New details emerge about decision to suspend gender surgery referrals

Martin Shipton

Details have emerged of the reasons behind a controversial decision to suspend referrals for gender surgery from the NHS’s Welsh Gender Service.

Referrals were halted in August after it emerged that they were running at between three and five times the equivalent rate in England.

The NHS says it was necessary to halt referrals pending a review, while those awaiting referral and surgery have told of their devastation at the decision.

More specific figures have now been published in the minutes of a meeting of the NHS Wales Joint Commissioning Committee.

For masculinising chest surgery – in other words, breast removal – there were 201 referrals from the Welsh Gender Service in 2025–26, equivalent to 6.3 per 100,000 people. This compared with 904 across gender services in England, or 1.5 per 100,000 people.

For masculinising genital surgery, there were 53 referrals from the Welsh Gender Service, or 1.7 per 100,000 people, compared with 332 in England, or 0.6 per 100,000 people.

For feminising genital surgery, there were 149 referrals from the Welsh Gender Service, or 4.7 per 100,000 people, against 569 in England, or 1.0 per 100,000 people.

Overall, there were 403 referrals from the Welsh Gender Service, or 12.6 per 100,000 people, against 1,803 in England, or 3.1 per 100,000 people.

The report states: “It seems unlikely that the marked difference in referral rates reflects differences in the incidence of gender dysphoria between Wales and England, and Wales uses the same service specification for surgical referrals as NHS England (NHSE). Data has been obtained on the rate of proceeding from surgical review to surgical procedure.

“Of patients listed for masculinising chest surgery 97% proceed to surgery, while of those listed for masculinising genital surgery only 36% proceed to surgery. We understand from NHSE that the rate of proceeding to masculinising genital surgery for Welsh patients is an outlier and substantially lower than for patients from England. This again suggests that patients from Wales are being inappropriately referred for surgery with the potential for actual harm.

“In addition, several complaints have been received by the Welsh Government, Cardiff and Vale University Health Board and the NWJCC alleging inadequate assessment prior to referral for gender affirming surgery.

“Finally, concerns have also been raised with the NWJCC Medical Director regarding the appropriateness of referrals to surgery from the WGS. This has been done verbally currently, but written confirmation has been requested. A surgical review is underway via NHSE currently but given that approximately 35 patients per month are being referred for surgery via the WGS, to a wait list of already more than 700 patients from Wales, a temporary pause to referrals is recommended whilst the assessment and referral processes are reviewed by CAVUHB, to ensure clinical safety and good governance.

“A review of the Welsh Gender Service is currently being undertaken by a panel of independent experts and is due to be completed by Q3/Q4.”

Escalation 

The report adds: “There have been several complaints and concerns raised about the service via members of the public during the last couple of years. There has been an escalation from August 12th 2026 in matters of concern brought to the NWJCC’s attention.

“Information obtained via a series of FOIs has been collated and shared with the NWJCC on August 12th, 2026, by one complainant that aligns with the issues of concern. This also suggests that the WGS is not operating to the same specification as in England, and that many of the safeguards within the assessment process are not being followed in practice.

“A new complaint has been raised on August 14th to the Deputy First Minister, and Cabinet Minister for Social Justice and Equality.

“A whistleblowing letter from a Welsh citizen and medical professional was received on 13th August by the NWJCC Quality and Nursing team, copied to Cardiff and the Vale Health Board and Healthcare Inspectorate Wales. The concern from the individual is that certain gender related surgical procedures are being presented to patients in a misleading way and that the evidence base, consent process, and governance arrangements supporting these interventions should be reviewed.

“Further to this, whilst there are no English or Welsh cases currently awarding damages to de-transitioners for surgery, courts are increasingly being asked to consider whether clinicians adequately assessed psychological readiness, whether information on risks was sufficient, and whether multi-disciplinary safeguards were followed.”

The report said adult gender services were subject to political and media scrutiny: “The NWJCC and CAVUHB have already received media interest in relation to the Welsh Gender Service, regarding referral patterns, behaviour of clinicians, and governance arrangements. Given the sensitivity of this area of healthcare and the vulnerability of the patient population, any communications will need to be carefully managed to ensure information is accurate, balanced and evidence-based while minimising unnecessary anxiety for patients and carers.”

Options

The report set out a series of options:

• To do nothing pending the outcome of the independent review of the Welsh Gender Service, continuing to assess and refer patients for surgery.
• To place the service in escalation at level 4, suspending all patient referrals from GPs into the Welsh Gender Service and thereby pausing the full range of assessment and treatment options provided by the service.
• To place the service in escalation at level 3, requiring Cardiff and Vale University Health Board to pause all onward referrals from the Welsh Gender Service for gender-affirming surgery until there was assurance of appropriate clinical governance of referral pathways to surgery.
• To temporarily suspend assessments by NHS England’s surgical providers of patients already referred and on the central waiting list until the independent review had concluded and there was assurance of appropriate clinical governance.

The report asked members of the Quality, Safety and Outcomes Sub-Committee to temporarily suspend referrals for gender surgery with immediate effect until assurance of clinical governance was in place, and to commission an external review of everyone on the waiting list to ensure they were both eligible and appropriate for surgery.

The recommendations were accepted, and the review is ongoing.

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