It has been a year since I revealed that the waiting list for the National Gender Service (NGS) had hit nine years. This year’s Freedom of Information (FoI) request has come back, so it’s time to do some maths.
At the end of 2022 there were 1,215 people on the waiting list. This response indicates that at the end of 2023 there were 1,643 people on the waiting list, of whom 494 were added in the past 12 months. This would make the wait to be over twice what I was expecting given the trends from previous years So, these numbers don’t seem right.
While I didn’t mention it at the time, this also happened last year. When I asked for confirmation it turned out that the 2022 numbers weren’t validated. And they were kind enough to provide the validated numbers. That is to say that there were some referrals that had yet to be processed and some people who had been called for assessment who had yet to be removed from the waiting list. Unfortunately, after pointing out that 2023’s supposedly validated numbers didn’t seem right either, I was not provided with the actual validated data.
I’m now left with the unenviable task of taking what information I have, and using it to produce the best estimate I can of how long the NGS waiting list really is.
Reticulating Splines
If I take 2022’s numbers of 1,215 people, 489 referrals, 136 people taken off the list, and presume the same again, the waiting list at the end of 2023 would amount to 1,704 people. This comes to a 12.5 year wait.
However, that’s presuming that referrals have remained constant. In actuality over the last five years they’ve been going up by about 18% year-on-year given that 209 people were referred in 2017. Assuming an 18% increase in referrals would give 1,792 people, with 577 added, for a 13.2 year wait.
You may notice that the 0-3 month wait time is suspiciously low compared to the rest of the year, presumably as referrals from the last month or two of the year are still pending. We can use this to get an estimate of the unprocessed referrals. Taking the average of the rest of the year we’d expect 143 referrals in 0-3 months, giving 77 unprocessed referrals. Alternatively, using the 12-24 month waits can help us account for seasonality. If the pattern of 2022 matches 2023 then 175 referrals would have been expected in 0-3 months, giving 109 unprocessed referrals.
This leaves us trying to estimate how many people who are on the list should have been removed.
I do have the initial unvalidated numbers from 2022, which shows 1,275 people were on the list and 459 added, indicating that 30 people were pending addition to the list and 90 were pending removal. Now being 90 people behind is about eight month’s worth, which seems like quite the backlog. However both the May and July 2023 minutes of the NGS’s Clinical Governance Committee mention this, so it sounds like lots of pending removals continued to be an issue in 2023:
Taking the estimate of 90 pending removals and the 77-109 pending referrals, that’d give a waiting list of 1,630-1,662, and 156 people removed from the list in 2023. That would be a 10.4-10.6 year wait.
You could also get the 156 by comparing this year’s apparently unvalidated numbers to the previous year’s unvalidated numbers. That approach would give 1,583 waiting with 524 added for a 10.1 year wait.
Finding Meaning
So how long is the waiting list? It looks like somewhere around 10-13 years, with the uncertainty down to it being unclear how many people are actually waiting as well as how many people were removed from the list in 2023. Keep in mind that someone being removed from the list doesn’t mean that they were assessed. They could, for example, have declined the appointment having found healthcare elsewhere. Accordingly, while it seems unlikely that the NGS decreased in efficiency in 2023, there’s no clear evidence that they increased in efficiency either.
To try to account for all the noise and uncertainty, I averaged these scenarios and the historical data for how many were removed from the list. Given all that, my best estimate for the length of the waiting list is a bit over 11 years.
What is certain is that referrals to the NGS continue to far outpace the people seen. The most charitable numbers here show 524 referrals with 156 people seen in 2023, a factor of around 3.4. If you were to quadruple the resources of the NGS, presume those additional resources weren’t wasted, and that the 20+ years of growth in referrals suddenly mysteriously stopped, it’d take about 15 years to get the waiting list to under a year.
Throwing more resources at the NGS isn’t going to fix it.
As I proposed all the way back in my first article, maybe it’s time for a different model where GPs handle this directly.
After all, the French can train a GP to prescribe trans medication directly in less time than it takes the NGS to complete one singular assessment.
Jes Black (she/it) wonders if it is too much to expect data in the same format, with the same semantics, in response to the same FoI request.
