Service for Children and Young People with Gender Incongruence: Referral Pathway Consultation
Task
NHS England is the responsible commissioner for specialised services for individuals with gender dysphoria, and, as such, held a consultation to seek views on changes to the referral pathway into the Children and Young People’s (CYP) Gender Incongruence Service, how the national waiting list is managed, and how transfers are made from the waiting list into the service.
NHS England ran a consultation from 7th December 2023 to 6th March 2024 to hear from a wide range of patients, patient groups, and other stakeholders in the development of its commissioning of services in order to check whether proposals were right and supported, to ensure the public understand their impact, and to identify any alternatives before decisions are made.
NHS England commissioned TONIC to produce a summary of responses to the consultation.
Our Approach
A total of 233 responses to the consultation were received. 36% were clinicians, 21% were parents or family members, 15% were patients or former patients, and 6% were service providers. 21% stated they were in the “other” category of respondent types. 42 of these responses indicated they were submitted on behalf of an organisation.
TONIC analysts conducted a thematic analysis of this data using Braun and Clarke’s six step method. Each response was read, all views, ideas and suggestions were recorded, and the overarching themes were described. These themes were then summarised, explained and illustrated in a comprehensive report. Notably, before the analysis could begin, a data cleansing process was conducted to ensure all responses being analysed were relevant.
Outcome
TONIC produced a report conveying the key messages that arose from analysis of the consultation responses. The report utilised the language and terminology used by respondents in order to provide the most reliable summary of these responses. Therefore, it was important to highlight that the views expressed, and language used in the report, do not represent the views of TONIC nor NHS England, but are a faithful analysis of the response data.
Throughout the report, TONIC set out the overall results of the closed questions showing the percentage of respondents who agreed, disagreed or were neutral for each of the proposals. Alongside this, the report showed the top three themes from the analysis of the written responses.
For example, for Question 1, 59% disagreed with the proposal that referrals to the waiting list may only be made by general paediatric services or CYP mental health services, while 39% agreed and 3% were neutral.
Those who agreed raised the following themes:
Supporting the requirement for a specialist to make the referral
The necessity for a comprehensive assessment prior to referral
Safeguarding considered crucial via professional gatekeeping
Those who disagreed raised the following themes:
Increased waiting times and a burden to services
Concerns regarding barriers to care and gatekeeping
The necessity of direct referrals from GPs
Those who were neutral raised the following themes:
A lack of training and understanding for key professionals
Concerns about the resources and capacity in the system
Potential bias based on professional beliefs