Green activist calls for resignation of Welsh Government ministers in trans surgery row

Martin Shipton

A prominent Green Party activist has called for the resignations of Health Minister Mabon ap Gwynfor and Deputy First Minister Sioned Williams following a decision to pause gender-related surgery while a review takes place.

A sub-committee of the NHS Wales Joint Commissioning Committee (NWJCC) decided to “pause” all surgeries and referrals after it emerged that the rate of surgical referrals from the Welsh Gender Service was running at three to four times the equivalent rate in England.

Tessa Marshall, who was the Green Party’s unsuccessful number two Senedd candidate for Caerdydd Penarth in May’s election, has written a lengthy Substack article in which she denounces the review as a transphobic attack on vulnerable people and calls for the resignation of ministers and for clinicians involved in pausing surgery and referrals to be struck off.

Ms Marshall writes: “This decision has devastated and crushed Trans+ and LGBTQIA+ people across Wales, whether they were one of the 500+ people on the surgical waiting list or not. Most people in our community know someone who was on that list.

“At least one patient was in hospital, in their gown, when nurses delivered the news that their surgery was cancelled. Others were prepared for surgery in the following days and weeks.

“This surgery is the critical, gender-affirming care Trans+ patients have waited years for – and worked to prove they need for at least two decades of their lives.

“The depth of the harm is overwhelming and still growing. The Trans+ community is reeling. Gender-affirming care is life-saving. This decision puts lives at risk.”

Ms Marshall states: “The decision put gender-affirming care up for debate, signalling a dangerous turn for the Trans+ and LGBTQIA+ community. This deplorable politicisation of surgical care marks a deeply ominous new chapter in the fight for the rights of Trans+ people to dignity, freedom, and healthcare.

“Although it’s over a month since the decision was made, the review still hasn’t started and there’s still very little evidence justifying the ‘pause’ of all surgeries and surgical referrals.

“There’s no information on when care will restart, so ‘stopping’ or ‘cancelling’ are more appropriate terms. There’s been barely an update on what the review will do, what criteria it will use to decide whether patients are eligible for care, or whether they’ll have their care ripped away.

“This has all shown that institutional transphobia is rife. A handful of senior directors of an opaque and inaccessible body can simply decide one day to put the lives of Trans+ patients on hold, despite having no information about them as patients, people or individuals, or what this surgery will do for their quality of life.

“And the Welsh Government, despite having the powers to oversee the decisions of the NWJCC and, crucially, to override them, has sat on its hands and done nothing.”

‘Evidence’

Ms Marshall goes on to claim that the only “cold hard evidence” shared so far to justify the cancellation of surgeries for almost 500 people is the data comparing surgical referrals in Wales with England.

She adds: “No safety issues have been publicly identified (as the Reform and Conservative members of the Senedd seem to believe). No patients have complained about the quality and standards of their care.

“Crucially, no desk-based analysis or report has been published to outline the case that cancelling surgeries is necessary and proportional, and how patients will be supported as a result of the decision.”

The activist argues that the comparison of referral statistics is an “inadequate and inappropriate metric” for the following reasons:

“In parts of England, patients are waiting over 8 years to have their initial appointment with their local gender service. In the Welsh Gender Service, this wait is a more proportional – yet still unacceptably high – 1 year and 8 months. With extremely long waits, it’s not unfair to presume that many English Trans+ people are simply self-funding private surgery.

“Many (if not all) Gender Services in England cover a larger population than the Welsh Gender Service, which covers just 3 million people.

“The Welsh Gender Service is also working through a backlog of patients, as the service itself is newer than those services in England.

“There is no Gender Service for children and young people in Wales, meaning Trans+ people first present for gender-affirming care with the WGS, unlike in England, where these services are theoretically available for those under 18 (although, in practice, they also have extreme waits of up to 4 years).

“The data itself aligns with the rates of referrals seen by the Welsh Gender Service between 2021 and 2025.”

Ms Marshall states: “It seems that instead of analysing the data provided by the Gender Dysphoria National Referral Support Service, the NWJCC and the Welsh Government took the figures at face value, failing to interrogate them in any desk-based analysis. This is deeply troubling.

“The GDNRSS is the English body overseeing the failing Trans+ healthcare system in England, biasing its data towards failing services.

“Instead of working with the Welsh Gender Service to interrogate and analyse the data, a basic comparison table was used to justify cancelling critical care for 500 patients, including at least 60 who had passed all checks and balances to reach the point of surgery. No one in the Welsh Government seems to have questioned this analysis.”

‘Crumbled’

Ms Marshall goes on to attack Plaid Cymru and its ministers, stating: “Plaid Cymru said in their manifesto they’d support the Trans+ community. But instead of publicly backing Trans people, they’ve crumbled.

“Over the summer they met with gender-critical groups, and rumour has it they didn’t know about the NWJCC decision until Friday August 28, along with everyone else.

“The decision to cancel surgeries is patently absurd, dangerous, and disproportionate.

“It’s undermined the trust the Welsh Gender Service built between the Trans+ community and the NHS, on the basis of flimsy evidence and the influence of extreme transphobia.

“There are obviously many other ways the so-called evidence could have been investigated before deciding ‘cancel all surgeries, now!’.

“Right now, there are people in very important jobs who made this decision to cause this harm and they continue to sleep comfortably at night.

“I want to see action and systemic change:

“The Health Minister should use his powers to suspend the Chair and Director and investigate the NWJCC.

“The Minister must reinstate the surgical pathway immediately. All 60 patients who were signed off to have surgery this year must receive surgery this year.

“After reinstating the surgical pathway, the Minister for Health should resign for allowing this harm to patients.

“The Minister for Social Justice [Sioned Williams, who is also Deputy First Minister] should also resign her position for failing in her duty to protect the Trans+ community from harm, but crucially for failing to advocate for the Trans community effectively in her important role as the national, governmental advocate for marginalised communities.

“Healthcare Inspectorate Wales should launch a concurrent investigation into the NWJCC and its decision-making processes, investigating whether these are fit for purpose, proportionate, and safe.”

The Welsh Government said: “The pause in gender-affirming surgery was an independent and clinically led decision made by the NHS Wales Joint Commissioning Committee. As is appropriate, the Welsh Government had no role in the decision.

“The Ministers sought and received assurances that the decision is a pause, not a stop. Each relevant case will be reviewed, and once the JCC has assurances that appropriate clinical assessments are in place, individuals will progress to surgery at the earliest possible opportunity. Ministers recognise the distress this pause is causing for those affected and the wider community. The Deputy First Minister has met several Trans Advocacy organisations to hear their concerns and perspectives and reassure them of the on-going support for the trans community.

“The Cabinet Minister for Health and Care has also written to Cardiff and Vale University Health Board and has received assurance that support is being provided for individuals affected, and that the patient body Llais is engaged.

“The Deputy First Minister and the Cabinet Minister for Health and Care continue to closely monitor the situation to ensure that patients and those affected are kept informed and supported.”

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