barriers than most.

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We know that the workplace conditions of healthcare professionals make up patients healthcare conditions. The new junior doctor contract represents a 30% real term pay cut to doctors salary. More than that though, it puts patients lives at risk by putting overworked and overtired doctors in charge our lives.

[The BMA / junior doctors strikes have been postponed til the end of the negotiation period as the government have come back to negotiation table. This represents a short term win for the doctors. Dont go to the picket lines tomorrow! Keep tuned in because strikes are still likely to happen if the govt doesnt offer significant changes to the contract.]

Junior doctors make up 65,000 members of NHS staff. They have overwhelmingly voted to go on strike, and have put in place mechanisms to strike in such a way that patients will not be put at risk. Action for Trans Health support the junior doctors strikes and are encouraging trans and queer people to support the strikes by attending picket lines, demonstrations, writing to your MP, and raising awareness on social media. Joining picket lines are an excellent way of building solidarity and coalition building between trans service users and healthcare professionals.

We are looking to create a list of picket lines where Action for Trans Health or other trans / queer organisations are joining the picket line in solidarity with junior doctors. If you are trans / queer and interested in popping down to your local picket on either the 1st, 8th, or 16th of December and want to be listed here, or have any further questions, get in touch info[at]actionfortranshealth.org.uk

Manchester: Manchester Action for Trans Health are joining pickets at the Manchester Royal Infirmary, 8.30am on the 1st December, potentially might join actions on the 8th and 16th too (to be confirmed).

Leeds: Leeds Action for Trans Health are planning on supporting picket lines (exact details to be confirmed).

Sheffield: Queer Agenda Sheffield are meeting at the Royal Hallamshire Hospital at 8am on the 1st December. Potentially future actions in the junior doctors on the other days (to be confirmed).

Liverpool: Liverpool Action for Trans Health are going to be joining the picket line on the 8th December (which picket to be confirmed).

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Join us to remember those we have lost from transphobic violence, discrimination and harassment. Organised by trans people, for trans people (although respectful cis allies are welcome).

Please bring candles with jam jars to hold them in, and flowers if you can afford them. We will be collecting donations to cover the cost of putting on the event, if we take in more money than it cost to put on the excess with be donated to a trans charity.

The venue:
Nexus Art Cafe, 3 Dale Street just off Oldham Street in the Northern Quarter.

Access:
The venue is wheelchair accessible through the Methodist Chapel on Oldham Street. The Dale Street entrance involves a flight of stairs.

Food / Drink:
There will be cakes and coffees / teas on sale at the venue. There is usually some form of gluten free and vegan cakes on sale. The venue is alcohol free.

Toilets:
The venue has flat access gendered toilets that are accessible with a code. The code numbers will be stuck on the doors so people do not have to ask venue staff for the code.

Facebook event here

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Our solidarity fund is now open for applications. The deadline for applications is the 15th November 2015.

Who can apply?
We are offering small grants for to help UK based trans and intersex people access healthcare. Any trans, nonbinary, intersex or otherwise gender nonconforming person based in the UK can apply. We have a specific fund ringfenced for grants to black trans people and are particularly keen to receive applications from trans people of colour.

What can you apply for?
We take a very broad definition of healthcare, and in the past have paid for appointments with doctors, therapy sessions, stipends to support people undergoing surgery, binders / packers / breast forms, clothes etc. We only ask that if the money is being used to access medication which will be needed long-term, that the applicant has thought about how to secure the long-term supply after the grant money has been spent. Its a small fund and we are unlikely to give a grant of over £500 to one individual.

How can I donate to fund?
100% of our donations and membership dues received through the website currently go into our solidarity fund. You can donate to the solidarity fund using the paypal button below, or become a member of Action for Trans Health here.

Help us to provide access to essential healthcare today.

How do I apply?
The application process is pretty simple. Fill in this short form, giving as much details about your situation as you can. After we have received your application, our administrator will anonymise it and pass it on to our funding panel who decide how to allocate the funds. If you have any questions, please get in touch at info[at]actionfortranshealth[dot]org[dot]uk