To say that the NHS is in crisis right now would be something of an understatement. Writes Alexis Chilvers as part of our push to raise the voices of trans people on trans healthcare in the UK in 2023.

More than a decade of austerity, privatisation and Tory mismanagement has brought a beloved institution to its knees. What is, for so many, a source of national pride has instead become a cautionary tale about the dangers of right wing policy.

Politicians speak passionately about what the NHS means to them and how they intend to fix it; I myself come from a family where both of my parents are health workers and my sister is training to become a doctor.

According to polls at the next general election we will have a Labour majority who will, in my mind, do a better job than the current administration. For many people around the country they can expect that the quality of service provided by the NHS will improve once funding and resources are given properly. For many, the NHS is beyond fault.

Any issues that it might appear to have are purely down to aforementioned lack of funding and poor decisions made by politicians. Ask a passerby in the street what they think of our National Health Service and they will likely conjure images of the dedicated doctors and nurses and staff who provide lifesaving care and treatment to patients and families all year round.

Reality however is far more grim, especially for trans healthcare in the UK.

7 years ago I sat alone in a room in central London and prepared for a meeting with a man whose name and face are lost to me.

He asked me about my sexual preferences and my fetishes. He asked me about my trauma and very little detail of my life. He asked me to defend my existence. I was terrified. I knew this stranger had the power to deny me access to trans healthcare in the UK. Healthcare that I needed. All while knowing he would not be the last stranger I would have to convince that I knew who I was.

When I think of the NHS I don’t picture those dedicated staff or even my own family members. I picture trans healthcare in the UK and I remember the pain and anxiety of waiting years for an appointment. I remember the anger of medication being denied to me by my GP. I remember the apathy as I watched so many years of my life slip away like sand in an hourglass whilst I waited for a decision to be made about what drugs I should take. I feel the heartbreak, sorrow and rage that a system so cruel has wrought upon us.

Trans healthcare in the UK isn’t just broken: It is killing us.

We all have a story to tell about our time with the GICs. From the interrogation we face at every step, to the rigid methods for treatment and the sheer insanity that are the waiting lists, which are now years long at every GIC in the country.

At the end of 2021 I was thrilled to finally be cleared to begin taking testosterone blockers. However, when I approached my GP I was told they were unable to continue prescribing the drug or administer it. They wouldn’t touch the issue. I was kindly informed that this was an issue for the specialists to deal with and my GP was not responsible for providing this treatment.

Legally, this is wrong.

After more than a year of back and forth discussion between myself, the GP and the GIC I was finally sent to a hospital where I was seen by an endocrinology team. They administered the drug that had been approved more than a year ago and kindly provided me with an explanation to give to my GP: explaining that it was indeed their responsibility through the shared care agreement to provide me with this treatment.

As I write this I am yet still to discover if my GP will actually accept this letter and, truthfully, I don’t believe that they will.

One fact is increasingly undeniable. Even past the places on decades-long waiting lists, the system used by the NHS, where all trans healthcare in the UK is funnelled into a handful of specialist centres across the country, is fundamentally hostile to trans existence. What we need is a patient first approach. What we need is an informed consent model.

If any cisgendered person today were to visit their local GP for hormone related issues, like menopausal symptoms or hair loss, they could be prescribed the same drugs that are given to trans people in a fraction of the time it takes to wait and see specialist care. Instead of the global standard we have created a monster of a system that funnels tens of thousands into waiting for drugs a cis person could receive within a week.

It is no surprise so many of us are turning to DIY treatment when the NHS simply will not provide the treatment and care we need.

So, where do we go from here?

The next government will, barring some political catastrophe, be a Labour government. I joined Labour after I already knew I was trans and today I am both a member and an LGBT+ Officer. I’m incredibly lucky in that I have always wanted to go into politics as a calling in life – although I never expected my mere existence would become a political issue itself.

As the founder and co-chair of Labour For Trans Rights I worked together with other members of the party to push back against the growing bigotry inside Labour, and this year we are looking to expand our efforts much further.

Beyond demanding Labour finally implement the rules against transphobia we were promised years ago, and keeping a close eye on the fabled GRA reform, we will begin to push for the actively transformational policies that could reshape trans healthcare in the UK. We currently have an open letter addressed to Labour leader Keir Starmer you can read and sign here.

This means getting support at all levels of the party from the grassroots members all the way up to elected representatives. It means talking to them about the system in use now, the horrors we have experienced and why we need a total redesign of access to trans healthcare in the UK.

It also means demanding a non-binary gender characteristic that can give security and dignity to people otherwise forced to make uncomfortable decisions about how they are recognised.

It will undeniably be a challenge to get the next government to pay attention to the pain being caused by the NHS and an even bigger challenge to compel them to change it, but it is a challenge at which we must succeed. We deserve to expect the same quality of care as cis people receive. Because frankly, we’ve waited long enough: We fucking deserve it.

This article was funded by LGBT+ Futures: Equity Fund is a two-year £786,000 partnership between Consortium and The National Lottery Community Fund, designed to help community-led and grassroot organisations supporting some of the most under-represented and marginalised LGBT+ communities. Read more here.