A year ago I wrote that the waiting list for the self-named National Gender Service (NGS) exceeded a decade for new referrals. My latest Freedom of Information (FoI) request is back so I can calculate how much longer the expected wait is as of the end of 2024. TL;DR it’s almost 13 years now.
Most usefully, the data is in the same form as last year so I can compare directly between the years. There are tiny discrepancies due to the waiting list snapshots being off by a few days. But for the sake of simplicity I’m going to presume it all aligns perfectly with quarters. This shouldn’t have any appreciable impact on the analysis.
Unlike last year, the NGS were able to say how many patients they have, which is 749. They were last able to provide this number in 2022, when it was 626. This implies that the number of people attending is growing by a little over 60 a year.
Do not look at math with remaining eye
As with last year the 371 referrals and 1,940 people on the list from simple addition can’t be used directly, as there are obvious discrepancies that I need to be corrected for.
Once again there are people on the list who should have been removed. Last year the removals were about 90 people behind and I’m going to assume the same for this year. Given that the NGS is apparently scheduling assessments for people who were referred around the start of 2021, the numbers look consistent with this assumption. Subtracting from last year’s data, this means that about 162 people were or should have been taken off the list in 2024. This doesn’t mean that 162 people were seen or received healthcare, as it would also include those who never responded to the invitation to assessment or who declined the invitation. This estimate of 162 is a new high. The previous peak of 160 was reached in 2021.
As with last year, it looks like a fair chunk of referrals from the end of the year remain unprocessed, and to a greater extent than last year. Given that Q4 2024 isn’t a zero, I infer that they are processing referrals out of order but honouring the original referral date. Comparing with last year, it appears this was also happening in 2023 given that the Q3 2023 number had gone up in addition to the increase in the Q4 2023 number that I was expecting.
The quarterly data is lumpy. However it does appear that there is at least some small seasonality. In particular, a tendency for slightly more referrals in the first half of the year. Presuming that 2023 is typical, the 309 referrals in the first half of 2024 imply a total of 606 referrals for all of 2024 with 236 pending additions to the list. This produces slightly more charitable numbers than the assumption that there isn’t any seasonality.
With 90 pending removals from the list and 236 pending additions, the list stands at around 2,084 people at the end of 2024. With around 162 people taken off the list in 2024, that gives an estimate of over 12 years and 10 months for new referrals.
2023 Hindsight
In order to account for the data quality last year, I looked at a few scenarios to try and accurately estimate how many people were referred. This latest FoI lets me compare to the actual data to see how well I did.
As a reminder last year my estimates for 2023 referrals ranged from 524 to 603, a waiting list of 1,583 to 1,792, and a wait of 10.1 to 13.2 years. Based on averaging the scenarios I estimated that a wait of just over 11 years was most likely at the end of 2023.
That same year there were in actuality around 581 referrals and (presuming that the 90 pending removals and 156 taken off the list was correct) around 1,640 people on the waiting list, for a 10.5 year wait. So while in hindsight I was off by around 6 months, I am satisfied with being in the right ballpark given the uncertainties involved.
As an aside, 606 referrals in 2024 is only a 4% increase on the 581 of 2023. This is quite a change comparing to the average 18% increase seen over previous years. This could be a blip as was the case in 2021, that we’re approaching the limit of trans people that could be referred, or trans people are now avoiding being referred to the NGS given its misinforming GPs and even threatening their licenses to discourage GPs from providing any form of trans healthcare.
Whether the expected wait is 10.5, 11 or now almost 13 years is fundamentally academic. It remains an effectively infinite waiting list. And there’s no guarantee of receiving healthcare at the end of it, if you’ve been happily on Hormone Replacement Therapy (HRT) for years.
As I said last year, throwing more resources at the NGS will not improve the waiting lists. What we need is a new model where GPs handle this directly on an informed consent basis, as is done successfully in many other countries.
Jes Black (she/it) is deeply appreciative of getting data in the same format, with the same semantics, in response to a similar FoI request.
