National LGBT Survey Analysis: Education

Schools, colleges, universities, training centres and other educational establishments should be places where everyone feels safe and supported by staff, regardless of their sexual orientation or gender identity. Yet report after report has shown that LGBTQIA+ staff and students do not always feel comfortable being in such settings. The much quoted Stonewall School Report 2017, conducted in partnership with the Centre for Family Research based at Cambridge University highlighted that despite noticeable decreases in overall levels of homophobic, biphobic and transphobic bullying in schools, there is still a worrying prevalence of transphobic language and bullying and lack of awareness of differing gender identities in general. There are a number of shocking statistics that stood out: 9% of trans students surveyed for the Stonewall School Report 2017 stated they had been subjected to death threats, 84% had said they had self-harmed at some point and 45% had considered taking their own lives (https://www.stonewall.org.uk/sites/default/files/the_school_report_2017.pdf).

A survey conducted by Dr Catherine Lee, head of education and social care at Anglia Ruskin University earlier this year which had 105 responses found that 46% of LGBT+ teachers working at village based schools had taken time off from work because of anxiety or depression brought on as a result of lack of acceptance of their sexual orientation; the figure for teachers based in urban areas was only 5%. Also 40% of rurally based teachers felt their sexual or gender identities had been a direct barrier to accessing promotional opportunities. 30% of teachers had left a role at a village school because they had experienced homophobia, whereas the figure for teachers based in towns and cities was 17%. (https://schoolsweek.co.uk/rural-lgbt-teachers-have-worse-mental-health/). Another survey, conducted for the NASWUT found that 50% of teachers who are LGBT+ felt their school wasn't a safe place to be open about their sexual orientation or gender identity.

The National LGBT Survey asked a number of questions relating to educational experiences, with responses coming from 16 and 17 year olds still in secondary school/sixth form as well as teachers currently based in schools and colleges. 36% of respondents to the survey had been in education in 2016/17, including 98% of respondents aged 16-17 and 64% of those aged 18-24 (p.109).

Many of the responses to the questions reflect concerns already expressed but I feel it's important to explore a number of them in depth to bring home the importance of ensuring educational settings are a place of safety and which nurture a feeling in students and staff alike for celebrating the diversity of human relationships and experiences:

• Respondents who had expressed at the start of the survey that they had a “minority gender identity” (i.e. trans, non-binary, genderqueer, agender etc) were asked a question about how understanding their teachers had been of issues facing trans, gender fluid and non-binary students. Only 13% reported that their teachers and staff had been very understanding or somewhat understanding, and 68% said they had been not very, or not at all, understanding. (p.103) 50% of respondents aged 16-17 and 67% aged 18-24 said that their teachers and other school staff had been not very, or not all, understanding of gender issues (p.103)
• 918 respondents to the National LGBT Survey talked about Relationships and Sex Education (RSE) - “the broader concept of better education in schools regarding sexual orientation, gender identity and being LGBT was the most discussed topic” and when respondents talked about sex education, a number stated that “it is, or was, in their own experience heteronormative, with little-to-no information on any LGBT-specific education about sex and related topics” (p.105). This demonstrates the need for RSE guidance to be LGBTQIA+ inclusive and written by experts who have experience of discussing and researching (and being in) LGBTQIA+ sex and relationships. Knowledge is power, after all!
• 50 respondents to the National LGBT survey talked about the need to discuss LGBT+ history in schools, especially the fight for rights (p.106): this could include lessons on Section 28, the Lesbian and Gays Support the Miners group and the passing of legislation in Parliament.
• Respondents who had reported they were in education stated more often than not that they had not been open with teachers and support staff- 53% of all respondents had not been open with teachers and 61% had not been open with non-teaching staff (p.110).
• 41% of trans respondents had not been open with teaching staff – non-binary respondents were more likely not to be open than trans women and men (p.116). 57% of asexual trans respondents were not open with their teaching staff.
• 18% of respondents who reported they were asexual had not disclosed their sexual orientation to their classmates.
• Only 1.3% of respondents had experienced only negative reactions from others when they disclosed their sexual orientation or gender identity but 31.2% had experienced both positive and negative reactions from others when disclosed
• 21% of respondents who had had experienced mixed reactions to disclosure at school, college or university during the 2016/17 academic year said disclosure had happened without their explicit consent and 19% “received verbal harassment, insults or other hurtful comments” (p.118)
• Over 1,200 respondents had mentioned bullying within education in their survey responses: “There was a consensus that the bullying of LGBT people is still common in schools, and that more could be done by government and schools to tackle it” (p.119).
• 88% of incidents perpetrated against respondents who were in education during the 2016/17 year were perpetrated by fellow students but 9% were perpetrated by teachers or other teaching staff (p.120)
• 11% of incidents of sexual harassment or violence against trans students were perpetrated by teachers and other teaching staff (p.120)
• 83% of the most serious incidents that respondents had indicated had taken place had not been reported by themselves or anyone else (p.121)
• 56% of respondents who had not reported the most serious incident said it wouldn't have been worth it and 37% said it would not have been taken seriously by staff or police (p.122)
• 77% of those whose incident was reported to an LGBT organisation or charity said that they had found them very or somewhat helpful, and 66% of those whose incident was reported to parents/guardians had found them very or somewhat helpful (p.124)
• After incidents had been reported, only 13% of respondents who had reported incidents said that the “negative comments or conduct in question had stopped completely (p.124)
• Catholic schools were particularly cited as being places which are “unsupportive” and respondents noted the lack of appropriate LGBTQIA+ RSE in those schools
• 16 responses were received in relation to being LGBTQIA+ and having special educational needs: “respondents noted that the intersectionality of having special educational needs and being LGBT could be a very difficult experience, in that people may conflate the two, or may not sufficiently understand either” (p.127). This indicates a need for more comprehensive guidance and support for staff supporting LGBTQIA+ students with special needs so they do not conflate and resort to use of stereotypes.
• 170 responses were from LGBTQIA+ teachers: more than 1 in 5 have been outed, a third have had a negative reaction from others towards them after disclosing their sexual orientation and/or gender identity, 6% have been excluded from events held in their educational establishments and more worryingly, 9% of the most serious incidents in school/college were perpetrated by their colleagues (read more here: https://www.tes.com/news/one-five-lgbt-teachers-outed-school)

The statistics outlined above paint a mixed picture of educational establishments across the country. It's important to make it clear that there are schools out there who have taken on board measures to improve LGBTQIA+ equality. Getting the basics right makes the biggest difference to the emotional wellbeing of trans, non-binary, gender-fluid, genderqueer and agender students:

• Ensuring anti-bullying policy and procedures include references to stamping out transphobic language and bullying by ensuring staff know what their responsibilities are in reporting and disciplining students who have perpetrated such acts
• Ensuring disciplinary and grievance procedures include reference to homophobic, biphobic and transphobic bullying, harassment and discrimination (with reference to the Equality Act 2010)
• Ensuring administrative procedures for updating the name and title marker for students and staff are made clear to teaching and support staff
• Ensuring ALL staff have received basic gender and sexual orientation awareness training from qualified and experienced professionals
• Marking awareness days, weeks and months in school, including LGBT Awareness Month (February), School Diversity Week (July) and Transgender Day of Remembrance (20^th November)
• Scheduling time in PSHE and RSE lessons to talk about LGBTQIA+ equality, relationships (sexual and otherwise) with students in a clear and non-patronising manner
• Embedding lessons on LGBT+ role models and issues across the National Curriculum
• Providing information to students about access to facilities, including toilets and changing rooms
• Engaging with educational organisations including Educate & Celebrate and Just Like Us
• Signposting students to local, regional and national LGBTQIA+ organisations, including Mermaids, Gendered Intelligence and Stonewall.

The situation for trans, non-binary, gender-fluid, genderqueer and agender students in a school will only improve when there is supportive leadership in place to garner the support from staff, parents, guardians, cares and governors needed to enact the measures. This is particularly the case for faith schools in more conservative, rural parts of England where there may not yet be any openly trans, gender-fluid, genderqueer and agender students or staff. Guidance documents such as the Church of England's Valuing All God's Children can help to further the argument towards celebrating diversity which goes beyond mere tolerance (https://www.churchofengland.org/sites/default/files/2017-11/Valuing%20All%20God%27s%20Children%27s%20Report_0.pdf). The guidance includes Anti-Bullying and Equality and Diversity policy templates which can be adapted for use. Books such as How to Transform Your School into an LGBT+ Friendly Place written by Dr Elly Barnes MBE and Dr Anna Carlile of Goldsmiths University of London, Department of Educational Studies can also help to provide the practical information and guidance needed for headteachers, teachers and pastoral care teams to implement positive change (there's a great section on awareness days, weeks and months for example). Department for Education guidance, issued on an ongoing basis are must-read documents: for example, they just updated the guidance for schools by creating a document on gender separation in mixed schools (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/719398/Gender-separation-guidance.pdf). One has to acknowledge that there will always be a small but vocal minority of Christians and people of other faiths who advocate denying the existence of different sexual orientations and gender identities but through increasing awareness and training, their potency which they use to control the overall conversation on gender and sexuality for others will begin to evaporate and LGBTQIA+ equality will advance further.

The findings of the National LGBT Survey with regards to education do not shock me. I had little exposure to LGBTQIA+ issues and did not learn about the fight to gain LGBTQIA+ rights at primary or secondary school. I knew a few openly LGBT classmates at secondary school and noticed the homophobic, biphobic and transphobic language most of us were subjected to whilst feeling that such language was unwarranted and affected our self-confidence. I think only one of us was out to teachers and they didn't really know how to support us other than to encourage our academic talents. My secondary school wasn't a bastion of hate but I certainly wouldn't exactly call it a haven of LGBTQIA+ awareness and tolerance either.

I hope that as the years progress and the push for improved rights for trans, non-binary, gender-fluid, genderqueer and agender people gathers steam, whilst LGBTQIA+ inclusive RSE is introduced as part of the PSHE curriculum, that more students and staff feel they can be authentically themselves whilst at school.

The UK Government's LGBT+ Action Plan....It's a start?

This week the UK Government released the findings of their National LGBT+ survey, conducted last year. There were 108,110 valid respondents from people living in the UK aged 16 and over. 61% of respondents were gay or lesbian and 26% were bisexual. 13% of respondents were trans, with 6.9% of respondents (7,800) being non-binary, 3.5% being trans women and 2.9% trans men. Interestingly, 2,970 responses were rejected because they were deemed "offensive, abusive, explicitly vulgar or otherwise unreliable"....I'm guessing some of those responses came from Trans-Exclusionary Radical Feminists (TERFs) spouting discourse against trans people so I'm glad there were robust checking procedures as part of the research collation and analysis. I'm going to be examining the report in depth and doing a number of blog posts over the month on the results of the National LGBT+ Survey but you can read the entire 304 page research report for yourself if you wish to here:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721704/LGBT-survey-research-report.pdf.

There are a number of statistics that have come out from the analysis of the LGBT+ survey that I feel need to be communicated widely:

• Trans respondents were much more likely to say that they had a disability (33%) than cisgender respondents (14%)
• Trans people had lower scores for life satisfaction in the UK: trans men scored on average 5.1/10, trans women and non-binary people scored on average 5.5/10 (the average for the UK population at large is 7.7/10)
• Only 37% of trans women, 34% of trans men and 38% of non-binary people said they felt comfortable being LGBT in the UK
• 72% of non-binary respondents had not disclosed their gender identity to their neighbours
• 68% of all respondents (who were lesbian, gay, bisexual, asexual or pansexual) said they had avoided holding hands with a same-sex partner in public
• 70% had avoided being open about their sexual orientation because they feared they would face a negative reaction
• 59% of trans women, 56% of trans men and 76% of non-binary people who responded to the survey have avoided expressing their gender identity openly but younger cisgender people were more likely to be open
• 24% of all respondents were not open in any way about their gender identity or sexual orientation with family members they lived with (excluding their partners)
• 40% of all respondents had experienced a negative incident in the 12 months prior to filling in the survey when the perpetrator was someone they did not live with on the basis of gender identity and/or sexual orientation or being perceived as LGBT
• 26% of all respondents had been subjected to verbal harassment in the last 12 months prior to filling in the survey
• 14% of respondents had their LGBT status disclosed to others without their express permission in the past 12 months prior to filling in the survey
• 6% of all respondents had been subjected to threats of physical or sexual harassment or violence in the 12 months prior to filling in the survey
• 2% of all respondents had experienced physical violence in the 12 months prior to filling in the survey
• 2% of respondents had experienced sexual violence in the 12 months prior to filling in the survey
• 11% of respondents had had private sexual images and/or videos shared without their explicit consent in the 12 months prior to filling in the survey
• 94% of respondents did not report the most serious incident they had been subjected to when the perpetrator or observers were people they lived with
• 45% of respondents who reported incidents to the police were unsatisfied with how reports were handled
• 5% of respondents had been offered conversion therapy and 2% had undergone such therapy
• 51% of conversion therapies were carried out by faith organisations and groups and 19% were carried out by a healthcare professional/provider
• 77% of overall respondents said that neither gender identity nor sexual orientation was discussed in their school lessons but this dropped to 54% amongst 16 and 17 year olds
• Only 9% of those respondents who had lessons on gender identity or sexual orientation said their lessons had prepared them for later life as an LGBT+ person
• 88% of the most serious incidents reported by respondents in education were perpetrated by a fellow pupil but 9% were perpetrated by a member of teaching staff
• Only 36% of respondents who were transitioning at school said their school was very or somewhat supportive of their needs
• 21% of respondents who stated they were trans who accessed healthcare services said their needs had been ignored: 18% said they had been subjected to "inappropriate curiosity" and 18% also disclosed that they had avoided treatment because of fear of discrimination
• 87% of respondents who had accessed sexual health services in the 12 months prior to filling in the survey said they had a positive experience
• 80% of trans respondents who accessed or tried to access gender identity clinics said it wasn't easy, with the waiting time being seen as the greatest barrier 
• Only 7% of non-binary people had accessed gender identity services with another 6% trying to access services.
• 23% of respondents had experienced a mixed or negative reaction whilst at work due to being LGBT or being perceived as being LGBT, with 9% being subjected to verbal harassment
• 57% of the most serious incidents reported by respondents as happening in the workplace have been perpetrated by a colleague (junior or at same level).

This short list of statistics will come as no surprise to those of us who have spent our lives trying to navigate challenges that originate as a result of ignorance, fear or blatant discrimination by those in positions of power and influence. My blog posts and those of many other LGBTQIA+ people are testament to that. The question is: how can the Government enact policies and legislation to improve the lives of people like me and the lives of those who may not yet have come out as LGBTQIA+?

The Government LGBT+ Action Plan, announced alongside the results of the National LGBT+ survey today aims to address the concerns of LGBT+ people expressed in the survey and by campaigners aiming to improve LGBT+ equality. There are 75 points to the plan and £4.5m announced to specifically support the enacting of the Action Plan which will be available till March 2020, with an LGBT+ Advisory Panel set up to help deliver it.You can read the full document here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721367/GEO-LGBT-Action-Plan.pdf.

One of the headline policy statements from this Action Plan is that conversion therapy will be banned, whether through passing new legislation or exploring non-legislation (i.e. regulatory) options. Conversion therapy is dangerous whereas affirmative therapy helps to improve the mental and physical health of LGBTQIA+ people who struggle initially with accepting their sexual orientation or gender identity. I hope conversion therapy of any kind on the basis of sexual orientation or gender identity will be banned, so that we can particularly protect vulnerable trans, gender-diverse and gender-questioning children and young people from being forced to accept gender identities to "fit in" with parental, religious or other expectations. I'd rather see it banned via the introduction of legislation but will wait to see what is recommended by the Government in the next few months.

I welcome and approve of the announcement of a national LGBT+ health adviser and hope I and many others will have an opportunity to meet them to discuss my concerns about the lack of awareness of trans and non-binary people's specific needs, so that we can improve standards of patient care and make our hospitals, GP surgeries, care homes and other spaces a more inclusive and welcoming place.

I'm happy to see the announcement on addressing body image pressures that LGBTQIA+ young people in particular face and hope there will be funding made available for specific body positivity campaigns at grassroots level so that young people themselves working within third-sector and public organisations can help challenge pervasive cultural body norms.

There is a need to help improve the lives of LGBTQIA+ people who have a learning disability so they have the confidence and freedom to engage in activism, in education and in loving relationships. Training for care professionals and carers is vital and that means updating advice and guidance documents in collaboration with charities and other third sector organisations who work on a day-to-day basis with people with learning disabilities.

The approach towards reporting and responses to reports of LGBT+ hate crime needs to be improved so that LGBT+ people have more confidence in the police and the overall system. I appreciate the announcement of a refreshed Hate Crime Action Plan and look forward to reading the recommendations regarding training of police officers and raising awareness of hate crime reporting routes in the local community. It's good to hear that "The Home Office and Ministry of Housing, Communities and Local Government will... fund a bespoke training package available to all police call handlers to help ensure victims are correctly identified and supported at this critical first point of contact" (p.17) and that the Crown Prosecution Service will work with their partners to improve reporting procedures for LGBTQIA+ victims of domestic abuse, rape, sexual assault and hate crime. However I'd like to see the Government adopt Labour's proposal for making LGBT+ hate crimes aggravated offences to deter perpetrators and send a clear signal that such crimes will not be tolerated.

I'm cautiously optimistic at the recommendations in the Action Plan to increase support for LGBTQIA+ survivors of domestic abuse. Police forces need to ensure that LGBTQIA+ people are aware of the support services they can access and that the review of domestic abuse services will highlight gaps in provision and provide recommendations to improve support packages. The non-legislative package of support which is being created to align with the Domestic Abuse Bill needs to fully consider the needs of LGBTQIA+ survivors. Increasing awareness of Sexual Assault Referral Centres for LGBTQIA+ survivors is also extremely important and I hope that any resulting marketing campaign will be created in full consultation with LGBTQIA+ organisations and the participation of survivors. 

LGBTQIA+ teachers, support staff and pupils all deserve to feel safe and secure whilst attending school or college. More school and college leaders should be encouraged to create or update their policy and procedures and ensure that all staff attend appropriate training which improves awareness of LGBTQIA+ issues but also provides practical, sustainable techniques and measures that can be used to improve LGBTQIA+ equality. Relationships and Sex Education, (when it is eventually introduced) must include LGBTQIA+ awareness and equality and guidance needs to be issued to schools and colleges which is fact-based, comprehensive and easy-to-understand. I'm also pleased to see a commitment from the Crown Prosecution Service to update their LGBT Hate Crime Schools Pack and will do so with the input of LGBTQIA+ young people and the Government's Equalities Office will work with the Equality and Human Rights Commission to produce comprehensive guidance to support trans, gender-diverse and gender-questioning children and young people.

It's good to see a commitment by the Government's Equalities Office to provide employers with free training materials to help them create a more inclusive working environment as well as creating an employers' working group to discuss key issues. I hope a range of organisations, large and small from across the UK can contribute to this working group and help with the creation of training materials.

I appreciate that non-binary people will have the opportunity to contribute towards a specific Call for Evidence so that ministers and decision makers alike can hopefully improve their awareness of issues that affect us but I hope they will continue to or begin consulting with experts who have extensive experience of working with non-binary people. The Gender Recognition Act needs radical reform to improve access to legal recognition for non-binary, agender and gender-fluid people and there needs to be appropriate and safe opportunities provided for non-binary, agender and gender-fluid people to contribute to the Gender Recognition Act (2004) consultation, without fear of being subjected to verbal abuse and harassment from opponents. I also welcome the attempts that will be made to make it easier to make changes to gender markers (which I hope will soon include non-binary ones) legally through a "Tell Us Once" type service. It could reduce the bureaucratic cost and ensure all documents are kept up-to-date as per current General Data Protection Regulation and Gender Recognition Act requirements.

Intersex people deserve to have their right to be protected from direct and indirect discrimination, victimisation and harassment enshrined within our legislative framework. The Equality Act (2010) should therefore be amended to include intersex as a protected characteristic. The National LGBT+ Survey had 1,980 responses from intersex people living in the UK and one important statistic that came out was that 16% respondents said their GP didn't know where to refer an intersex patient for further advice and guidance. It's important therefore that healthcare professionals receive appropriate training as part of their Continuing Professional Development (CPD) requirement so they have more awareness of intersex advice organisations and provide the right advice and guidance to support patients. Equally there needs to be a bill brought before Parliament to ban unnecessary cosmetic sex assignment surgery on intersex infants and young people and procedures brought in so that intersex people have the undeniable right of access to their medical records to find out what surgical interventions they had been subjected to.

I must say I am disappointed to see a firm commitment to bringing marriage equality to Northern Ireland, but given the current political situation with Brexit, and PM May's reliance on the votes of DUP minsters, I am not surprised. LGBT+ people in Northern Ireland deserve to enjoy the same rights as those living in London or Lincoln and I hope that the next Labour Government will push more fervently for reform if this current Tory Government fails to do so. That being said, the Government has now committed itself to putting on an international conference on LGBT+ issues so I hope that will provide an opportunity to address LGBT+ discrimination in Commonwealth countries (there are still 37 countries where homosexuality is still criminalised). There is also the idea of the UK bidding to co-chair the Equal Rights Commission in 2019 so we shall what happens with that in the next few months.

I'm also disappointed at the lack of detailed policy reform to support LGBTQIA+ asylum seekers who come to the UK to escape persecution on the basis of their sexual orientation or gender identity. We need to end the hostile approach (which has led to what has been dubbed the "Rainbow Rush scandal") and do this by bringing to an end the detention and deportation of LGBTQIA+ asylum seekers and speed up the application process for all asylum seekers so that they can all begin to rebuild their lives knowing they have a safe place in which to do so. It is good nonetheless to see a commitment to reviewing guidance for caseworkers and reviewing the training of professionals dealing with asylum claims across the board. Let's demonstrate our compassion and fight for and protect the rights of all LGBTQIA+ people living in the UK, whether they are British citizens or not.

There are policies to be commended in the LGBT+ Action Plan and if implemented in full, it will lead to improvements to the lives of LGBTQIA+ people across the UK, through the dissemination of knowledge, increased participation opportunities for engagement on policy and a systematic shift in the way key societal institutions view LGBTQIA+ equality. As Dawn Butler, Shadow Secretary of State for Women and Equalities highlighted in her response to the LGBT+ Action Plan, there is a need for sustainable funding so that policy actions and consultations can take place. It's a reasonable start, but no campaigners would deny there is still much to do.

The spectre of Section 28 still lingers on but there's hope for better LGBTQIA+ equality in the UK...

Today marks 30 years since Margaret Thatcher decided to enact Section 28, a draconian and discriminatory piece of legislation designed to stop education professionals in schools across the UK from discussing non-heteronormative sexual orientations in the classroom (with a specific focus on stopping gay and lesbian people, including teachers from talking about their sexual orientation and life experiences with students) with the ultimate aim of reducing the “promotion” of LGBTQIA+ lifestyles. Local authorities were also prevented from such “promoting”, with libraries being forced into not stocking literature or films that contained primarily gay, bi or lesbian themes, although Jeanette Winterson's Oranges are Not the Only Fruit (1985) was a notable novel read by students and studied for GCSE and A-Level exams which allowed young people to read about the life experiences of a young lesbian growing up in a deeply religious (Pentecostal) community.

I feel I owe a huge debt of gratitude to the LGBTQIA+ campaigners who fought against the introduction of this despicable clause from the off. For example, Joe Summerlad in his article for the Independent mentions the three amazing lesbian activists, calling themselves the “Lesbian Avengers” managed to gain access to the public gallery of the House of Lords and abseiled down to the chamber, an act which gained them and the anti-Section 28 cause national attention (https://www.independent.co.uk/news/uk/politics/section-28-explained-lgbt-education-schools-homosexuality-gay-queer-margaret-thatcher-a8366741.html) Mancunians also made their feelings towards the legislation clear with the “Never Going Underground” demo which took place on the 20^th February 1988, and which attracted at least 20,000 demonstrators from around the UK and had speakers including Jimmy Somerville (http://www.gayinthe80s.com/2018/02/section-28-feb-20th-1988-never-going-underground-demo/).

Thatcher used her Christian conservatism to attack openly gay and lesbian people. She never acknowledged publicly (to my knowledge) the existence of bisexual people and I don't even want to contemplate what her views towards openly non-binary trans people like me would have been. The Tories pretty much backed her all the way, claiming that it was Labour who were determined to bring pro-LGBTQIA+ books into school to challenge “traditional values”. The Tories capitalised on

on the fear rhetoric perpetuated by the right-wing press, just like the social conservatives and trans-exclusionary radical feminists do today with regards to their attitudes towards trans activists and further trans equality. As Ruth Hunt points out in her very pertinent article, “shocking levels of misinformation and scaremongering are cruelly attacking trans people's right to exist, as well as publicly questioning their identities. Deeply misleading headlines about the GRA (Gender Recognition Act 2004) and young people “being turned trans” echoes exactly the way LGB people were talked about under Section 28” (https://www.independent.co.uk/voices/section-28-school-sexuality-education-gay-lgbt-trans-rights-thatcher-a8366751.html). Editorial teams based at The Sun, Daily Mail, Daily Express, New Statesman and The Spectator in particular need to look very carefully at the way they choose articles to include in their newspapers but I'm guessing they probably won't reform their processes given their desire to provide clickbait for the right-wing masses.

I went to primary school, junior school and the first 3 years of secondary school with Section 28 still being in place in England. It's no wonder that teachers, teaching assistants and pastoral staff were reluctant to talk about being gay, bi or lesbian to students like me in front of other students because they had not had the freedom to do so in the years before I entered the state education system.

Homophobic and biphobic language was commonplace in the junior school playground and I never heard such language challenged by the playground assistants. I have no doubt that young people I knew in my classes at secondary school internalised feelings of fear and believed the stereotypes being perpetuated and it made them feel they could not be proud of their sexuality, even after they decided to come out.

LGBTQIA+ rights have improved somewhat since the repeal of Section 28 under Tony Blair's Labour Government in 2003, not least with the introduction of the Equality Act in 2010 and the Same Sex Marriage Act 2013. However, the legacy of Section 28 still lingers on today. Just Like Us, an organisation who recruit LGBTQIA+ students to go into schools to champion LGBTQIA+ equality and that has created Schools Diversity Week to “empower schools across the UK to tackle homophobia, biphobia and transphobia” have recently reported that “almost 90% of young LGBTQ people still hear homophobic language in schools and 50% self-harm” (http://www.gaytimes.co.uk/news/106845/school-diversity-week-2018/). The Stonewall School Report 2017 found that 45% of LGBT respondents (and 65% of trans respondents) have experienced bullying at school and the statistics highlight that LGBTQIA+ people of faith and people of colour are more likely to experience bullying and hate incidents whilst at school (https://www.stonewall.org.uk/school-report-2017). Meanwhile we have radical feminist dominated organisations such as Transgender Trend who claim they are “gender critical” advocating for trans people not being given the opportunity to talk about their life experiences in school for fear of “turning children trans” (an out and out lie on their part) and we have some education professionals who have a socially conservative mindset still fiercely resisting calls to introduce LGBTQIA+ Relationship and Sex Education (RSE) into all schools in England. They cite freedom of conscience, religion and expression as a legitimate basis for their objections. Yet in their efforts to defend “traditional British values”, they fail to acknowledge the liberal, modern values that we should all possess, either as British Citizens or residents of the UK or as I like to think, as Citizens of the World. Compassion and love of diversity are values central to a liberal, progressive outlook. So are tolerance and reverence for the Rule of Law. Any programme that can reduce instances of hate incidents and hate crime motivated by homophobia, biphobia and transphobia should be endorsed wholeheartedly. Any programme that promotes love and understanding for one another over misinformation and mistrust is one that I cannot help endorse as a Lutheran Christian. Yet worrying evidence collated by Dr Laura Watt and Professor Mark Elliot from the National Survey of Sexual Attitudes and Lifestyles carried out by 1990 and 2010 have shown that acceptance of same-sex relationships percentages has slowed down since 2000, with 60% of 16-44 year olds who attended at least 1 religious service a week viewing homosexuality as always wrong when asked in 2010 (only down by 8% from 1990 figures) (http://www.manchester.ac.uk/discover/news/peak-acceptance-of-homosexuality/).

Demonstrating freedom of conscience and expression, the things that religious conservatives bang on about so often means that every student has the right to explore diverse life experiences through finding out about LGBTQIA+ role models. Students of all ages have the right to explore their own feelings towards sexuality and gender through access to age-appropriate RSE sources. Just as students should have the opportunity to find out about multiple faiths in their Religious Education lessons, free from teacher judgment/bias. To me therefore it is illiberal for social conservatives to even object on the grounds of conscience or religion to LGBTQIA+ people being encouraged to come into local schools and talk about their life experiences, just as it would be illiberal to object to faith representatives coming into schools to talk about their experiences.

Numerous organisations have highlighted the lack of LGBTQIA+ RSE within the PSHE curriculum post the repeal of Section 28. A survey by Stonewall found that only 13% of respondents had learned about healthy same-sex relationships, 1 in 5 had learned about consent law in relation to same-sex relationships and 20% have learnt about keeping themselves safe in same-sex experiences. Fewer students have learned about trans people's experiences of sex. As for exploring asexual (ace) experiences in the classroom, very few teachers have the awareness necessary to facilitate discussions, despite more young people coming out openly as ace whilst at secondary school (although much more research needs to be conducted to highlight this).

There are increasing numbers of LGBTQIA+ graduates entering the teaching profession and education sector as a whole and an increasing number of teachers coming out. Teach First has collated data on the number of LGBT+ teachers between 2014 and 2018 and found there had been a 4% increase. The Independent (who has really led the way on coverage of LGBTQIA+ issues I think) has an article where several LGBT teachers who have been part of the Teach First programme talk about what actions they have taken to improve awareness inside the classroom. For example Laura, a teacher based in London decided to hold LGBT+ assemblies, run clubs, and taken her sixth form students to London Pride to march. I love Laura's passion for empowering her students to be positive about their own sexuality and gender identity and agree with her that her students “will continue to strive for a more accepting and equal society (https://www.indy100.com/article/lgbt-teachers-section-28-sexuality-education-schools-8363746).

It's great that we now have more role models like Laura for students to look up-to but there still needs to be changes to attitudes in the workplace to ensure that trans, non-binary, genderqueer, gender-fluid, and agender people feel they can enter and thrive in the teaching profession. A real-time poll, carried out by the NASUWT of attendees at their LGBTI Teachers' Consultation Conference, held in Birmingham (https://www.nasuwt.org.uk/article-listing/not-doing-enough-to-promote-lgbti-equality-.html) found that:

• 43% of respondents have experienced discrimination, bullying, harassment, or victimisation in the last 12 months because of their LGBTI identity
• 29% of respondents stated that levels of anti LGBTI bullying and language have increased or stayed the same in their school in recent years
• 86% of respondents said they do not believe that the Government is doing enough to communicate the importance of LGBTI equality to schools and colleges
• 56% of respondents said their school wasn't committed to LGBTI equality for staff and pupils
• 4% of respondents said their school had a programme of activities to mark LGBT month
• 1/3 of respondents said their school or college wasn't a safe space for LGBT teachers
• 49% of attendees said they wouldn't recommend teaching as a career to families or friends.

In the same vein, a 2018 British Social Attitudes survey found that whilst over 8 in 10 British people described themselves as not being “prejudiced at all” towards trans people, only 4 in 10 had said that trans people who had the qualifications needed to become a primary school teacher should “definitely be” employed in that role (http://www.natcen.ac.uk/blog/how-do-british-people-feel-about-transphobia-and-transgender-issues). This is concerning and highlights the work that needs to be done to debunk stereotypes that have pervaded about trans people and the interactions they may have through positive engagement work with governors and parents in schools.

It must be remembered that schools and colleges (and local authorities for that matter) are bound under the Equality Act to help improve LGBT+ equality. Under the Public Sector Equality Duty, schools must ensure they pay “due regard to the need to eliminate discrimination, harassment, victimisation and any conduct that is prohibited under the Act; to advance equality or opportunity between those who share a protected characteristic and those who do not and to foster good relations between people who share a protected characteristic and those who do not” (https://www.churchofengland.org/sites/default/files/2017-11/Valuing%20All%20God%27s%20Children%27s%20Report_0.pdf). If schools and colleges do not adhere to this Duty, they can face enforcement action brought by the Equality and Human Rights Commission. So what more could be done by schools to further fulfill the Public Sector Equality Duty? Well for starters, every school needs to check their Equal Opportunities/Equality and Diversity policy to ensure they are trans-inclusive. A specific commitment to tackling homophobic, biphobic and transphobic bullying should be contained within the Anti-Bullying policy. Forms should be reviewed to ensure students can reflect their identity openly but only information that is absolutely necessary should be collected. An Equality and Diversity steering group with student representatives would be a great way of reviewing and amending such policies.

Teachers should feel empowered to follow clearly defined procedures in the event of students using persistant transphobic language in the classroom and address that language as soon as they hear it. There should be LGBTQIA+ clubs available to students to attend at lunchtime or after school with activities, support and advice being offered.

Access to training on trans awareness should be available to all members of staff and volunteers as part of their Continuing Professional Development, with that training being delivered by qualified and experienced people. Stonewall, Gendered Intelligence are examples of organisations that have offered very effective training but there are a diverse range of trainers located across the UK, including those who are trans, non-binary, genderqueer, gender-fluid or agender who could be counted upon to deliver appropriate training. Members of the community who are LGBTQIA+ should be invited to deliver assemblies, attend RSE/PSHE lessons and/or work with students on Pride celebrations.

RSE and PSHE leads should have the opportunity to attend LGBTQIA+ specific conferences and network with organisations so they can have access to the research and support network they need to deliver truly LGBTQIA+ inclusive RSE. I hope more conferences will be created for RSE professionals as the subject is made a statutory part of the curriculum from next September.

Making provisions to celebrate key awareness days and awareness weeks would also help to raise the profile of LGBTQIA+ people in schools (aside from LGBT month in February).

A list of key dates that I'm aware of are listed below:

• Zero Discrimination Day: March 1^st
• International Transgender Day of Visibility: March 31^st
• Lesbian Visibility Day: 26^th April
• International Day Against Homophobia, Biphobia and Transphobia: May 17^th
• School Diversity Week: July 2nd-8^th
• Bisexual Visibility Day: September 23^rd
• Asexual Awareness Week:
• National Coming Out Day: October 11^th
• Hate Crime Awareness Week: October 15^th- 22^nd
• Intersex Awareness Day: October 26^th
• Intersex Day of Remembrance/Intersex Solidarity Day: November 8^th
• Transgender Awareness Week: (Second week of November)

The results of the LGBT survey, commissioned by the Government last year and which has had over 100,000 responses is due to be released in a few weeks time. PM Theresa May has promised to create a strategy designed to reduce the prevalence of homophobia, biphobia and transphobia and advance LGBTQIA+ rights. I hope that such a strategy will include more funding for trans awareness training in schools, statutory LGBTQIA+ inclusive RSE guidance and a move towards self-identification of legal gender. A bold approach is needed if society is to continue the fight to improve LGBTQIA+ rights and equality in the UK. Let's hope those changes I've highlighted above will spearhead that bold approach.

Thoughts on the NHS England Gender Identity Services For Adults Consultation 2017

Gender Identity Services (GIS) in England are currently inadequately funded and staffed to meet the needs of trans and non-binary patients. Trans healthcare was one of the key areas of concern highlighted in the Trans Inquiry findings published by the Women and Equalities Committee last year (you should read the evidence submitted to the Trans Inquiry if you haven't already because it lays out the extent of current issues facing trans, non-binary, genderfluid and genderqueer patients when trying to access and when accessing GIS: https://publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/39008.htm). It was clearly stated in the final Trans Inquiry report that the Women and Equalities Committee believed that the NHS was "letting trans people down" and failing to adhere to the Public Sector Equality Duty that they are mandated to follow under the terms of the Equality Act 2010. This is backed up by the findings of the Unhealthy Attitudes Survey carried out by Stonewall in 2015 (http://www.stonewall.org.uk/sites/default/files/unhealthy_attitudes.pdf) which was completed by 3,001 health and social care professionals. 28% of respondents to the survey stated that they did not feel that doctors were confident enough to respond to the specific care needs of trans patients, 9% were aware of colleagues experiencing discrimination or poor treatment because they are trans and 7% of respondents openly stated that they would "not feel comfortable" working alongside a trans employee.  Transphobic attitudes held by some GPs, nurses and other healthcare professionals needs to be stamped out, through the beefing up of HR led equality and diversity training. With regards to training, the Unhealthy Attitudes Survey found that 72% of respondents had not received any training on the specific healthcare needs of LGBT+ people; only 23% of respondents had received training on the legal rights of trans service-users. Also, only 27% of respondents said they'd received training on the legal rights of trans colleagues. There's definitely room for improvement.

The overall recommendation made by the Women and Equalities Committee was for the NHS to conduct, complete and publish a review of trans healthcare generally. There is also a  specific need to improve GIS, recommending that GIS be separated from mental health services and review their"treatment protocols", including the "Real-Life Experience" requirement to have access to surgery. However the Women and Equalities Committee refused to advocate for "on demand services" which made me think that there is still a general reluctance to accept that trans and non-binary people know their own mind and should have a larger stake in talking through procedures necessary to help them to lead their own lives.

NHS England have realised that GIS provision for adults needs to be improved and so have come up with a plan that they believe will make GIS more accessible and efficient. They have put these plans out to consultation and are encouraging trans (and non-binary) patients along with organisations such as Stonewall and GIRES to respond to their plans directly. So I'll offer a few of my own thoughts in this blogpost and encourage readers to consider responding to the proposals whether through YouTube videos, podcasts, blog posts or via NHS England's webpage (https://www.engage.england.nhs.uk/survey/gender-identity-services-for-adults/). It must be noted that this consultation is designed to bring in measures to replace the interim set of rules that were created in 2013 and that there have been 2 attempts to replace these rules which have not managed to progress. The 90 day consultation period (ending on the 30th September 2017) should allow for a range of voices to contribute their opinions about the proposed specifications and hopefully NHS England shall listen and make any necessary changes suggested in feedback.

The Consultation Document: 

Firstly, the Consultation Guidance from NHS England admits openly and honestly that GIS for adults need to improve. That includes looking at data collection, creating "quality and outcome measures", increasing capacity within GIS so that more patients can have access to treatment, addressing workforce constraint issues (the lack of specialist nurses, sexologists etc which is apparently primarily the concern of Health Education England), equalising "access to specialised interventions", addressing "infrequency and number of appointments" and revising administrative procedures. I'm glad that NHS England have identified these specific service improvements to focus on but as with everything NHS related these days, I wonder how much it will cost to implement these suggested improvements in England and whether NHS England are truly brave enough to ask for a specific increase in funding to allow these improvements to GIS to happen. No budgetary breakdown is offered in the consultation document itself but I am aware that an additional £4.4m had been invested in 2015/16 specifically for GRS in England. I'd like to know how much is estimated to be invested in GICs generally during the 2017/18 financial year with a breakdown of how much money has been allocated to each GIC for the 2017/18 financial year.

I am delighted to read that the consultation document makes it crystal clear that NHS England will not fund or allow providers of GIS to engage in the promotion of reparative therapy (aka conversion therapy) in any way. The non-surgical specification states that "the practice of conversion therapy is unethical and potentially harmful" and that "conversion therapy" is an umbrella term that includes any "therapeutic approach, or any model or any individual viewpoint that demonstrates an assumption that any gender identity is inherently preferable to another which then aims to get a patient to change their gender identity or suppress it". I hope that all NHS professionals working in GIS can agree with this declaration and that those working in the NHS more generally can regardless of their own private views.

As I've noticed with other recent NHS Consultation documents, there is a desire for NHS services to use advanced technological tools to help in the provision of advice and guidance for patients. I can see that for some trans and non-binary patients, Skype consultations with specialists could be appropriate, especially to discuss the effectiveness of current treatment plans. However, patients who are less comfortable with remote based conversations must still have access to face-to-face discussion appointments.

Referrals for gender reassignment surgery (GRS) on the NHS should on the whole be made through the GIS, provided that the multi-disciplinary teams at the GIS are in agreement that the individual is physically fit to go through GRS. Risk assessment should be the same as for any major form of surgery and should not over-focus on a trans person's "social issues" (those issues shouldn't matter anyways!) The GIS team must listen carefully to the needs of the patient and allow them to trust their own judgement (i.e. on an informed consent basis).

I understand that other NHS professionals who are not specialists (e.g. GPs) may feel reluctant about referring a patient directly for treatment, whether non-surgical or surgical. Training should be provided through Continuing Professional Development schemes to equip GPs with the knowledge they need to support a trans or non-binary patient throughout the initial referral process. My local GP was extremely proactive in finding out about access to my local GIC in Nottingham, ensured that they carried out all of the baseline tests within a fortnight of having had an initial meeting with them and then made the referral to Nottingham only a few days after the results of those baseline tests. My GP treated me with respect, non-judgement and listened to what I had to say, the same attitude that they would have had with any other patient. My GP may have only had a half-hour time slot to see me in (which was pre-planned by the surgery after I made the phone call to discuss GIC access; the receptionist on the phone was courteous and made no judgement). The nurses were equally empathetic; I remember during one baseline test I had to take off my vest and I was very nervous about doing this (I've never undressed in front of someone to that level since before secondary school) but the nurse carrying out the test put my mind at ease and never once referred to me by incorrect pronouns or tried to insinuate I was an "attention seeker" or "misguided" words you read on social media (luckily for me it's a rare occurrence). The service my local GP surgery provided was exemplary.

There is an increasing belief amongst LGBTQIA+ equality groups such as UK Trans Info that self-referral for GIS should be the norm because there is no real need for a GP to be involved in the initial referral process because it may be the case that GPs who have a bias against non-binary patients in particular may not carry out the referral to a local GIS despite an expressed wish by the patient on several occasions. There needs to be reassurances made by organisations such as the General Medical Council, British Medical Association General Practitioners Committee and The Royal College of General Practitioners that any unwarranted obstruction in access to service would lead to a GP facing disciplinary action as it may contravene the Public Sector Equality Duty placed on GP services by the Equality Act 2010. This should satisfy most concerns regarding the referral process.

I wonder whether private clinics should be necessarily ruled out from providing GIS on the NHS, especially if those private clinics have experienced professionals who deliver GIS on a regular basis. That being said I have concerns about increasing outsourcing of services to private sector organisations; Labour voters would not be happy to see more NHS funding being used to fund private sector treatments on a regular basis. What is important to remember here is that NHS Clinical Commissioning Groups (CCGs) should decide what happens in cases where a patient who has been able to afford private surgical treatment then loses their job and can no longer afford to pay for further treatment. Should those patients be automatically ruled out from consideration? I would argue that private patients should be allowed to access a NHS pathway of surgical treatment provided funding is in place from local CCGs to fund it. No patient should be turned away because they started their transition privately.

I agree with the proposal put forward to allow 17 year olds to access adult GIS in England and for the Gender Identity Development Service for Children and Young People (GIDS) to only accept referrals in future up to the age of 16, provided there is capacity in the system to allow 17 year olds to be seen swiftly. 17 year olds have reached past the age of consent (which is 16) and should have access to medical treatment (e.g. hormone replacement therapy) without facing unnecessary delays. I am concerned by the proposal that GIDS should remain responsible for the care of young people who may have "complex or psychosocial conditions" (it's not clear which conditions are included under NHS England's definition in the proposed specifications but it includes conditions such as schizophrenia, obsessive compulsive disorder and anorexia) which are thought to currently prevent them from pursuing physical interventions. I disagree that all psychosocial conditions must be included within this provision- for example, I am not necessarily convinced that a young trans person with ADHD or anorexia should be prevented from considering surgical treatment unless it could be proved beyond reasonable doubt that such treatment would exacerbate the problem. I think that these young trans and non-binary patients should take part in the decision making process when it is clear they have the mental capacity to be able to engage in the process.

Family members should only attend appointments when a trans or non-binary patient has specifically requested they attend with them; clinicians should not be allowed to demand a family member attend an appointment, even if they attempt to justify this on "emotional" grounds. A family member should never be asked to consent on behalf of the patient; a patient who has reached the age of consent (16) should be trusted to make their own decision. Never pressurise a trans or non-binary patient to bring someone with them; they may not have talked about their change in gender identity with family or friends before attending the GIC.

I am sympathetic to the proposal to reduce the number of clinical opinions needed to approve GRS to 1. I understand NHS England's concerns that a Registered Medical Practitioner should be the main clinical opinion sought during the process because they will have access to the patient's current and past hormone therapy data and be able to give their opinion regarding suitability for surgery. However I am also interested in hearing more about the proposal put forward to by the Clinical Reference Group for Gender Identity Services which states that no Registered Medical Practitioner opinion is necessarily needed because the specialist surgery team would examine patient history once they have been admitted into the unit.

I am extremely pleased to note that there is a firm commitment to ensure that all GIS will be available to non-binary and gender-fluid patients should they wish to have access to them, including surgical interventions.  Patients definitely have the right to self-expression ("personal autonomy") of their gender identity and presentation/ expression and also be referred to by the correct pronouns and names throughout the process. Regardless of these positive changes, it must be recognised that not every non-binary or gender-fluid person wants to have hormone treatment or surgery and should still have the right to self-identify and legally gain a Gender Identity Certificate without having to go through GIS or to "prove their identity" by going through a panel. Those legal changes are going to be discussed once the results of the national LGBT survey commissioned by the Secretary For Women and Equalities, Justine Greening, have been collected, collated, analysed and evaluated. I think we will all be interested in those findings when they are published (I am presuming this will be early 2018 at the latest).

The 12 month "Lived In Experience" requirement for GRS does seem rather an outdated concept to me personally. Most trans patients will have spent more than 12 months in their acquired gender before they even get to the GRS consultation stage and any consequences that come about as a result of GRS would only occur once the GRS has been undertaken. There is also no way of determining an objective assessment of  what the typical "Lived in Experience" is for a non-binary person so non-binary patients who wish to undertake GRS may be barred from accessing GRS based on not fulfilling the current requirement; this contradicts NHS England's stated aim of making GIS equitable for non-binary patients.

It's great to read that there has been a call for applications for more research on GIS from the National Institute for Health Research (June 2017). Improving the objective evidence base may mean that GIS will be commissioned that better meet the needs of patients and if some of the final reports are then made available in the public domain, we will all have a better understanding of how to provide the best level of care and support to trans, non-binary, gender-fluid, genderqueer and agender patients as well as helping to promote self-care where appropriate. That can only be a good thing.

As of yet I am undecided regarding the best prescribing arrangements for hormone replacement therapy for trans, non-binary genderfluid and genderqueer patients. At the moment, the specialist team based at the GIC will assess a patient's needs on an individual basis and then pass on the information to the patient's GP who then take full responsibility "for prescribing and administering the medicine (and to perform standard pre-treatment physical monitoring and laboratory investigations)". There are 3 alternative models that have been suggested regarding the prescribing arrangements for trans, non-binary, genderfluid and genderqueer patients. These are:

• "A specialist team based at the GIC being responsible for issuing the first prescription" with the data relayed to the patient's GP who takes on responsibility for prescribing then onwards (Option B)
• A specialist team based at the GIC issuing prescriptions for 1 year "or until the patient's endocrine treatment has been stabilised" with the GP prescribes from then onwards (Option C)
• A specialist role being developed for GPs at a Clinical Commissioning Group level (or Sustainability and Transformation Plan level in the future if they get approved) with that dedicated GP issuing prescriptions "for all relevant patients in the area on the recommendation of the specialist team" (Option D). 

UK Trans Info (who have far more collective experience of advocating for better trans, non-binary, genderfluid and genderqueer healthcare than myself) have argued that the best model for providing HRT would be Option D because it "allows for the most efficient treatment of trans people in an area without requiring excessive amounts of travel" (http://uktrans.info/nhsconsultation2017). The consultation document does flag up the concern that some trans, non-binary, genderfluid and genderqueer patients may be asked to travel to a different GP practice than their own for the HRT, which may be difficult because they may not have the money available to allow them to travel, especially if they are unemployed. I cannot see a situation where the NHS would be able to routinely help with the costs of travel incurred, especially under the current funding constraints.
However, it must be pointed out that travelling to the local specialist GP's surgery would probably be cheaper and less time-consuming than constantly travelling to the GIC for a year (Option C). The consultation document does also point out that there may be issues trying to attract local GPs to consider taking up the specialist role, which "risks an inconsistent and inequitable approach to care"; will there be enough specialist GPs in rural counties such as Lincolnshire? Lincolnshire would need more than one specialist GP with it being the second largest county in England; one would need to be based in Lincoln to cover North and Central Lincolnshire with another based in Grantham or Boston to cover South Lincolnshire. There may be an issue with succession planning in the future too; what would happen if a specialist GP decided to relocate or retire and there aren't any qualified specialist GPs to take their place to allow for a seamless transition in prescription care? Patients would not accept a lengthy delay in receiving their HRT. 

That being said, Option D could be a blueprint for helping to develop local expertise and GPs in the local area may learn "experientially" about trans healthcare and endocrine management, which would be very beneficial in the long term; in fact, as specialist GPs become more experienced, they may be able to "take on more of the clinical services currently provided by GICs" but it is acknowledged that more funding would be needed to facilitate this decentralisation of services. 

UK Trans Info has pointed out that there may be long waiting times for patients and have argued that GPs should be able to give out bridging prescriptions if it takes more than 18 weeks for that specialist to issue the first prescription; the General Medical Council guidance issued last year recommending that GPs offer bridging prescriptions in exceptional circumstances (if they have been self-medicating or to reduce the risk of self-harm or suicide). UK Trans Info agrees with the GMC guidance and believes that any trans, non-binary, genderfluid, genderqueer or agender patient that has been self-medicating when they approach their GP should not be told to stop as is currently the case; instead there should be a bridging prescription made available, with regular monitoring of those trans and non-binary patients who have self-medicated in the past. Not ever GP will feel comfortable with the idea of offering bridging prescriptions without seeking specialist advice and guidance. Zara Aziz, a GP partner in a practice based in north-east Bristol wrote a recent article in The Guardian where she argued that whilst GPs are specialists "in prescribing and monitoring in many clinical areas that ...(they) commonly encounter or that...(they)...have developed an interest in", they do not have such awareness with regards to giving holistic care to patients and it could lead to an increased risk in the number of "complaints and litigation against family doctors", pointed out in guidance provided by the British Medical Association's General Practitioner Committee. Dr Azis argues that handing over most of the responsibility for specialised care to GPs in regards to GIS could lead to other specialised care responsibilities being given to GPs, stretching their time and money further. Dr Aziz wants to see the NHS "commission a robust and accessible GIC locally that can support patients and GPs alike" which would have a multi-disciplinary team in place to provide a holistic service.

I think it is important that specialists make it crystal clear to patients that they may experience a loss of fertility and that they may be able to freeze sperm or eggs but only if their local CCG agrees funding for this; patients cannot demand this service at the moment and it is unlikely that funding will made available in every CCG any time soon.

It's pleasing to see a requirement in the specifications that surgeons must perform a minimum of 20 procedures a year that have been commissioned from the provider and that surgeons are required to demonstrate evidence of Continuing Professional Development and engage at least once a year with their fellow surgeons to share best practice. This group of surgeons will then publish an annual report with data on caseload, outcomes and any complications that have resulted from surgery.

If a trans or non-binary patient requires treatment for complications that have arised as a result of surgery will be able to have treatment provided for up to 18 months after the surgery has taken place; the original surgeon will perform the new surgery.
If a patient does not want to continue treatment with a particular surgeon, they will be referred by the surgeon directly to another surgeon working in a NHS England commissioned surgical unit. The choice of surgeon will be discussed and agreed with the patient.

The Equality and Inequalities Impact Assessment: 

The Equality and Inequalities Impact Assessment identifies a number of areas that have been addressed by NHS England in order to improve trans and non-binary patient care:

• Front-line staff need training to be able to treat trans and non-binary patients with respect, including making sure that trans patients are not placed on the wrong sex ward in hospitals and are not excluded from screening programmes. NHS England have decided to "undertake an initial scoping and feasibility study" to address concerns, focussing on "non-specialised services such as gynecology and voice and communication services" that form part of the NHS pathway of care within NHS England's service specification. The data and recommendations made as a result of carrying out this project will then be used to assess how changes can made "across NHS services more generally".
• The proposed specifications do not have an upper age limit for non-surgical and surgical inventions which means that any patient who wishes to be referred to a GIC should be able to receive treatment when the specialist team prescribes it.
• Patients with communication difficulties as a result of co-existing complex physical or mental health conditions or as a result of a learning difficulty (I prefer the term difference) will require additional support from GICs and from their GP. The EIA makes it clear that in both specifications, a tailored individual treatment plan will be provided and allow for "additional assessment consultations" and "additional support services" when appropriate.
• The EIA confirms that patients with a Body Mass Index (BMI) of more than 30 (for genital surgery) will be required to lose weight unless a surgeon has approved surgical invention once a risk assessment has been carried out.
• Trans patients with HIV would have "consistent access to the range of available interventions" which would lead to "more timely assessment, diagnosis and treatment".
• A patient's history of substance misuse would be a factor in determining access to treatment; those with a current addiction to non-prescribed drugs and alcohol it would seem would find it more difficult to access treatment but it's not clear from the consultation document how long a patient would need to be "clean" before being allowed to access non-surgical and surgical treatments.
• There is an under-representation of BAME trans and non-binary people attending GICs and I agree with the EIA conclusion that GIS must be delivered in a culturally appropriate way. I hope that NHS England will take the time to consult with patients and organisations representing the trans and non-binary BAME community to come up with specific recommendations as to how GIS can be made more accessible, including designing training for frontline healthcare professionals to follow. It is good to see NHS England make a specific commitment to improving their data collection procedures to ensure full compliance with the Equality Act Public Sector Duty.
• It's interesting to note from the consultation document that the Trans Mental Health Study (2012) found that most trans patients have no religious affiliation (62%) but out of the remaining 38%, 20% of trans patients identified as Christian. Data Collection carried out by NHS England from GICs in 2016 had the number of patients who had no religious affiliation at 61% and those who were Christian at 21%. Only 35% of patients filled in the "Religion and Belief" field. Despite this, there must be Chaplaincy services available to those trans and non-binary patients who require "pastoral or spiritual care" regardless of their religious belief.
• The proposed specifications should not discriminate on the basis of sexual orientation and frontline healthcare professionals must not pry into a patient's sexual history because it is irrelevant for non-surgical and surgical treatment processes. Where a patient actively chooses to disclose their sexual orientation, this information must be kept strictly confidential.
• GIS must be inclusive and accessible to patients who may not be registered with a GP. It can be difficult for certain patient groups to register with a GP; e.g. a homeless patient has no fixed address and a sex worker may have no proof of address or identity and may be excluded from registering with a GP based on this. NHS England believes that patients must be registered with a local GP because they are currently best placed to "offer healthcare support", prescribe drugs and monitor treatment, especially once "contact with specialist teams has reduced or come to an end". They reiterate that GP surgeries cannot refuse to register a patient because they do not have personal information to hand (there is no statutory requirement to request this). Therefore, patients currently not registered with a GP should be encouraged to register if they wish to access GIS.

The consultation document also identifies other areas NHS England needs to take into consideration. Many trans and non-binary GIS patients have stated publicly that waiting times for initial appointments are far too long. For an initial appointment with Nottingham GIC for example, I was told that 18 months was the standard waiting time and since I was referred in April 2016, I will probably not receive an appointment letter until early 2018 at the earliest. These waiting times are in breach of the NHS Constitution but NHS England insists that the proposals made in this specifications will go some way towards addressing the waiting time issue and that they will focus on recruiting more specialist staff in the future to relieve pressures. James Palmer, in his first blog as the Senior Responsible Officer for GIS (https://www.england.nhs.uk/blog/we-are-meeting-concerns-on-gender-services/) states openly that the 18 Week Referral to Treatment standard will be monitored "throughout the entire trans pathway" with "regular consistent reporting" beginning from 2018 which will allow for "absolute transparency about waiting times".

NHS  England also noted in February 2016 that they had a "shortage of suitably qualified staff" (http://www.bbc.co.uk/news/uk-england-35605956) but recruitment and retention of talent is flagged
up as a continuing issue at the beginning of the consultation document. Unless NHS trusts find a way of encouraging more qualified staff to join English GIS, waiting times may remain stubbornly high.

The consultation document doesn't specifically address access to services for trans and non-binary patients who are in the criminal justice system. Current evidence states that trans and non-binary prisoners are "routinely segregated" on secure prison wards and denied gender-affirming products whilst in prison which means they are less likely to fulfill the current "Lived In Experience" requirement for surgery. The Department for Justice released guidance (Prison Service Instruction) to prisons on the issue of access to healthcare for trans, non-binary and intersex prisoners which was issued in November 2016 and which came into force on 1st January 2017 (https://www.justice.gov.uk/downloads/offenders/psipso/psi-2016/PSI-17-2016-PI-16-2016-AI-13-2016-The-Care-and-Management-of-Transgender-Offenders.docx). The policy specifically states: "Establishments must ensure that prisoners who have been diagnosed with gender dysphoria have access to the same quality of care (including counselling, preoperative and post-operative care and continued access to hormone treatment) that they would expect to receive from the NHS if they had not been sent to prison." If a prisoner has attended a GIC and has been receiving non-surgical treatment and signals their desire to carry on with their treatment, "it should be continued until the prisoner's gender specialist has been consulted on the appropriate way to manage the prisoner's treatment unless the doctor working in the prison has reasonable clinical grounds for not doing so."

The policy also states that access to private health clinics for prisoners is restricted: "there must be sound and demonstrable clinical reasons for allowing access to private health services. There must be evidence that this will improve the health of the individual and is not based on uninformed personal choice".

When a trans, non-binary or intersex prisoner signals an intention to begin hormone replacement therapy for gender dysphoria, the prison health care team have a responsibility to inform the relevant Clinical Commissioning Group and "request a point of contact for liaison". When a prisoner wishes to undergo GRS, the prison GP must liaise with a consultant directly to accept advice from them. The Governor may also "prepare a report to the consultant as to the practical impact within a prison context" of the prisoner recovering from GRS. The consultation document and specifications do not give guidance on how the referral process for trans and non-binary prisoners may differ as a result of a prison Governor's report intervention, for example. 

What's been made clear in the consultation document is that NHS England will not provide surgical and non-surgical treatment to patients whose presentation "primarily relates to intersex conditions" (aka disorders of sexual development) who have expressed a desire to have surgery through the future GIS. This may be because NHS England believes that a standard treatment pathway may not fully take into account specific needs of intersex patients. UK Trans Info have argued that intersex patients should have full access to non-surgical and surgical treatment when they have expressed a wish to undertake such treatment but that they should not feel forced or coerced into undertaking any treatment correctively. They also point out that whilst not most intersex patients will not identify as trans, there are some intersex patients who do publicly identify as trans or non-binary; are they going to be denied access to non-surgical and surgical treatment entirely? If such services are not going to be provided through GIS, where are trans and non-binary intersex patients going to have access to non-surgical and/or surgical treatments? When will NHS England unveil this alternative pathway? How much longer would trans and non-binary intersex patients have to wait to be seen by specialists?Would specialists in the alternative pathway  have the contextual knowledge to treat trans and non-binary intersex patients with true respect and dignity? These questions need to be answered and I think a review of intersex patient healthcare is timely and necessary so that healthcare professionals and the public alike understand clearly what will happen.

An interesting response to the NHS Consultation : 
Not every organisation is in favour of engaging with the NHS consultation; the main reason being that they do not believe that the current GIS system is acceptable in any way whatsoever. The Edinburgh Chapter of the Action On Trans Health organisation have released their own "Trans Health Manifesto" (https://edinburghath.tumblr.com/) designed to revolutionise the way that trans and non-binary healthcare is delivered: "we demand nothing less than the total abolition of the (Gender Identity) clinic, of psychiatry and of the medical-industrial complex". Instead, there would be:

• universal access to hormones and blockers through free prescriptions so that trans and non-binary patients can self-medicate
• access to therapy at drop-in clinics or through self-referral
• anonymous blood tests with equipment being delivered through "post or at drop-in endocrinology clinics"
• an end to surgical prerequisites with access to tailored surgery, including access to reversal surgery on demand
• resources for hair removal of any kind 
• voice coaching that doesn't "coerce us to alter our voices in ways we do not express a need for"; such coaching should respect accents 
• medical training so that self-medicating trans and non-binary patients can carry out research in order to "improve the quality of medications" and "reduce negative side-effects in the long term"
• create research centres and libraries which are organised for and by trans patients with "full funding" being made available for any projects carried out

The initial concern here again would be with funding; how much would it cost to fund the surgeries required, the research collectives and the medical training. Even with the money saved from shutting down GIS (which I am concerned about), I suspect there will be not enough funding available to meet such demands. There are other aspects of the vision document which do not sit well with me, including revoking the medical licences of GIS staff, who are on the whole extremely hard working and passionate and whose knowledge and skills would be needed to help direct training to aid research anyways. There are other elements of the vision statement that I agree with, including the mandatory education about trans and non-binary issues that should at least involve trans people and organisations and the demand for accessible, high quality housing  for trans and non-binary people who find themselves unemployed or on in-work benefits. Anyways read the document for yourself; it's thought provoking! 

Conclusion:

The two draft specifications that have been offered by NHS England are broadly speaking to be welcomed; there are proposals which will help to provide better standards of patient care for trans, non-binary, genderfluid and genderqueer patients. There is a commitment to reviewing waiting times, a commitment to treating non-binary, genderfluid and genderqueer patients with respect and dignity and for most 17 year olds to access adult GIS so they can begin HRT as soon as possible. There are issues with the specifications with regards access to treatment for patients who have a mental health condition (there needs to be clarity regarding what mental health conditions would necessarily preclude a trans, non-binary, genderfluid or genderqueer patient from being able to go through HRT or GRS). There needs to be much more clarity regarding intersex patients who also happen to be trans or non-binary and their access to GIS. There needs to be a review into surgical procedures that can be offered on the NHS, including the ability to access corrective surgery including when complications have arisen after the 18 month time-frame. The Lived-In Experience requirement needs to be reviewed for effectiveness; if it's impossible to quantify what constitutes what is a "normal" experience for a non-binary person, there's no way a non-binary patient can fulfill the requirement and can therefore not gain access to GRS should they require it. Equally, there is no real way to be socially a man or woman that isn't rooted in gender stereotypes; a trans man can still wear dresses occasionally if they choose even if this isn't typical of all men and this should not impact in any way the validity of that trans man.  As UK Trans Info have pointed out, the Lived-In Experience requirement may also be seen as patronising; do trans people need to be taught about the consequences of transitioning? Prescribing service provision needs to be agreed with the consent of all stakeholders involved; Option D may be the ideal but there may be pushback from CCGs in certain areas of the country who believe there can be no special GPs allocated to become specialists in prescribing and offering specialist care and support to patients. I look forward to seeing the results of the survey and conclusions and recommendations drawn and hope that NHS England will be proactive in reviewing and addressing areas of concern within the specifications. Then perhaps we will begin to see GIS that truly provides the highest standards of specialised and effective patient care across England. 

Stonewall School Report 2017: What Needs To Be Done To Make Our Schools Truly LGBT+ Inclusive

This morning there was the release of Stonewall's 2017 School Report, research that had been conducted by the Centre for Family Research at the University of Cambridge. The report provides a vital snapshot into the experiences of LGBT students, with 3,713 participants having responded to
an online questionnaire covering areas such as language, wellbeing and mental health and Internet and Social Media use. The School Report indicates that there has been improvement in schools tackling homophobic, biphobic and transphobic (HBT) bullying: the percentage of HB bullying has decreased from 55% in 2012 to 45% in 2017 and 50% of students hear homophobic slurs "frequently" in the classroom environment, which is down from 70% in 2012. However, the percentage of students who have experience transphobic bullying remains worryingly high, with 64% of respondents stating that they had been bullied on the basis of them being openly trans. 57% of non-binary pupils have also stated they were being bullied for being open about their identity. The question is, how do schools help to create an environment that is truly inclusive, where teachers, support staff and students feel comfortable enough to be open about their gender identity and sexual orientation and whether students have the awareness needed to act as responsible global citizens who are tolerant and respectful of differences?

HBT Bullying and Language:

It's pleasing to see that some progress has been made towards address HB bullying; 70% of LGBT+ students have said that their school has openly stated that HB bullying is wrong, a massive increase from 25% in 2007. However, only 41% of students reported that their school had openly stated that transphobic bullying is wrong. This is unacceptable and there needs to be a change in attitudes in schools that makes it clear that transphobic bullying under any circumstances is wrong. In order to explore why I believe it is wrong, I feel it's necessary to reflect on my own experiences whilst at secondary school in the early and mid 2000s.

I was extremely lucky to attend the Priory LSST (now The Priory LSST Academy) that had an inclusive culture in place which included a zero-tolerance attitude towards bullying of any kind. I did experience name-calling  (the usual gay being used as a slur, camp hand gestures because the pitch of my voice was higher than others in the year, being called he-she/fag/tranny etc) on a systematic, weekly basis from a group of specific individuals but because I wasn't openly calling myself trans non-binary at the time, I didn't feel I experienced any specific name-calling and bullying that directly targeted my gender identity at the time. I now realise that they were bullying me because of aspects of my identity and I didn't deserve to be subjected to it. You are who you are. I was personally afraid to be open about my feelings because I thought I'd been perceived as "mad" by my friends but the signs that I didn't perceive myself as being male were there: I'd never take my vest off in the changing rooms for fear of being stared at by my peers and I always felt uncomfortable being referred to in the third person or as a "boy", insisting they use my name instead. I always insisted on playing a female role in Drama lessons and whenever I created my own characters, they were always female. I have met friends who are non-binary who carried out similar actions at school without explicitly coming out as non-binary. It may have been because the words "trans" or "non-binary" were never used at school and my parents never used them at home either. Instead my Mum always referred to me as "different" and just loved me for who I am.  Again, that's me being fortunate and lucky but it's still sad to see that 40% of respondents to the survey say they can't speak to a parent about LGBT+ issues.

The name-calling I've described above was on top of the name-calling I received due to my short stature and the way I moved due to my dyspraxia (a disability affecting hand-eye coordination). For example, I was regularly called "Colleywobbles" because of the way I walk (my feet are misshapen and face outwards as result of how my feet developed whilst I was at primary school). The School Report figures have revealed that disabled LGBT+ young people are more likely to experience HBT bullying than non-disabled LGBT+ ones (60% as compared to 43%). This is not acceptable and teachers need to support disabled students who are bullied for both being LGBT+ and for their disability. That means reiterating that they are available to have confidential conversations and take action against the bullies as soon as possible, making good on the commitment they have made openly. You see most of the teachers at the school reminded us that we could confide in them privately if we had been name-called on a systemic basis but I never felt I could talk to them fully about my gender identity or sexual orientation because no action was ever taken to rebuke HBT bullies. That in addition to there being no teachers and support staff who openly discussed their gender identity or sexuality in the classroom made me feel as if I'd never be understood and helped in any other way than academically. I was always speaking to my teachers before and after class but this was almost exclusively on academic issues- whether I could make a good teacher when I finished my education, whether Henry VIII really loved Anne Boleyn, whether 2+2 =4 etc etc. I never spoke to them directly about the bullying I experienced as a result of my disability because I don't think many of them knew what the definition of dyspraxia really was and adding my feelings of gender dysphoria into the mix, it made me a very shy but supposedly "gifted and talented" child. The School Report shows that students still feel wary about talking about the HBT bullying they experience: 45% of students say they've never told anyone about the bullying, with 63% stating that "it's not easy to talk to anyone". With teachers not talking about LGBT+ issues, I'm not surprised at these figures.

What was effective at the Priory LSST was the  "anti-bullying champions" Prefect system, created to help foster a zero-tolerance culture against bullying in all its various forms. Such champions (drawn from Year 9 through to Year 13) would befriend and hang around with Year 7-9  students who may have been perceived as "different" by others and be open to homophobic, biphobic and transphobic bullying. I remember an instance of homophobic bullying that occurred in an English lesson where I walked in on a group of three (rather nasty) Year 10 boys picking on my fellow Year 8 friend, calling him a "pansy", a "nancy-boy" and a "groper", falsely accusing him of having touched one of them on the bottom. It turned out that aforementioned Year 8 friend had tried to get past the boy in question and his schoolbag happened to brush past him, making contact. A Year 11 anti-bullying champion happened to be in the vicinity of the classroom and stopped the boys from gesturing and name-calling, managed to get some initial witness statements from those in the classroom and informed the teacher promptly when he arrived. Luckily the Year 10 boys were the only ones to end up facing punishment (I later heard they'd been given detention for a week) and they were made to apologise to my friend for their behaviour. So you see, anti-bullying champions can really make a difference to the school environment and the more of them that are trained in having the confidence to help LGBT+ students, the better; the School Report reveals that only 41% of LGBT+ students had seen their peers intervene to stop HBT bullying which is still more than the 22% of students who had seen teachers intervene.

I realise my school's attitude towards HBT bullying in the early 2000s seems rather proactive in hindsight. I've spoken to LGBT+ friends whose school experiences involved sustained stalking, systematic abuse and harassment and in one case, sexual assault. The School Report states that 7% of LGBT+ students have been the victim of physical bullying, with trans students twice as likely to be a victim than LGB students who do not identify as trans (13% compared to 6%). Any physical act of violence shown towards a LGBT student should be recorded, with the perpetrators removed immediately from the classroom and reported to the police if the act has resulted in the LGBT student sustaining injuries (i.e. a crime). Perpetrators should also be appropriately disciplined, whether that involves detention, temporary suspension or exclusion. Schools must be a safe environment for all pupils, including those who openly identify as LGBT+. The School Report shows this is not yet the case: 19% of LGBT+ students stated that they do not feel safe at school, 9% of trans students stated that they have received death threats whilst at school, 3% have experienced sexual assault and 4% have been threatened with a weapon. That shocks me to my core. Why is it the case that students feel emboldened to threaten their trans peers (open and not) with knives or sexually assault them?

Attitudes need to change amongst the teaching establishment as a whole. Teaching unions are leading the way in encouraging teachers to support their trans students and headteachers need to make it crystal clear that teachers have a duty to tell their students openly that transphobic bullying and language is wrong in any context. Not addressing transphobic language, attitudes and bullying when students are at secondary school does lead to those students entering the working world still believing such attitudes are acceptable when they are not. Transphobic discrimination in the workplace is illegal under the terms of the Equality Act 2010 (protected characteristic of "gender reassignment surgery" applies to employees who are intending, are perceived as intending or going through such surgery) and if a transphobe has committed a criminal offence, they may be prosecuted and convicted of carrying out a hate crime (Parliament has passed legislation in the Legal Aid, Sentencing and Punishment of Offenders Act 2012 that means that offenders can receive tougher sentences if prosecutors can provide evidence of that offender having hostility towards trans people). We want to reduce instances of transphobia in society in general and teachers and support staff need to play their part in this.

I'm concerned to read in the School Report that teachers and support staff are not routinely challenging HBT language when they hear it in the classroom; 68% of respondents say they've very rarely or never heard their teacher "sometimes" challenge those students who are using HBT language. Teachers and support staff must have the confidence to explicitly state the language is wrong and if they do not believe themselves that the words being used ("tranny", "fag/faggot", "he-she", "shim" etc are are wrong, they desperately need to go on a diversity training course as part of their Continuing Professional Development (CPD) to learn why those words cannot be condoned in any form and if they can't get to grips with that, they genuinely need to question whether the teaching profession is right for them when they feel they cannot protect all students within their classroom. Enough of bigotry and enough of silent acceptance. Stand up and support your LGBT+ students.

A zero-tolerance approach across the school environment to HBT bullying is essential and headteachers should review their bullying policies to ensure that they are fit-for purpose. Headteachers could discuss their policies with organisations such as Stonewall and take on-board suggestions made. They must also ensure that all teachers and support staff at the school sign up to the policy and promise to implement measures when they observe HBT bullying in the school environment. If teachers fail to take necessary action and refuse to take part in attending training courses, disciplinary procedures must followed and if teachers are found to participate in HBT bullying in any way, disciplinary procedures must be enacted as soon as the report has been received. Headteachers must explicitly state that transphobic bullying and language use is wrong. The School Report reveals that in schools where this has happened, trans students are less likely to worry about bullying and more likely to report it and are twice as likely to "rarely" or "never hear" transphobic language at school.
Most importantly, headteachers should openly support LGBT+ equality; only 19% of students said they'd heard their headteacher talk about it. Part of supporting LGBT Equality is to encourage the setting up of LGBT+ group for students that meets once a week to allow students to socialise and to discuss the issues that affect them. A representative from the group should be on the school board to discuss the concerns raised with the headteacher. The benefits of the group are that LGBT+ students are more likely to feel part of the school community and are having their concerns addressed. There's no extortionate expense to setting up the group and it can actually lead to real change in the culture of the school environment. That can only be a good thing.

Accommodating Trans and Non-Binary Students: 
I think it's essential that schools take a positive approach to helping students who have disclosed to them that they are trans and non-binary:

• student confidentiality must be respected; I'm happy to read that when trans students disclose their status to teachers, 75% of them ask about how best to support them but it's not acceptable that 19% of trans students have stated that their teachers did not respect their wish for anonymity. No teacher should disclose a student's gender identity without permission because such disclosure could lead to them becoming subject to bullying. The choice to publically disclose is the trans student's alone. 
• teachers should have a basic idea of when to signpost trans and non-binary students for further advice and support: 60% haven't been provided with any advice and guidance, such as which organisations they can speak to (Mermaids is one dedicated organisation that all trans and non-binary students can be referred to). 
•  trans and non-binary students should be allowed to use the bathroom or changing room they feel comfortable using; if a student has openly disclosed their status and have indicated which bathroom and changing room they wish to use, they should be accommodated wherever necessary and dispel any stereotypes being perpetuated by students (e.g. a pre-op trans female student isn't going to flash their penis).
• trans and non-binary students should be referred to by their preferred name and pronouns, with registers being updated to reflect this; 33% of trans students report that their school keeps using their dead name rather than their preferred name.
• trans and non-binary students should be able to wear the uniform they feel comfortable in; 20% of students are still being told they cannot wear the uniform that reflects their gender identity. 

These 5 actions need to be taken if schools are to be truly trans and non-binary inclusive.


LGBT Teacher Recruitment: 

There is far more that educational establishments can do to try and reduce instances of trans bullying; for example, incentivising the recruitment and retention of trans and non-binary teachers in state-maintained schools would help provide a number of positive role-models for students to identify with, regardless of their own gender identity or sexual orientation. The report states that there are no figures for students who knew trans members of staff in school; it's bad enough that only 4% of respondents to the School Report knew they had an openly bi member of staff in their school! Bi and trans visibility in the teaching professions remains stubbornly low, with graduates being put off pursuing a worthwhile career because they feel they may be openly discriminated against on the basis of their gender identity and/or sexual orientation. Universities who run PGCE courses and schools participating in teacher training programmes should proactively counter and challenge the narrative that schools are not trans and non-binary inclusive and reach out to LGBT+ societies on campuses to encourage students to consider volunteering in schools to explore teaching as a viable career option. I would have dearly loved to have become an English and Philosophy teacher but I found it very difficult to find a volunteering opportunity after I graduated in 2010 to gain the necessary experience needed to have a chance of having my teacher training application approved and I don't want other trans and non-binary graduates who have achieved the necessary qualifications to go through the same experience.

Sex and Relationships Education:

The School Report findings back up recommendations made by organisations such as the Terrence Higgins Trust that Sex and Relationships Education (SRE) is needed in schools that is at least LGBT inclusive (I'd like it to be non-binary, queer, intersex and asexually inclusive too): 40% of respondents revealed they are not being taught anything about LGBT issues at school, 76% haven't learnt anything about bisexuality in school and 77% have not been taught about gender identity and so have no idea what being "trans" means. Only 20% of LGBT students overall and 10% of faith school students had been given any advice and guidance on same-sex relationships. 13% of LGBT students have been taught about healthy same-sex relationships and only 20% of students have learnt about consent in same-sex relationships. 17% have learnt about violence or abuse in relation to same-sex relationships. Given that the primary duty of an educational establishment is to impart vital information to students so they can appreciate the diverse world in which we live, the fact that students are still leaving school without any understanding of gender identity, healthy same-sex relationships, consent and domestic abuse and violence is quite frankly shocking.

It is important that SRE guidance provided to schools is appropriate, written by SRE experts with input from LGBT people to inform lesson planning. Whether SRE would be delivered by the same teacher who has responsibility for Personal, Social, Health and Economics Education (PSHE) or whether it will be a teacher with a background in social sciences or the Arts is not yet clear. I would love for there to be a specific PGCE pathway to be created that allows for applicants to train in PSHE and SRE as their main specialism but embedding SRE into existing PGCE and teacher training programmes could be a way of ensuring teachers are equipped to teach the subjects when required to do so. I'd rather foster a passion for SRE and PSHE; if teachers are engaged with the subject material, they can impart that information in a lively and enthusiastic way and students may be more likely to retain the information years afterwards.

Current PSHE must include the basic information on LGBT+ issues; it's embarrassing that some students are leaving school with no idea that gay, lesbian and bi people can get married (58% of respondents said they've never been taught about same-sex marriage or civil partnerships).

Another aspect of the School Report that concerns me about the current curriculum is that only 20% of LGBT pupils are being taught about safe sex in same-sex relationships. There is an argument put forward that teachers do not have the time or the resources available to them to be able to teach their students about all forms of safe-sex. At my secondary school we received no direct sex education that was LGBT inclusive (hence why I had no idea that trans people existed) and the only sex education we did receive was delivered in a half-an-hour Biology video in Year 9, a series of worksheet based lessons that followed on from that video and a Year 11 hour lecture delivered to the whole year group with the instructor talking about how to put a condom on the banana. Not very instructional or reassuring (good job I haven't shown much inclination for sexual activity anyways!) I believe that sex education in schools must include helpful information on same-sexual intercourse free from judgement. It's embarrassing that young people are being left to learn about same-sexual intercourse online and are being taught that it shouldn't be talked about; silence is sending out a signal that same-sexual intercourse is still "wrong" when in-fact it is far from being wrong.

However, having strong SRE and PSHE provision isn't really enough. The National Curriculum as a whole should have a focus on LGBT+ acceptance and encourage students to take an interest in LGBT+ issues and admire LGBT+ role models. Only 25 of LGBT students reported that they had discussed LGBT+ issues in English or Geography. Embedding LGBT+ awareness into PGCE courses beyond the Equality and Diversity requirement is key. Why not talk about Lord Byron as a bisexual in English Literature lessons? Why not celebrate Alan Turing as a gay role-model in Science lessons? Students in GCSE Religious Studies lessons already learn about marriage and divorce and various religious and ethical views on sex, so why not devote a lesson to discussions of gender identity, with reference to a range of religious views (OK some of those views are far from accepting but they have been openly stated-e.g. Pope Francis talking about the "ideological colonisation" which is nonsense btw)? Discussions about gender identity should take place but in a respectful manner. The individual responses quoted in the report which talk about positive experiences of embedding LGBT+ issues into the curriculum speak for themselves; Sadie mentions that she discussed work by Oscar Wilde and Audre Lorde whilst studying A-Level English Literature; how amazing it would be if engagement with LGBT+ authors, poets and playwrights happened at Key Stages 3 and 4?

Wellbeing and Mental Health: 

We need a comprehensive approach to help deal with the mental health crisis affecting our LGBT+ students in schools. The name-calling that I received systematically from my bullies in the early years of secondary school (it fizzled out by Year 10) made me feel anxious and worried about being truly myself. I remember numerous school days which ended with me coming home, running to the toilet, locking the door and crying for an hour or two wondering what I'd done to deserve such bullying. There were days when I didn't want to go to school to face my bullies and I'd be happy whenever I happened to have the flu or vomiting bug because it meant I didn't need to attend and listen to their vitriol. Yet anxiety is unfortunately not the only mental health condition experienced by LGBT+ students. It's not right that 84% of trans young people who responded to the School Report have self harmed and 45% of them have attempted to commit suicide. The figure for LGB students self-harming is at an unacceptable 61% with 22% attempting suicide. It breaks my heart as an equal opportunities activist to read these figures. No young person should ever have to feel ashamed of their feelings or their identity to the point where they are cutting themselves with razor blades and planning to end their own lives. Labour have a specific plan to help these students, which involves ensuring that every school in England has access to a counselling service, the number of mental health professionals including specialist nurses increasing and the number of school nurses increasing too. The Conservative Minority Government, propped up by an openly homophobic, biphobic and transphobic Democratic Unionist Party have shown very little inclination to make the counselling service immediately available to schools, which I think is a great opportunity missed. PM May promised to protect LGBT+ people in the UK if she were to retain her premiership during the last General Election campaign Pink News interview; she now needs to prove that her words are worth more than the computer they were written on. That means providing investment in school counselling and pushing forward with plans to make mental health services more accessible to young people who are self-harming. Organisations such as Mind and the LGBT Foundation have specific programmes in place to help LGBT young people; for example Mind has their online Elefriends community which has currently 50,000 members who help each other talk about their condition free from judgement and if a similar scheme were to be brought in specifically aimed at 12-18 year olds and curated and monitored by trained professionals, it may help them discuss their mental health in an open way. All teachers should be trained in mental health first aid by headteachers signing their schools up for the "Mental Health First Aid" programme and school nurses should be aware of how to help LGBT+ students with specific health concerns. Schools should liaise closely with Childhood and Adolescent Mental Health Services so that students have access to the specialist support they need as quickly as possible.

Social Media: 

65% of LGBT+ students believe that social media companies would not tackle abuse or remove HBT content when it had been reported by them to those organisations. Young people are spending increasing hours accessing social media content and I believe that Facebook, Instagram and Twitter have a responsibility to carefully filter and curate the content with offensive posts being removed as quickly as possible after being flagged. Whilst I accept that it is inevitable that young people may come across HBT abusive content whilst online (97% of respondents have seen such content), taking robust and quick action when the content is reported might increase confidence and trust in online platforms which would be a positive outcome.

There is a problem with Social Media trolling at the moment and I believe that it needs to be addressed in a robust, comprehensive and rigorous manner. 40% of respondents to the survey indicated that they had been a direct victim of HBT abuse carried out by trolls, including 58% of trans respondents. With digitalisation has come new forms of abuse and it's worrying to read that 6% of LGBT+ students have been photographed or filmed without their consent and 3% of students have had social media accounts created by abusers pretending to them to get them into trouble. 75% of students who have been bullied online did not reported the abuse to the platform. That demonstrates a lack of trust in online platforms to tackle HBT abuse.  I also believe trolls need to be blocked from accessing the platform entirely if evidence has been found to indicate sustained stalking and trolling of young people's social media accounts, with them being reported to the police for appropriate action to be taken.  Stonewall has recommended that social media platforms consult with organisations to improve their reporting procedures but I also believe that clearer signposting needs to be made available online to victims of HBT abuse and bullying so they access the help and support they need emotionally to deal with the after-effects of that abuse; you'd think in 2017 that Facebook would be able to send a message to victims that had details of organisations such as Stonewall or the NSPCC given that they already have online websites, Facebook pages and Twitter accounts with contact information on.

We must also beef up Internet Safety lessons in primary and secondary schools at all key stages within the National Curriculum further so that students gain the confidence needed to report content and trolls because they understand it is part of keeping themselves safe whilst online. Such lessons would also protect LGBT+ students from becoming victims of abuse online perpetrated by padeophiles. The Dare2Care campaign, established by Sarah Champion, MP for Rotherham and Shadow Secretary of State for Women and Equalities has a recommendation within their National Action Plan that calls on teachers and support staff to be given training on a regular basis so they have up-to-date knowledge and awareness of new online platforms, apps and trends. If we are to help LGBT+ students, the training provided as part of a teacher's Continuing Professional Development must be fully LGBT+ inclusive. That may mean the Department for Education commissioning organisations such as Stonewall and Mermaids to design specific courses to help deliver content directly to teachers and other educational professionals; LGBT+ people should be involved in the creation of content to ensure it is truly fit-for-purpose and can give teachers some ideas that they can implement in their own classrooms.

Conclusion: 

The School Report 2017 findings have shown that there is an urgent need for schools and educational establishments to look at their plans, processes and systems to ensure that they are truly LGBT+ inclusive, especially for trans, and non-binary students. Teachers and support staff must continue to have access to training opportunities so they can increase their awareness of LGBT+ issues and develop strategies to help students in their classrooms on an individual basis. Headteachers need to openly talk about LGBT+ equality, take a firm stance against HBT bullying and encourage the setting up of LGBT+ inclusive groups. Schools should work with local Child and Adolescent Mental Health Services to allow LGBT+ students access to counselling. Signposting should be available to students so they can access advice and guidance from organisations such as Mermaids and Stonewall. There should be a drive towards encouraging more trans, non-binary, gender-fluid, genderqueer and agender graduates into the teaching profession. The National Curriculum should be embedded with opportunities to discuss LGBT+ issues and role-models.Most importantly of all, SRE needs to be introduced that is truly LGBT+ inclusive. If I was the Secretary of State for Education, I'd be asking for the creation of a SRE curriculum that can be delivered in all schools and mandating that it will be delivered in faith schools, with lessons already built in addressing LGBT+ issues. Perhaps that may one day be the case. For now we have to make do with the rather wishy washy promise to provide guidance to state-maintained schools and hope that individual schools openly choose to have discussions around safe same-sexual intercourse and gender identity. I only hope the School Report shocks schools into action so they can truly be an inclusive and nurturing environment for ALL students, where they can be open about their gender identity and/or sexual orientation and respected for their openness.