Legal challenge to NHS England and St Peter’s Andrology Centre over delays to transmasculine gender-affirming surgery

Human rights lawyers at law firm Leigh Day wrote to NHS England and St Peter’s Andrology Centre in March 2024 on behalf of the group “left in limbo” when NHS contractual issues halted their surgery journey. 

Leigh Day began legal investigations into NHS delays in receiving gender-affirming surgeries in 2022 after a group of trans men, (used here as an inclusive umbrella term to also include individuals identifying as transgender and transexual), were “left in limbo” with indeterminate genitalia and psychological distress because of significantly delayed transmasculine genital surgeries.  

On behalf of the group, human rights lawyers say that failures by NHS England and St Peter’s (the only commissioned provider of these services at the time) led to the collapse in commissioning arrangements and caused the delays, as did the 18-month gap between St Peter’s being decommissioned and a replacement provider being appointed.  

The claimants who have asked to have their claims investigated say the delays have created physical and psychological distress and have increased their gender dysphoria, affecting their work and personal lives.    

Transmasculine genital surgeries, including metoidioplasty and phalloplasty (the creation of a penis from existing genital tissue or from skin grafts from elsewhere on the body respectively), are available to trans men who were assigned female gender at birth. They are complex procedures that commonly require three stages of surgery.    

St Peter’s website states that there would normally be at least a three-month wait between surgeries and patients were told by their surgical teams that they could expect to wait from six to 12 months between surgeries. However, following the commissioning issues, patients now face delays of up to three to four years.    

St Peter’s was not recommissioned by NHS England when its contract expired at the end of March 2020. The new provider, New Victoria Hospital, was not appointed until September 2021, meaning there are thousands of people on the waiting list for masculinising surgery, many of which consented to the first stage of their surgeries prior to 2020 without being informed of the delays and are still waiting to finish the process.  Leigh Day has also been approached by people who are yet to receive a surgical referral, or who have received a surgical referral but are yet to be added to the waiting list, due to the delays.  

Patients have also been informed that New Victoria Hospital will perform stage two of the metoidioplasty surgery (hysterectomy and genital reconstruction) in two procedures rather than one, meaning that patients now face an additional surgical procedure that they did not expect or consent to when they chose their treatment plan. Additionally, New Victoria Hospital, the only provider that currently offers phalloplasty, is reportedly not accepting any new surgical referrals.    

The legal team is investigating claims against St Peter’s and NHS England on behalf of patients to hold those responsible to account and prevent such mistakes from being repeated. Claimants could be entitled to compensation if the claims are successful.    

Leigh Day has agreed a November 2024 deadline for a formal response to the letter before action, which lays out the details of the group’s legal argument.    

Speaking on behalf of TransActual, director Chay Brown said:  

“Those on the list have been left in limbo for far too long. Not only have their mental and physical health been impacted, but also their careers, life plans, and personal relationships.   

“We believe that there are things the Defendants could have done to mitigate the impact of the commissioning issues, such as moving some surgeries abroad, and putting in place dedicated counselling, but NHS specialist commissioning chose not to and has not even apologised to those affected.” 

Leigh Day solicitor Anna Dews said:  

“This claim raises important issues around access to healthcare but there are equally important legal questions around informed consent. Our clients agreed and anticipated undergoing surgeries which have been a far cry from what they have actually received.”

Leigh Day solicitor Kate Egerton, said:    

“We have taken the first formal step in our legal action and are now awaiting a formal response to the proposed claim from the Defendants.    

“Those who consented to undergo the surgical process agreed to a particular timeframe and are now facing significant and life changing delays. Being left in between surgeries, or for the procedures to commence, has created intense physical and emotional turmoil for our clients who are facing increased gender dysphoria, the very thing that the surgeries were supposed to mitigate. We are arguing that the Defendants have been negligent in their provision of the surgeries and have breached our clients’ human rights.”

Want to find out more?  

If you are thinking of bringing a claim or are interested in finding out more, please contact us at surgerydelays@leighday.co.uk or call us on 020 3780 0210. We are happy to discuss your enquiry with you over the phone. If you would like to speak to a current client about their experience so far, please contact pressoffice@leighday.co.uk and we will do our best to connect you with someone.