(or why I won’t be responding to another government consultation on trans healthcare).

Just weeks after having submitted an invited response (invited as an academic expert) to a government consultation on making a legal ban on puberty blockers permanent, ANOTHER government consultation on trans healthcare has today been launched.

This one is on adult trans healthcare services. There are many reasons to approach this consultation with concern. The consultation itself provides a link to the incredibly biased and prejudice-ladden letter from Dr Cass which is a driver of this current review.

I cannot even remember how many government consultations related to trans rights or trans healthcare I have completed over the past 8 years. It is far far far beyond a joke.

And each public consultation takes the same form. The new NHS adults services consultation even provides a link to an analysis and summary of responses to the 2017 consultation. Reading the executive summary of that analysis is very telling and illustrative of the problem. In the 2017 consultation, responses were divided into three groupings:

• Current, former or prospective user of gender identity services (30.15% of respondents)
• Individual member of the public (26.8% of respondents)
• Clinician (16.75% of respondents)

The 2017 consultation responses summarises very succinctly the differences between these responses (worth reading on pages 2-6). In short, the current and former users of gender identity services provided detailed and meaningful suggestions on how services could be reformed and improved. Clinician respondents, who were, mostly GPs, broadly didn’t know what to do with trans people and didn’t want to have responsibility. Members of the public felt being trans was a mental disorder and wanted services to be made significantly worse for trans people. The consultation presented all of these contrasting views, with the views of actual trans people in one grouping (glossing over nuances in actual recommendations re different ways of improving trans health), while views that were ambivalent or fundamentally opposed to trans well-being and healthcare rights were given equal weighting to those of actual service users.

This pattern has then repeated time and time again since 2017.

This pattern will be repeated in this new NHS consultation. Although now the anti-trans lobby is much more organised and assertive, so I expect even more volume of anti-trans submission, including from transphobic clinicians and medical professionals, and including from those purporting to be prospective service users (or concerned family members of service users).

This pattern of public consultation for minoritized healthcare is extremely abusive.

Every consultation response is a huge amount of effort to do well. It is a significant extraction of labour from already exhausted trans people, including from those of us who are called to respond as trans-supportive researchers or on behalf of civil society.

It is abusive to ask us for consultation after consultation after consultation. Every single one we respond defensively, knowing that the purpose of the consultation is not to improve services and respect rights, but to justify an ever further roll back of those rights, and ever more severe degredation of those services.

It is abusive to ask trans folks to engage in yet another consultation where the views of those fundamentally bigoted about trans existence are given equal weight.

It is abusive full stop.

This particular consultation is where I personally draw a line. It is not acceptable.

I expect adults trans healthcare will be made worse in the coming years, building upon Cass. I expect this public consultation, including the thousands of responses from profoundly anti-trans individuals and lobby groups, will be used to justify that degregation of essential healthcare. To justify the inclusion of ever greater rights violations in our healthcare. To justify ever greater encroach into the reasons to deny care to those of us who are the wrong kind of trans.

Esteemed trans healthcare scholar Dr Ruth Pearce wrote all the way back in 2018 (about another consultation on trans health conducted about us yet without us), that “we respond not with hope or optimism, but in fear. This is the power you wield over us”.

Over the past years I have responded to more government consultations on trans topics than I can count. Every single submission I have written, not out of hope, but out of fear. Out of a feeling of responsibility to use my relative privilege to at least try and change the outcomes, to raise my voice to highlight the current injustices and the harms of abusive practice.

But we are clearly not being listened to. Time and time again we are not being listened to.

How long do we keep collaborating in the same pattern. How long do we keep gas-lighting ourselves?

Today I’m saying no.

I refuse to remain in any part of this extremely abusive relationship.

I refuse out of principle to engage in any way with a consultation that is equally interested in the views of non-service users, that does not have really basic ethical commitments to trans depathologisation, dignity and healthcare rights, that does not have trans leadership and trans power at its centre.

I refuse to respond defensively while having zero hope that my words and my time are going to change the outcome. In this case, as before, I fundamentally don’t believe my inputs will in any way change the outcome. Quite the opposite – I believe my words and my submission, alongside those of others submitted and hard-worked-on out of a feeling of responsibility to our communities, will provide the government/NHS with a veneer of respectability, that they asked and listened to all views.

Listening to all views is not good enough. I literally cannot stomach another consultation that will be written up as “here’s what trans people want, however here’s what doctors and members of the public want, so we are therefore going to make trans healthcare worse”. It is not good enough. I am out.

I’m not saying that stepping out of this consultation will be enough to change the outcome. I’m not saying there is a clear path to trans justice.

But I’m at least not going to waste my time on another heartless and fundamentally flawed process.

Today I will choose to do something better with my time.

I hope we can at some point be more coordinated and demanding, standing together in solidarity and power, saying we will not engage with processes that are fundamentally dehumanising and abusive. Most folks I know right now are too worn down by all the loses, by all the pain, by all the energy expended on heartless consultations, to have the energy and reserves to try and take back any power.

Maybe that is one of the ways forward. For now we take time, we rest, we refuse to respond defensively, we let go of the fleeting hope that our submission will be enough to change power structures that continue to inflict harm after harm.

We focus our time and energy on ways to keep ourselves and those who are suffering afloat through these tough times.

We state clearly and in unison that when the government and the NHS decide they believe in our humanity, when they have an ounce of care for justice and equality, when they recognise that anti-trans views are not welcome in consultations on our healthcare, then we have plenty of ideas to share on the meaningful reform of trans healthcare. But until that approach is made in good faith, and with trans people in positions of authority – we have better things to focus on. We focus on surviving the anti-trans hate that continues to grow in the UK, including in senior leadership in the government and NHS.

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