Jersey gender service within HCS (FOI)

​Request

I have been informed that there is a Jersey gender service within HCS.

The following questions relate to this gender service, as well as policy on the provision of gender services to Jersey residents:

1. Where is the Jersey gender clinic located?

a) If within the hospital, within which department?

b) If outside the hospital, at what clinic?

2. What is the annual budget for the Jersey gender clinic for this calendar year?

3. What has been the annual expenditure of the gender clinic since its establishment?

4. Are any gender services, including gender affirming therapy, gender assessments, cross-sex hormones, being offered in Jersey outside of the gender clinic funded by the Jersey government?

5. What is the minimum age for referral to the Jersey gender clinic?

6. What services does the Jersey gender clinic provide?

7. If the gender clinic provides therapy:

a) Who provides the therapy?

b) Is the therapy provision within the clinic and/or outside the clinic?

c) What is the therapist(s) training and credentials in respect of providing this type of therapy?

d) What is the minimum age for receiving therapy at the Jersey gender clinic?

e) If the Jersey gender clinic does not provide therapy to minors (under 18), which clinic or service are under 18s referred to?

8. If the gender clinic provides medication/prescriptions, is it for:

a) Puberty blockers? 

b) Cross-sex hormones? 

c) Other?

9. Who is allowed to write initial prescriptions for puberty blockers and/or cross-sex hormones?

10. Can GPs prescribe puberty blockers and/or cross-sex hormones in the first instance without referral from the gender clinic?

11. Who can renew these prescriptions?

12. Can GPs provide repeat prescribe puberty blockers and/or cross-sex hormones once the initial prescription?

13 .What type and frequency of monitoring is done with regard the effects of puberty blockers and cross-sex hormones?

14. Is any masculinisation or feminisation surgery taking place in Jersey? This includes, but is not limited to double mastectomy (“top surgery”), genital surgery (“bottom surgery”), facial and other feminisation or masculinisation surgeries?

If yes to question 14):

15. who is conducting these surgeries in Jersey and on whose approval or authorisation?

If no to point 15):

16. where are individuals in Jersey referred to for these surgeries?

17. Which adult gender clinic in the UK is working with the Jersey gender clinic?

18. What is the referral process for referring patients to the adult gender clinic in the UK?

19. Are minors (under 18s) from Jersey referred to gender clinics in the UK?

If yes to question 19):

20. Which clinic(s)?

​21. What is the referral process for referring minors to gender clinic in the UK?

Response

1

The gender service comprises a mental health component, a speech and language component, and an endocrinology component. These are generally delivered at Health and Community Services’ (HCS’) Enid Quenault site.

2

Costs are £20,940 per annum.

3

Annual costs have been consistent since the service commenced.

4

No.

5

Patients are only seen in HCS’ clinic at aged 18 years and over.

6

The service provides clinical assessment and diagnosis, individual support, prescribing where clinically indicated, and speech and language therapy support with voice. The service links with the NHS Gender Clinic at the Tavistock and Portman, and makes joint referral for surgery when indicated.

7

The clinic does not provide formal therapy. 

Anyone under 18 years of age would be referred to a specialist service within the U.K. This previously would have been at the Tavistock and Portman; no referrals have been made since the changes occurred in the U.K. services.

8

The service provides puberty blockers and cross-sex hormones, both only for adults aged 18 years and over.

9

Initial prescribing is only done by the specialist (endocrinology) doctors within the service.

10

No.

11

General Practitioners (GPs) can write repeat prescriptions, but these are reviewed / changed within the Endocrinology clinic.

12

Cross-sex hormones are currently repeat prescribed by GPs; puberty blockers tend to be done by the Endocrinology service.

13

6-monthly review and blood tests are undertaken within the Endocrinology clinic.

14

No. patients are referred to the U.K. for surgery.

15

Not applicable.

16

Patients are referred to private specialist provision within England for surgical assessment and surgery, once the correct assessment pathway has been completed.

17

The Tavistock and Portman clinic.

18

The psychiatrist within the Jersey service will refer to the U.K. clinic. They also have regular supervision and discussions with a consultant psychiatrist from the U.K. service, and cases will be discussed there. At times, a joint assessment will be undertaken.

19

Young people under the age of 18 would be referred to a specialist service within the U.K. Previously this would have been to the Tavistock and Portman’s Gender Identity Development Service (GIDS). Since that service has closed there have been no referrals.

21

This would be done through Child and Adolescent Mental Health Services (CAMHS).​