Welsh Gender Service surgery referrals suspended amid concerns over referral rates

Nation.Cymru staff

Referrals for gender-affirming surgery through the Welsh Gender Service have been suspended after concerns were raised about significantly higher referral rates than those seen in England.

The NHS Wales Joint Commissioning Committee (NWJCC) has asked Cardiff and Vale University Health Board to immediately pause new surgical referrals as well as assessments and operations that had already been scheduled while an independent clinical review is carried out.

The decision follows a meeting of the NWJCC’s Quality, Safety and Outcomes Committee on August 24, when the service was escalated to Level 3 – a formal NHS process involving increased oversight, monitoring and improvement action.

In an official statement, Cardiff and Vale University Health Board said concerns had arisen from 2025-26 data showing “significantly higher rates” of referrals for gender-affirming surgery from the Welsh service compared with English gender services. Concerns had also been raised about aspects of its referral and assessment processes.

The health board said: “We recognise that this announcement may be concerning for patients, their families, staff and the wider community. We are committed to providing clear, factual and timely information about what this means and the support available.”

The Welsh Gender Service, based in Cardiff, provides specialist NHS assessment and support for adults experiencing gender incongruence, including psychological support, hormone therapy care, endocrine reviews and referrals for surgery.

Nation.Cymru reported earlier this month that the service was facing increased scrutiny over its surgical referral rates.

Figures obtained through Freedom of Information requests by freelance journalist Nick Wallis suggested the service was referring between three and four times as many patients for gender-related surgery per head of population as the UK as a whole.

Mr Wallis reported that in 2025 the Welsh Gender Service referred 207 patients for masculinising chest surgery. He calculated that Wales accounted for around 16% of confirmed UK NHS referrals despite having around 4.6% of the UK population.

The Welsh Conservatives subsequently called for a full independent review, with their then health spokesperson Natasha Asghar raising concerns about both surgical referral rates and the recording of information about patients recommended for hormone treatment.

The health board had previously said an independent review was being commissioned to assess the service against recommendations arising from NHS England’s review of adult gender services, with recommendations expected in 2027.

Surgical pathway

The latest decision applies specifically to the surgical pathway and does not suspend the Welsh Gender Service as a whole.

Hormone therapy support, endocrine reviews, psychological support and speech and language therapy will continue. Patients with scheduled appointments have also been advised to attend for discussions about their next steps and psychological support.

The independent clinical review will examine assessment, referral and governance arrangements and determine whether changes are needed.

The health board said: “The Welsh Gender Service supports people at important stages in their lives and we understand that uncertainty about treatment can be distressing. Our priority is to ensure patients are treated with dignity and compassion throughout this process.”

It added that gender-affirming care attracted “strong and differing views across society” and said public and political discussion should be based on accurate information and avoid harmful speculation.

Affected patients will be contacted directly if developments arising from the review affect their individual care.

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