FOI – 2024-000376 Gender Reassignment Surgery (HTML)

Date received – 06 November 2024 | Date responded – 04 December 2024

Request

To whom it may concern, please treat the following as an FOI request.

I am aware that in conjunction with NHS England National Services Scotland commissions the provision of male to female and female to male genital surgery and male to female specialist chest reconstructive surgery from providers within England.

As such, can you tell me: how many patients from Scotland have undergone male to female and female to male genital surgery and male to female specialist chest reconstructive surgery from providers within England in EACH of the last 10 financial years and so far this financial year? Please break the figures down to show any age bandings you can for the patients who underwent this surgery. Please also break the figures down to show how many surgeries in EACH year were male to female, and separately, female to male.

Please provide details as to the total amount given in funding EACH year for the surgeries detailed above.

In EACH of the last 10 financial years and so far this financial year, how many patients were under the age of 18 when they requested funding for gender reassignment surgery with a view to being assessed by the surgical service? Please provide figures for each year.

How many transgender people in Scotland have detransitioned in the past five financial years and how many are currently in the process of detransitioning?

Response

I refer to your freedom of information request that we received on 06 November 2024. We have now completed the search of our records and can provide you with the following information:

I am aware that in conjunction with NHS England National Services Scotland commissions the provision of male to female and female to male genital surgery and male to female specialist chest reconstructive surgery from providers within England. As such, can you tell me: how many patients from Scotland have undergone male to female and female to male genital surgery and male to female specialist chest reconstructive surgery from providers within England in EACH of the last 10 financial years and so far this financial year?

Please find attached Appendix 1 – Gender reassignment surgeries, detailing the number of patient requests for surgery in the last 10 financial years as per above request.

Please note the following caveats regarding the data:

• National Services Scotland (NSS), National Services Division (NSD) fund gender reassignment surgery under 3 broad categories; male-to-female lower genital surgery, female-to-male lower genital surgery and specialist chest reconstruction (masculinising chest only). NSD does not capture procedure specifics.
• NSS does not keep an end-to-end record of the patient’s journey and therefore we are unable to advise how many surgeries have taken place. We can provide data on the number of gender reassignment funding requests.
• The numbers do not include funding requests for revision/unscheduled aftercare.
• Territorial Health Boards may decide to directly refer to specialised/highly specialist services without seeking NSD risk share funding and are therefore responsible for these costs.
• NSD has no role in the authorisation of funding for planned state healthcare treatment in an EU country or Switzerland. This is funded via either the planned treatment scheme (S2 funding) route or the EU directive route (in place prior to 2021) which is managed by Territorial Health Boards in conjunction with the Department of Health.

Please break the figures down to show any age bandings you can for the patients who underwent this surgery. Please also break the figures down to show how many surgeries in EACH year were male to female, and separately, female to male.

Under Section 38(1)(b) of the Freedom of Information Scotland Act 2002 (FOISA), NHS NSS has withheld this information in line with Caldicott Principles due to patient numbers falling below 5, providing this information would risk making the data identifiable.

Please provide details as to the total amount given in funding EACH year for the surgeries detailed above.

Please find attached Appendix 2 – Gender reassignment total funding. These figures are the total costs of the gender surgical service provision, rather than the costs of surgeries. They include costs for the service set up and development, including staff training. Since 2020/21, the figures also include costs for Scotland’s contribution to the Gender Dysphoria National Referral Support Service (GDNRSS). GDNRSS has been established to process referrals and provide advice and support for all individuals from across the UK.

Please note the following caveats regarding the data:

• The numbers provided are reflective of the number of ‘approved’ NSD funding applications submitted by the 14 territorial NHS Boards in Scotland.  It does not indicate the number of actual patients as an individual may have more than one need or request.
• Although funding has been approved, the patient or their clinician may decide they no longer wish to or need to proceed with investigation or treatment and NSD does not keep an end-to-end record of the patient’s journey.
• The numbers do not include funding requests for revision/unscheduled aftercare.
• Territorial Health Boards may decide to directly refer to specialised/highly specialist services without seeking NSD risk share funding and are therefore responsible for these costs.
• NSD has no role in the authorisation of funding for planned state healthcare treatment in an EU country or Switzerland. This is funded via either the S2 funding route or the EU directive route (in place prior to 2021) which is managed by Territorial Health Boards in conjunction with the Department of Health.

In EACH of the last 10 financial years and so far this financial year, how many patients were under the age of 18 when they requested funding for gender reassignment surgery with a view to being assessed by the surgical service? Please provide figures for each year.

Please find attached Appendix 3 – Patient requests when under the age of 18, detailing how many funding requests have been received in each of the last 10 financial years.

Under Section 38(1)(b) of the Freedom of Information Scotland Act 2002 (FOISA), NSS has withheld some information where the details of patients fall below 5 to protect their identity in line with the Caldicott Principles.

Please note the following caveats regarding the data:

• Where patient numbers fall below 5, we have redacted these in line with Caldicott Principles.
• Age is reflective of age at the time funding applications have been received. It does not necessarily reflect age at the time of actual referral and/or surgery.
• Numbers do not include funding requests for revision/unscheduled aftercare.
• Territorial Health Boards may decide to directly refer to specialised/highly specialist services without seeking NSD risk share funding and are therefore responsible for these costs.
• NSD has no role in the authorisation of funding for planned state healthcare treatment in an EU country or Switzerland. This is funded via either the S2 funding route or the EU directive route (in place prior to 2021) which is managed by Territorial Health Boards in conjunction with the Department of Health.

How many transgender people in Scotland have detransitioned in the past five financial years and how many are currently in the process of detransitioning?

Under Section 17 of FOISA an organisation does not have to provide that information if it does not hold that information. NSS does not hold this level of information. NSS, NSD funding does not cover de-transition surgery. This would be the responsibility of the NHS Board of residence.

I trust you will find the information of assistance and if you require any further information, please do not hesitate to contact us.

If you are unhappy with any aspect of how we have dealt with your request, you can make representations to us asking us to review the handling of your request.

If you require any further information, please contact the Associate Director Governance and Board Services (Board Secretary) within 40 working days of the date of this correspondence.

Contact

Address

If after a review you are still unhappy, you also have the right to apply to the Scottish Information Commissioner, who can be contacted at Kinburn Castle, St Andrews, Fife, KY16 9DS, or via their application form.

National Services Scotland (NSS) is committed to publishing all information released in response to Freedom of Information requests. You can view all FOI responses within our FOI Publications repository.