NHS not transgender-friendly enough, says nurse
The NHS is failing to meet the needs of transgender adults and children, says a nurse who has first-hand experience both working in a hospital and as a transgender patient.
Kirsty Cass, 53, works at a private hospital in southern England. But in 2012, she was an NHS patient having gender reassignment surgery.
When she woke up from her operation, she remembers a member of staff on the ward referring to her as "he".
She says: "It was so demoralising."
Kirsty tells BBC News: "I'm female. Another patient in the same ward who had had the same operation as me told me she had been referred to as 'mate' by one of the porters.
"It's not what you need."
A few years later, Kirsty had to go into another NHS hospital, to have a biopsy to check for possible cancer.
The test thankfully proved to be negative, but her stay on the ward was, again, very stressful.
"I got wheeled back on to a male ward," she says.
"The duty sister sitting at the desk looked at me and then asked, 'Why have you brought a female into this ward?'
"I was horrified. I felt so humiliated. I was reduced to tears."
The professional union the Royal College of Nursing says transgender patients regularly face prejudice and a lack of understanding.
It surveyed 1,200 nursing staff and found few felt they were trained enough in this area.
Three-quarters (76%) said that more training for all health-care staff was needed to improve care and understanding.
One nurse said: "I have cared for one girl who wanted to be a boy and no-one on the ward knew what to do or say.
"So I took this opportunity to sit and talk to the patient, and they were so happy that someone had asked them what they like to be called and took the time to talk to them about it."
Gender is more complex than the traditional binary definitions of "man" and "woman".
It goes beyond simple anatomy and is about how a person identifies themself.
A person may look like a man, but feel like woman or vice versa. Some people self-identify as entirely genderless.
A mismatch between sex and gender can be distressing. And when it is, it is recognised as a medical condition - gender dysphoria.
Gender dysphoria is not linked to sexuality, and being transgender does not automatically make you gay.
Some people may want hormone treatment and surgery to change their physical appearance, but others may not.
A recent parliamentary report also criticised the way transgender people are cared for by the NHS.
The government said it would work to improve NHS staff training in this area.
The RCN has produced guidance called Fair Care for Trans Patients that sets out best practice.
It says patient preference should be taken into account when deciding which gender ward to assign them to.
And it acknowledges that psychological therapy should not be provided as a vehicle to change the trans person's mind about their gender, as well as offering the following tips:
- be positive and proactive in your approach to welcoming trans patients to your care
- always treat trans patients in a respectful way, as you would any other patient or client
- if you are unsure about a person's gender identity or need more clarity about how they would like to be addressed, then ask politely and discreetly
- avoid disclosing a patient's trans status to anyone who does not explicitly need to know
- discuss issues related to a patient's gender identity in private and with care and sensitivity