Select Committee on Health Written Evidence


Evidence submitted by Press for Change (EPR 06)

SUMMARY

  1.  Trans people are a small and vulnerable minority whose needs have historically been overlooked in legislation, creating injustices which have taken decades to resolve.

  2.  Protection for vulnerable minorities must be assessed before the uploading of any data to the Electronic Patient Record.

  3.  The uploading of data without patient consent would leave General Practitioners open to prosecution.

  4.  If the benefits of the Electronic Patient Record are as great as the Government claims, then trans people need to be persuaded of those benefits—not just omitted because it would be more expedient.

ABOUT PRESS FOR CHANGE

  5.  Press for Change (PFC) is the largest representative organisation for transsexual people in the UK. PFC was formed in 1992 to "achieve equal civil rights and liberties for all transgender people in the United Kingdom, through legislation and social change".

  6.  The campaign seeks to achieve its objectives through education and engagement rather than confrontation or demand-making. Good relations have been established with Ministers and officials, as Government has addressed the problems faced by trans people.

  7.  In 1997-99 PFC took part in consultation and negotiation with the DfEE as it set out to introduce the Sex Discrimination (Gender Reassignment) Regulations 1999.  PFC made substantial contributions to the work of the 1999-2000 Interdepartmental Working Group on Transsexual People.

  8.  During 2002-04 PFC was involved as the main stakeholder with the Department for Constitutional Affairs in the shaping of the Gender Recognition Bill 2004, working closely with ministers, officials, and parliamentarians of all parties as the bill progressed. We have since been closely involved with the implementation and promotion of the Act.

ABOUT TRANS PEOPLE

  9.  Transsexual people, or trans people as is preferred, identify themselves as members of the sex opposite to that assigned at birth, and may undergo medical treatment known as gender reassignment.

  10.  Trans people are a discriminated against minority who guard their privacy jealously.

  11.  A soon to be published report for the Government's Equalities Review reveals that 20% of trans people consider their General Practitioner to be trans-unfriendly. Such attitudes traverse the NHS, affecting not only trans people's access to gender identity treatments but colouring all interactions with the "caring profession'.

  12.  PFC calls for detailed study of this phenomenon and the development of the appropriate training and good practice before trans people are requested to consider disclosing their details in a way that could seriously affect the quality of their healthcare.

THE ELECTRONIC PATIENT RECORD

  13.  Press For Change is concerned that the Department of Health has made proposals for the medical records of patients to be uploaded to a central repository without the express consent of the patient.

  14.  Whilst we accept that there are good reasons for medical personnel to have immediate access to a patient's records in the case of an emergency, we believe that these records would be available to any person working in the healthcare industry—from receptionist upwards, as well as IT professionals managing the system.

  15.  Section 22 of The Gender Recognition Act 2004 makes it a criminal offence to disclose protected information that has been acquired in an official capacity to a third party. This would include any medical information that a doctor may possess regarding their patient as well as the fact of a Gender Recognition Certificate.

  16.  Paragraph 5 of the Gender Recognition (Disclosure of Information) (England, Wales and Northern Ireland) (No. 2) Order 2005 (Statutory Instrument 2005 No. 916) gives exemption where the disclosure is made on medical grounds. It does, however, draw very strict boundaries within which this is permissible.

    5.—  (1)  It is not an offence under section 22 of the Act to disclose protected information if—

(a)  the disclosure is made to a health professional;

(b)  the disclosure is made for medical purposes; and

(c)  the person making the disclosure reasonably believes that the subject has given consent to the disclosure or cannot give such consent.

  17.  The intention to upload the medical histories of trans people who are in receipt of a Gender Recognition Certificate without their express consent would therefore fall foul of at least paragraph 5(1)(c) of the above S.I.

  18.  Published good practice suggests that, where the existence or otherwise of a Gender Recognition Certificate is unknown, the assumption should be that the trans person has been legally recognised in their correct gender and they should be treated accordingly.

  19.  We therefore ask that you protect General Practitioners from the danger of criminalization by recommending that all patients are asked for their consent before their most personal information is uploaded to any central servers.

  20.  We believe that to compel trans people to have their most intimate details recorded on the Electronic Patient Record (or to do it without seeking their informed consent) would be to condemn those people to the inevitability of discrimination and second class care.

  21.  Conversely, we recognise the potential health benefits that could accrue to anyone having details accessible in an emergency, so the solution is not to simply exclude trans people from the Electronic Patient Record.

  22.  It is not a clear cut case of being included (with the risk of discrimination) or being excluded (with the risk of medical professionals not having access to vital details in an emergency). A lose-lose choice is not a choice. If there are genuine benefits to be obtained from the Electronic Patient Record then we want trans people to be able to enjoy those benefits equally to anyone else; the caveat is simply that adequate research of the problems currently experienced, and effective steps to ameliorate them are both necessary before asking trans people to accept a system that's otherwise guaranteed to disadvantage every member of our community.

Tracy Dean

Press for Change

25 February 2007





 
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Prepared 25 April 2007