Abigail Thorn, actor and writer of Philosophy Tube, posted a video two years ago about her (awful) experiences of the NHS. The short version: she demonstrated how the NHS is institutionally discriminatory towards trans people. So I imagine she was quite surprised when a very senior NHS figure approached her about being the face of a new campaign about changes in NHS trans provision.

Thorn said no, and has written an article explaining why. Thorn is the first to say that there are some very good people working in the NHS, and in trans care specifically. But the organisation itself is broken, and treats trans people appallingly. And it’s getting worse.

I’m writing this in my sixth month of having my basic healthcare refused by my GP, healthcare that the GP happily provides to dozens of cisgender people but which is apparently too difficult to provide to me. I’m a few months away from finally getting surgery I first asked to be referred for six years ago, a referral that was never made because the gender clinic doctor simply didn’t bother doing it, a mistake or deliberate omission that I didn’t find out about for two years. My next referral was delayed because the gender clinic made an appointment for the mandatory second opinion, never told me about the appointment, and then concluded that I had changed my mind about wanting referred because I didn’t attend. Another year gone.

So it’s fair to say I’m sympathetic to Thorn’s argument.

There are many problems with NHS care for trans people, and they’re about to get worse with a Cass-style stitch-up labelled as a review of adult care. That review isn’t going to recommend that the NHS does something about the infiltration of conversion therapists, or the humiliating assessments we have to go through, or the woeful lack of staff, or the waiting lists that mean many trans people will die before even having a first assessment. And it’s not going to do anything about making trans people’s access to care any easier, because as Thorn points out:

every single person I have spoken to in the NHS- from local GPs to the National bosses- told me they are powerless. There is nobody at any level of the organisation who takes responsibility for the state the service is in and the suffering it is causing. Every single person blames the person above them, even the man at the top.

…I agree with others who study this field that consultations and “stakeholder meetings” have become a form of abuse by the NHS and the government: we’re included nonperformatively – given time to speak in order to legitimise the process of ignoring us.

In years to come, this will rightly be viewed as a scandal. But it’s going to harm many more people before that happens.