In last year’s article the waiting list for the self-named National Gender Service (NGS) was over 2,000 people and an estimated wait time at almost 13 years for new referrals. My Freedom of Information (FoI) request for the latest numbers has been kindly processed, so let’s look at how things were at the end of 2025.
As with the previous two years, the data is in the same format which makes the analysis much easier. Also as before, there are tiny discrepancies due to the report being run on different days of the year. Again, I’ll ignore that for simplicity as there’ll be no significant impact.
Suspiciously easy numbers
In previous years the data for the last few months of every year was incomplete, seemingly due to referrals not being processed, therefore requiring a correction to get an accurate estimate. Last year, due to the aforementioned correction, I had estimated 606 referrals in 2024, so I’m happy I was pretty on the ball given the 610 from this year’s FoI. This year the numbers across the four quarters of 2025 are fairly even, so I’m happy to take the 652 referrals in 2025 at face value. This is 42 more referrals than 2024, an increase of around 7%. While the growth rate has flattened considerably since 2022, referrals continue to increase.
This leaves the question of how many more referrals should have been removed. If we take this end of the waiting list at face value, then 239 people are left of the 395 that were referred in 2021, which is consistent with reports from the community that the NGS reached June 2021 around the end of November 2025. That would come out to 89 referrals removed from the list (including those that declined the invitation, didn’t receive healthcare, etc.), and an almost 30-year waiting list. However, a sharp 45% drop in patients invited to assessment seems unlikely to me.
Give this, the numbers are turning out to be less easy to calculate. It seems likely that 2021 was not uniform in terms of referrals, with one the NGS staff member allegedly mentioning to one person that there was a surge in January and February 2021. That’d be honestly unsurprising. A lot of eggs were cracked during COVID and it’s not unusual for trans people to resolve to pursue medical transition over Christmas.
With this in mind, I ran the numbers a few different ways, such as by taking the seasonality from 2022 into consideration and working from various reports within the community about the state of the waiting list. In the end I decided to use the approach that was the most charitable: By looking at staffing changes in the NGS.
The NGS currently has 7.25 clinical staff, and they lost two staff during 2025; one near the start of the year and one near the end. In effect, they went from 9.25 staff in 2024 to an average of roughly 8.25 staff, from which you’d expect around a 11% drop in throughput. Given that I estimated they removed 162 people from the list in 2024, that implies that around 144 were removed in 2025. That’d make them 55 behind on removing people from the list, so I estimate that 2,583 people remained on the list at the end of 2025.
Doing division, that implies the wait at the end of 2025 was just shy of 18 years, so it’ll easily be a solid 18 years by now. As a reminder, this is the conservative, charitable estimate. So, when I say the wait for new referrals is estimated at at least 18 years, it may be a few years more than that.
Every time God closes a waiting list…
My FoI also asked how many patients the NGS has on its books, which came to 749 in 2024. Unfortunately, they were unable to provide this for 2025. I must admit it seems a bit odd to be demanding more resources when you can’t even say how many people the current resources are being used on. I see the attempts to close their waiting list as an admission that their service is failing. For those who wish to get on the NGS waiting list, the good news is that the Department of Health has confirmed reports in the press that the waiting list remains open. And that the NGS will continue accepting referrals.
As I’ve said in years past, throwing more resources at the NGS will not reduce the waiting lists. There are much more effective gender services out there which we can and should take inspiration from.
Last year I was part of a group that visited the informed consent adult gender service in Iceland, where we had extensive discussions with both the clinicians running the service and the Icelandic queer NGOs. It was very clear that the service was working well for everyone, and that the clinicians and community were working together on further improvements. They have more patients and about half the staff of the NGS, yet in two years they eliminated their 700 person waiting list. They usually only need 30-45 minutes of assessment, and in their intensive weeks they’d start 30 people on HRT. This is a fine example of how we could do things in Ireland and I was glad to see that the Minister of State for Mental Health, Mary Butler, visited later on in the year.
In December the Labour party brought a Dáil motion on trans healthcare which subsequently passed. I had the privilege of watching the debate from the public gallery and it was wonderful to see the speeches from the government parties and many of the opposition parties in support of trans healthcare and in particular those that supported the informed consent GP-led care developed in collaboration with the trans community that we so sorely both need and deserve.
This article is adapted from a poem Jes Black (she/it) first performed at a top surgery fundraiser.
