Doctors' union votes for ‘identity-based care' despite warning over lawfulness
But the British Medical Association (BMA) has been warned the move risks going against the law, after the Supreme Court ruling in April that the terms woman and sex in the 2010 Equality Act 'refer to a biological woman and biological sex'.
At the BMA's annual representative meeting in Liverpool on Wednesday, a majority of members voted in favour of a motion said to centre on 'respect, safety and dignity' of LGBTQ+ doctors and patients.
In a speech in support of the motion, member Bethan Stanley described a 'blatant transphobia' in the current political climate, and insisted 'gender-affirming care is healthcare'.
Urging her fellow members to vote yes, she said: 'I feel it is a no-brainer that we should support care that is going to improve the welfare and wellbeing of our patients.'
To lengthy applause, she added: 'Trans women are women. Trans men are men.'
The motion called on the BMA to 'affirm the right of all LGBTQ+ patients and staff to identity-based care and working conditions – defined as care and policies that actively account for the individual's lived, intersecting identities (including sexuality, gender, neurodivergence, race, and cultural background)' and for guidance and a 'lobbying strategy to embed this principle into NHS equality standards, training frameworks, and institutional policies'.
Speaking against it, Louise Irvine said while it had a 'laudable aim of protecting LGBTQ+ and other people's rights to fair treatment' it also 'risks advocating that the BMA and other organisations adopt policies which are unlawful'.
She noted two cases of nurses suing their health trusts for providing changing rooms based on gender identity rather than sex and urged the BMA to study the legal implications of the recent Supreme Court judgment.
A group of nurses are challenging County Durham and Darlington NHS Foundation Trust over a policy allowing a trans colleague to use the female changing rooms at work, with their case due to be heard at an employment tribunal in the autumn.
Meanwhile, in Scotland, nurse Sandie Peggie is suing NHS Fife after sharing a female changing room with a transgender doctor, with that tribunal expected to resume in July.
Ms Irvine said: 'Lobbying for organisations to provide services on the basis of gender identity and not sex, means advocating that organisations disregard their public sector equality duty obligations.
'This could lead to legal liability for any discrimination or harassment experienced by service users expecting a single sex service.'
She added that the BMA lobbying for organisations to adopt policies for patients and staff based on gender identity instead of sex 'could put us at variance with the law, with all the risks that that carries'.
The vote reflected the 'deep passion within the profession for delivering truly personalised care', BMA representative body chair Dr Latifa Patel said.
She said the court ruling 'does not prevent healthcare that takes gender identity into account' and said the union will 'call for clear, national guidance and a real lobbying strategy that enable doctors to deliver identity-informed care, so that no one is left behind'.
The doctors' union has previously called for a delay to implementation of the Cass Review into children's gender services – which concluded gender care was an area of 'remarkably weak evidence' and young people had been caught up in a 'stormy social discourse'.
NSH England (NHSE) last year rejected the call for a delay, saying it has 'full confidence' in the Cass Review final report.
The BMA said it would carry out its own 'critique' of the report, which is yet to be published.
While initially stating this would be shared with its UK council at its January meeting, a BMA spokesperson said: 'We want to be as sure as we can be that data collection and analysis processes are as rigorous and robust as possible; this requires time, rather than be rushed.'
A Department of Health and Social Care spokesperson said: 'We are committed to providing safe, inclusive and appropriate care for all patients, including those questioning their gender.
'We expect NHS organisations to follow employment law and good HR practices, ensuring all staff feel respected and included.'
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Guardian
a day ago
- The Guardian
US supreme court rules key provision of Obamacare constitutional
The US supreme court has ruled that a key provision of 'Obamacare', formally known as the Affordable Care Act, is constitutional. The case challenged how members of an obscure but vital healthcare committee are appointed. The committee, the US Preventive Services Task Force (USPSTF), is a panel of 16 volunteer health experts who determine which evidence-based preventive health services private insurance companies must cover without cost for patients. The requirement is a provision of the ACA – and one of the few instances when privately insured American patients pay nothing for healthcare. The case, 'in line with other court decisions, strengthens the control of political appointees over the bureaucracy', said Dorit Reiss, a University of California San Francisco law professor and an expert in health law and vaccine policy. The case, formally called Kennedy v Braidwood Management, Inc, affirms that final decisions come by secretaries, in this case health secretary Robert F Kennedy Jr, a known vaccine skeptic. 'This makes it harder for Congress to isolate expert decisions from political review. So the stakes in appointing the political heads – in this case the secretary – are very, very high,' said Reiss. While the court affirms the constitutionality of the taskforce itself, it also held that members force can be removed at will by the health secretary, and that the secretary may review the taskforce's recommendations before they take effect. Kennedy used those powers only this June, when he unilaterally fired all sitting members of a critical vaccine advisory panel, and remade the panel with ideological allies. The new panel members then delivered Kennedy a victory by recommending against a vaccine preservative called thimerosal, despite a scientific consensus that the ingredient was safe. The court issued the opinion in a 6-3 ruling. The opinion was written by Justice Brett Kavanaugh, and joined by John Roberts, Sonya Sotomayor, Elena Kagan, Amy Coney Barrett and Ketanji Brown Jackson. In 2020 alone, an estimated 150 million Americans benefited from the preventive healthcare provision, according to the O'Neill Institute at the Georgetown University law center in Washington DC. Although the provision requires insurers to cover a wide range of services – from annual check-ups to cancer screenings and immunizations – the case centered on the provision of Prep, or pre-exposure prophylaxis for HIV. A small group of plaintiffs claimed provision of PrEP violated their religious beliefs. They were represented by Jonathan Mitchell, the former solicitor general of Texas who pioneered the state's 'bounty hunter' abortion law. Their arguments were backed by Republican and conservative groups, although the specific ACA provision was defended by both the Trump and Biden administrations. Major public health groups, hospitals, disease advocacy groups and Democratic attorneys general opposed ending the provision. Although the court affirmed the constitutionality of the panel, it also affirms that any health secretary, including Kennedy, could remake the panel with allies. The secretary could 'override experts' conclusions and remove things like PrEP', said Reiss. However, she added that the power was not 'absolute'. If the secretary's recommendation contravened the decision of an expert panel and there was a lawsuit, the secretary would still need to make 'a convincing case that there was a reason to deviate from the panel, if there is a lawsuit', said Reiss. That has left the Aids institute, and other groups who advocate for healthcare access for HIV and Aids patients, to say it 'celebrates' the decision while acknowledging uncertainty about the future. 'I think we have to be worried about what that means for future USPSTF decisions given what has happened with' the vaccine panel, said Rachel Klein, the deputy executive director of the Aids Institute. 'Knowing what preventive care is effective to keeping people healthy – and therefore cost-effective to cover – is crucial to helping people be as healthy as possible. That requires listening to medical and scientific experts. We hope that USPSTF will continue to be a body worthy of our trust to make scientifically sound decisions about preventive services going forward.'
Times
a day ago
- Times
GP surgery awash with ‘tsunami of pee'
A medical practice has urged patients to stop dropping off unsolicited urine samples, saying the 'high volumes' are hindering their ability to provide timely care. Saltoun Surgery in Fraserburgh, Aberdeenshire, has been inundated with specimens, forcing them to implement a strict new policy: no urine samples will be accepted unless specifically requested by a staff member. 'This change is necessary due to the high volume of inappropriate or unsolicited samples being submitted, which affects our ability to provide timely care to all patients,' explained the practice manager in a statement. While the image of a 'tsunami of pee in Fraserburgh doesn't really bear thinking about,' as one health agency spokesman put it, the issue of uninvited samples is not unique to Saltoun Surgery. The British Medical Association confirmed that 'unsolicited urine samples can be an issue' with practices developing their own solutions. The surgery said the unsolicited samples were affecting its ability to offer timely care Many GP surgeries have had to issue public notices, often via text messages or signs in their waiting rooms, explicitly stating that they will no longer accept unsolicited urine samples. In 2022, Hartshill Medical Centre, in Stoke-on-Trent, sent a text message to patients saying, 'Due to recent incidents, we will no longer be accepting unsolicited urine samples.' The Royal College of General Practitioners (RCGP) offers guidelines for managing urine sample collection. Typically, practices provide patients with containers and clear instructions. Speaking anonymously to The Times, one GP noted that many Scottish surgeries have signs discouraging unrequested samples. This is often aimed at older patients who suspect a urinary tract infection (UTI) and drop off samples without prior consultation. 'We really, really want patients to speak to a clinician for a proper medical assessment before we ask them to bring a sample in,' the GP said. 'And when they do, we will issue them with sample bottles to return, rather than random domestic containers which can sometimes be inappropriate.' The RCGP's own website highlights a practice that successfully changed its processes after dealing with 20 to 30 unsolicited samples daily. By implementing new protocols from a UTI toolkit, the practice managed to streamline its system. Patients often use 'random domestic containers' instead of sterile sample pots provided by the practice. This increases the risk of contamination, rendering the sample useless and potentially leading to inaccurate results. Saltoun Surgery hopes its new policy, though strict, will allow the practice to better serve patients and manage the flow of vital medical information.
NBC News
a day ago
- NBC News
By maintaining Obamacare pillar, Supreme Court hands win to HIV advocates
The Supreme Court on Friday granted the HIV-prevention field a historic win — yet with a major caveat — as it upheld a federally appointed health task force's authority to mandate no-cost insurance coverage of certain preventive interventions, but clarifying that the Health and Human Services secretary holds dominion over the panel. The 6-3 decision in Kennedy v. Braidwood Management, Inc. essentially leaves in place a popular pillar of the Affordable Care Act, which mandates that most insurers cover various task force-recommended preventive screenings, therapies and interventions, with no out-of-pocket costs imposed on patients. The case reached the high court after a group of Christian businesses in Texas objected to being compelled to cover a certain drug used for HIV prevention, known as PrEP, given their claims that it 'promotes homosexuality.' 'Since our efforts to address HIV in the U.S. are under attack on so many levels, preserving insurers' requirement to cover preventive services, including PrEP, will help ensure access to people who need it,' said Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, a patient advocacy group in Washington, D.C. But the court clarified the scope of the task force's independence, thus potentially compromising its impact. Addressing concerns that the 16-member volunteer task force's power over insurers was unconstitutional, the justices asserted that the health secretary holds the authority to appoint and dismiss the panelists and to block their new recommendations from mandating insurance coverage. The secretary could also possibly direct the panel, including one stocked with his or her own hand-picked members, to revisit previous recommendations that have already gone into effect. Given the unpredictable nature and unconventional approach to health policy of the current health secretary, Robert F. Kennedy Jr., HIV advocates are concerned that he might undermine the task force's current or future endorsements of HIV-prevention medications, known as PrEP. The ruling 'is a victory in the sense that it leaves intact the requirement to cover task-force recommendations,' said attorney Richard Hughes, a partner with Epstein Becker Green in Washington, D.C., who represented a group of HIV advocacy organizations in submitting a friend-of-the-court brief in the casel. 'It was always going to be a double-edged sword, as the political accountability that salvaged its authority comes with the ability to alter its recommendations.' The U.S. has secured only a modest decline recently in HIV cases, and HIV advocates stand at a crossroads amid the Trump administration's dramatic withdrawal of support for their cause. Promisingly, the Food and Drug Administration last week approved a long-acting injectable form of PrEP, Yeztugo, made by Gilead Sciences. Injected every six months, Yeztugo overwhelmingly bested Truvada, a daily-pill form of PrEP also made by Gilead, at lowering HIV transmissions in clinical trials. But Yeztugo has debuted as the Trump administration is gutting the Centers for Disease Control and Prevention's HIV-prevention division and after it canceled scores of HIV-related research grants. HIV experts have warned that this upheaval could lead HIV to rise again. Kennedy v. Braidwood Management, Inc. The plaintiffs' initial religious-liberty complaint was ultimately dropped from the case. The court more narrowly considered the constitutionality of an ACA provision that lent effective authority to a longstanding volunteer medical task force to mandate no-cost insurance coverage to preventive interventions that the expert group rated highly, including PrEP. The plaintiffs argued that because the task force was not appointed by the president and confirmed by the Senate, granting it such power over insurance markets violated the Constitution's appointments clause. The justices grappled with the task force's balance of independence versus accountability. In particular, they sought to determine whether the task force members were appointed by the Senate-confirmed Health and Human Services secretary. In addition to PrEP, the task force has issued high scores, for example, to screening for lung cancer, diabetes, and HIV; treatment to help quit smoking; and behavioral counseling to prevent heart disease. Had the Supreme Court fully sided with the plaintiffs, insurers would have been free to drop such popular benefits or, at the very least, to impose related co-pays and other cost sharing. Writing for the majority, Justice Brett Kavanaugh found that the health secretary has the power 'to appoint Task Force members, and no statute restricts their removal.' He was joined by an ideological mix of colleagues, including Chief Justice John Roberts and Justice Amy Coney Barrett on the right, and Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson on the left. Concerns and uncertainty about Kennedy HIV advocates expressed concern that Kennedy might undo the task force's recommendation for PrEP, or at the least deprioritize ensuring that Yeztugo receives a clear coverage mandate. Earlier this month, Kennedy dismissed the entire CDC Advisory Committee on Immunization Practices, or ACIP, and replaced them with his own hand-picked selections, including one notable anti-vaccine activist. At the first meeting of the newly formed committee this week, ACIP dropped recommendations for some flu vaccines over claims, widely debunked by researchers, that one ingredient in them is tied to autism. Mitchell Warren, executive director of the HIV advocacy nonprofit AVAC, expressed concern about 'what happened with the CDC ACIP this week, as it could be a harbinger of what a secretary of HHS can do to twist committees and task forces that should be composed of experts guided by science to ones that are guided by ideology and politics.' In an email to NBC News, Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School, characterized Kennedy's potential approach to overseeing the health task force as unpredictable. 'RFK has been skeptical of the medical approach to HIV/AIDS in the past, and that may color his attitude to revising PrEP guidance,' Shachar said. HHS did not immediately respond to a request for comment about the HIV advocates' concerns. In 2019, the health task force granted Truvada as PrEP a top rating. The drug was already widely covered by insurers. But under ACA rules, the task force's recommendation meant that by January 2021, insurance plans needed to cease imposing cost-sharing for the drug. The Centers for Medicare and Medicaid Services, or CMS, then clarified that insurers were also forbidden to impose cost sharing for the quarterly clinic visits and lab tests required for a PrEP prescription. A CDC study published in October found that about 200,000 people were using PrEP at any point in 2023. In 2019, the FDA approved another Gilead daily pill, Descovy, for use as PrEP. In late 2021, ViiV Healthcare's Apretude — an injection given every two months — was also green lit. The health task force gave top ratings to both of the newer forms of PrEP in 2023, which triggered a mandate for no-cost coverage to begin in January. A generic version of Truvada emerged in 2020 and now costs as little as $30 per month. The list prices of the three brand-name PrEP drugs range from about $2,200 to $2,350 a month. How the court's ruling could play out for HIV prevention Were Kennedy to appoint task force members who ultimately voided the PrEP coverage mandate, generic Truvada, at the very least, would still likely remain widely covered by insurance. But insurers would be free to demand cost-sharing for all forms of PrEP, including for required clinic visits and lab tests. And they could restrict access to the more expensive versions, including by imposing prior authorization requirements and higher cost sharing. Research suggests that even a small increase in monthly out-of-pocket costs for PrEP can depress its use and that those who accordingly forgo a prescription are especially likely to contract HIV. Johanna Mercier, Gilead's chief commercial officer, said even before the health task force's 2023 insurance mandate for Descovy went into effect in January, the drug's coverage was still pretty solid. Private insurers provided unrestricted coverage of Descovy for PrEP to 74% of commercially insured people, and 40% of prescriptions for the drug had no co-pay. After the mandate went into effect — including after CMS released a clarification on the PrEP-coverage mandate in October — those rates increased to 93% and 85%, respectively. This experience, Mercier said, has left the company optimistic that an increasing proportion of health plans will cover Yeztugo during the coming months. Health-policy experts are not certain whether the existing PrEP rating from the task force automatically applies to Yeztugo, or whether the drug will require its own rating to ensure coverage comes with no cost sharing. If Apretude's history is any guide, a requirement for Yeztugo to receive a specific rating could delay a no-cost insurance-coverage mandate for the drug from going into effect until January 2027 or 2028. It's also possible that CMS could release guidance clarifying that the existing mandate for PrEP coverage applies to Yeztugo, which would likely have a more immediate impact on coverage. However, Elizabeth Kaplan, director of health care access at Harvard's Health Law and Policy Clinic, said in an email that 'given this administration's and RFK's stated priorities,' the publication of a guidance on Yeztugo coverage by an HHS division 'appears unlikely.'
