Transgender Awareness Project In it together Transgender Awareness Project Jenny-Anne Bishop, Unique Transgender Network Dafydd Snelling, Screening Engagement Team Public Health Wales Insert name of presentation on Master Slide

Aim of the Presentation To Explain the importance of this work Highlight factors which affect the Trans* community Explain how Public Health Wales, Screening Division works with its Partners Provide an overview of the ‘In it Together’ Transgender Awareness Project to Illustrate ABCD community partnership working

Why is this important? Human Rights Act (1998) Equality Act (2010) Equality Duty (2011) Standards for Health (2010) Together for Health (2012) Public Health Wales Strategic Equality Plan (2012) Prudent Health Care Happier, Healthier, Fairer Wales Strategy

Facts About the Trans* Community Many Trans* people do not reveal their gender variance to their GP or seek medical advice so their Trans status goes unreported Studies suggest that the incidence of potential transitioning transsexual people in Wales is around 6000 GIRES (2011) state that the present growth rate in the incidence of new people requiring medical and other care is likely to continue at a growth rate of 15% (approximately doubling every five years) The current rate from GIRES (2016) is 50% in the Adult Service and 100% in the Adolescent and Child Service Reference: GIRES(2011) The Number of Gender Variant People in the UK http://wwww.gires.org.uk/Prevalence2011.pdf

Why we need the Trans* community to work properly with Service Providers ● Service providers have a propensity to ignore the needs of Trans* people and treat them less favorably because of their lack of knowledge, fear of getting it wrong and desire not to offend, places a barrier to proper community engagement ● There is a great need for awareness training and for Trans* people to bust the myths so as to “Tell it like it is” 5 5

Understanding Trans Men’s Issues Trans men can face: Refusal to recognise their male identity Partnerships may be threatened by family exclusion Trans men have poor uptake of gynecological and screening services – so post-menopausal symptoms can go untreated Continuous use of Testosterone increases the risk of cervical malignancy in those who still have a cervix

Understanding Trans Women’s Issues Trans women can face: Refusal to recognise their female identity Partnerships threatened by family exclusion May abhor intimate care from a male nurse May be threatened and ostracised by their peers and care workers May miss out on AAA Screening

Things you need to know when accessing screening services ● National screening programmes invite eligible people by age, gender and where they live ● How a Trans person is registered with their GP will determine how they are invited for screening ● Once their new name and gender is registered with their GP, they will be treated as their acquired gender for calling for screening. ● It is important that a Trans person is registered appropriately with their GP as this will determine if they are invited for screening or not If a Trans person is unsure whether they are to be screened they should contact their GP or Public Health Wales, Screening Division

Screening for Male to Female Trans* (Female Registered with GP) Screening Test Note Required Will be Notified Age Breast Screening Yes* Yes 50-70 Cervical Smear No 25-65 Abdominal Aortic Aneurysm (AAA) 65+ Bowel Screening 50--74 Currently there are no national screening programmes to support the following: Prostate Screening (Where Provided) 50+ Testicular Cancer (Where Provided) * Yes (Pre-op)

Screening for Female to Male Trans* (Male Registered with GP) Screening Test Note Required Will be Notified Age Breast Screening (Depends on Surgery) * Yes** No 50-70 Cervical Smear (Hysterectomy recommended after 5 years on Testosterone) Yes 25-65 Abdominal Aortic Aneurysm (AAA) 65+ Bowel Screening 50-74 Currently there are no national screening programmes to support the following: Prostate Screening (Where Provided) 50+ Testicular Cancer (Where Provided)

What it means to me? “Don’t fear the Smear” “AAA Screening”

About the Project Insert name of presentation on Master Slide

Who are we? Screening Division Public Health Wales Breast Test Wales Cervical Screening Wales New Born Hearing Screening Antenatal Screening

Who are WE? The Screening Engagement Team (SET) is a small team who work with all the adult screening programmes in Wales

Screening Engagement Team (SET) Partnership Working Public Engagement Service Improvement Public Information Development Education / Training

What is Screening? Screening aims to detect cancer, abnormal changes or a condition at an early stage Screening tests are offered to people without any symptoms of disease Finding cancer or a condition early can give you a better chance of successful treatment Screening can save lives!

NHS screening in Wales Women aged 50-70 are invited for a breast X-ray every three years. Women over the age of 70 can ask for a screening appointment. Women from the age of 25 are invited for screening every three years. Women aged 50-64 are invited every five years. Men and women aged 60-74 are invited to take part every two years. Men aged 65 are invited for a one-off ultrasound screening test.

UK National Screening Committee: Informed Choice UK National Screening Committee: “ The public should be given a realistic view of the merits and flaws of screening so that they can make an informed choice and decline an invitation if they wish”

In it together Public Health Wales, Screening Division continues to work in partnership with Transgender service users in Wales to improve service provision and access to NHS screening programmes.

At the beginning Our journey together began in December 2012 Transgender in Wales contacted the Screening Engagement Team (SET) to discuss how if at all, we could work together to improve screening services for Trans service users Transgender Awareness Wales and Unique Transgender Network were invited to the Screening Engagement Team meeting - this was a shared learning experience for all Members from Female To Male (FTM) Wales, Unique Transgender Network and the NHS Centre for Equality and Human Rights(CEHR) have been involved throughout the project Initially those discussions centred around CSW and BTW but everyone saw the benefit of looking at this cross programme. Frank discussions - personal experiences of Lewis’s made the team look at things in a new perspective Managing expectation of both parties was paramount Being open and tranparent was also paramount if we were to work together in an ongoing partnership

In it together A number of issues affecting Transgender service users were highlighted. These included: Communication Education aimed at staff, public and Professionals did NOT include Trans information No Trans* specific public information Poor engagement between Trans* service users and screening services Communication - talk about social media and how this is the preferred method of communication Public info – talk about the images used by screening and how they are not inclusive to trans people Poor engagement – talk about the way we used to work and the fact that having worked together for the last year we have made considerable headway

Working Together Following the initial meeting, an action plan was jointly written to take forward key areas of work These included - Training/Education Trans* specific public information development Active public engagement Communication

Training Representatives from Transgender Awareness Wales and Unique have met with Heads of Programmes to raise awareness of Transgender issues Equality and Diversity training (mandatory for all staff) updated to include Transgender issues FTM (FTM Wales)and MTF (Unique) transgender service users have attended staff training days for relevant teams as part of their CPD and given specific training to the relevant screening programme practitioners Talk about the digital story development which will support the Equality Training.

Public Information Transgender specific screening leaflet and Information Cards Frequently Asked Questions Short films Accessible information on programme websites Trans* specific information reviewed by transgender service users

Engagement SET have attended the Swansea Sparkle TG event each November Presentation delivered to the LGBT Network in Cardiff Improved links with the Unique Transgender Network Shared Partners Shared Partners – talk about how new trans groups are being identified through the in it together project which we would not have had a year ago.

Raising the profile As part of the resource development Screening has worked with partners to gain feedback The All Wales Gender Dysphoria Partnership Board with WHSSC has been established Representative from FTM Wales and the Unique Transgender Network have attended Trust Equality and Service User Experience meetings The Trans* community is delivering workshops for the NHS Centre of Equality and Human Rights Working with partners- highlight that this is a slow process there is no magic bullet. It is about gaining trust and taking small steps to achieve goals.

Is there a Magic Bullet? Hard work and commitment Working together from the start Recognising that we are not all the same Consulting as much of the Trans* community as possible Realistic expectations Small steps Achievable and measurable goals Facing the challenges together and publicising the outcomes for all to see

What Else Officially launched the Trans leaflet, Videos & FAQ’s Evaluated the leaflet with the Trans* community Continue Working with Trans* groups to deliver community based education to service providers Use digital technologies to ensure we are consistently inclusive and reach a wider audience Continue to Work together in the ‘long term’ and not the short – Set up the next Initiative – Trans* Health Leaflets To share good practice with other organisations, Inc. Public Health England

The “Magic” Ingredients 1. LOVE 2. PASSION 3. ABSOLUTE COMMITMENT 30

Any questions?

For further information Heather Ramessur: Lead Screening Engagement Specialist Heather.ramessur-marsden@wales.nhs.uk For further information: www.screeningforlife.wales.nhs.uk Jenny-Anne Bishop: Unique Transgender Network http://www.uniquetg.org.uk/ Jennyannebuk@yahoo.co.uk