Visualising GIC FOIs

This is a summary of Freedom of Information requests made to adult GICs in the UK during 2021. Through surveying these FOIs, there is evidence of a widespread failure of GICs manage their ballooning waiting times, with gulfs between referral numbers and numbers of people being seen for their first appointments. There is a large variation in what data was asked for, and how it was responded to by the GICs / Trusts, which shows that we need to be more unified in how we ask for data from the clinics. My recommendation would be to have a set of questions that we want updated from each GIC (e.g. the date of referral currently being seen for first appointment, and the number of people on a waiting list) and that we ask the same questions to all the GICs, to allow for comparison. Where possible, asking for monthly breakdowns would be of great use, and making sure that we get contextual data such as the overall operating budget and the full-time equivalent hours of staff working will be incredibly useful. This is not meant as a complete survey, and I am hoping to do similar write ups every six months or so.

All of the graphs were made using publicly available FOI data in RStudio/ggplot2.

The Tavistock and Portman Adult GIC

J Scott 2021

The most recent FOI concerning the Tavistock and Portman Adult GIC comes from J Scott’s FOI requests from April to June 2021. This asked for the number of referrals, first appointments, second appointments, “post-1st”[RD3] appointments, the numbers of those on waiting lists, the annual budget, and the number of full-time staff at the clinic. They found that the budget increased from £3.978m in 2017 to £5.923m in 2020:

At the same time, the number of full-time-equivalent staff members increased from 18.8 FTE to 22.7 FTE:

You can see the large increase from 2019–2020 form 19.2 FTE to 22.7 FTE.

This FOI also investigated the numbers of patients at each stage of the GIC waiting list, and found that whilst the number of people having their first appointment, their second appointment, any appointments after a second appointment, and the number of referrals accepted were all constant, there was a sharp increase in the number of people on the waiting list to be seen:

It is somewhat reassuring that people are being seen at similar rates for their first and second appointments, as opposed to over-focusing on initial appointments to get through the waiting list[RD4] . However it is greatly concerning that the number of referrals is on average 2.7 times higher than the number of first appointments, and 6.4 times the number of appointments during 2020 (likely due to the Covid-19 effect). This has led to the waiting lists multiplying on average 1.4 times each year (although it is actually getting somewhat lower each year).

Thanks to the diligent work of J Scott, this FOI allows us to further compare both the budget and the number of full-time hours at the clinic to waiting times, and people at different stages of the GIC pathway.

For patient numbers we have the following graph:

This shows that whilst the budget has gone up about 150% over the four years, there has been no appreciable change in the number of appointments processed, and has had no appreciable impact on waiting lists.

Likewise, we can plot the number of full-time hours against the patient numbers at the GIC to find a similar pattern:

The number of FTE staff has increased, particularly from 2019–2020, and there has been no clear change in any appointment numbers (excepting the 2020 drop in first appointments due to the pandemic).

It is unclear what this added money and staff are doing for the GIC, and although it may take some time for these measures to actually result in a change at the clinic, and caveating that this is correlatory and impacted by the pandemic, it is incumbent on the GIC to prove that their system of gatekeeping is a suitable spend of public money and resources.

I am currently waiting on FOIs to all the other GICs for their budgets, which will allow some comparison with J Scott’s work.

J Hackett May 2021

J Hackett has further FOIed the Tavistock and Portman Adult GIC to delve a bit deeper into the clinic. She has found that the clinic:

• Does accept self-referrals
• That between January and March 2021 the average wait time for patients to be seen for their first appointment is 106 weeks, or just over two years
• That for the first quarter of 2021, patients were being seen that were initially referred in September 2017
• And that the average wait time for follow-up appointments is between 12 and 18 months

L-M Nelson March 2021

L-M Nelson looked into the number of people being discharged from the Tavistock and Portman for the financial years 2017/18–2020/21 and found that there was an increase from 442 to 1228 from 2017/18–2019/20, which then fell to 1070 for 2020/21.

The reasons for this were multiple, and include being admitted elsewhere, having treatment completed, the patient not attending etc. It is therefore unclear what percentage of this is due to someone completing all their required care at the clinic, and those that are discharged because they are, e.g. not deemed trans enough for the service. A future FOI could push further for this breakdown, although the response to L-M Nelson’s FOI was that the Tavistock and Portman do not hold this data.

O Newport January 2021

O Newport asked the Tavistock and Portman for data on their adult GIC in January 2021. This found that as of March 2021:

• The number of patients waiting for their first appointment as of 16/3/2021 was 7902
• That the longest time on a waiting list was 1433 days (which is about 48 month, or almost four years)
• That the longest time waiting for a second appointment is 994 days (~34 months or 2.7 years)
• That the number of patients accepted or processed from January 2019 to March 2021 was 5256 patients

This data was repeated in A Williams’ FOI around the same time.

H Burns April 2021

H Burns found similar data to J Scott’s FOI, looking at first appointments by year. In addition to this, they found that as of the 4/5/2021 8741 people were waiting for their first appointment. We can compare this to O Newport’s FOI to find that between 16/3/2021–4/5/2021, the number of people waiting for their first appointment increased by 839 people, an astonishing increase of 44 people a day.

NHS Lothian (Chalmers St GIC)

T Cowie April 2021

Thomas Cowrie looked into the number of people on waiting lists and seen each year at the Chalmers St GIC run by NHS Lothian, in Edinburgh. Cowie found that: there were 552 people on their waiting list, with 21 people currently being triaged; the longest waiting time from referral to first appointment was above 1000 days, and found the following numbers of patients seen each year:

This shows a worrying 3-fold drop in patient numbers seen between 2018 and 2019 (from 336 to 110 patients), with this leveling off somewhat due to the pandemic in 2020. That this decrease predates the Covid-19 pandemic is particularly concerning, and seeing their budget and full-time equivalent hours numbers of staff would be very useful contextual data.

Sandyford NHS GIC

L Jack March 2021

Lilidh Jack looked into the numbers of referrals, and attendances & individuals, at the Sandyford GIC in Glasgow. This FOI reaped incredibly useful information, giving a month-by-month review of all the people referred and seen from January 2019 to March 2021.

The referrals received graph looks like this:

The large spike of 123 people in November 2020 is due to a backlog of referrals being processed at the same time. It is hard to see much of a trend throughout this, especially with such a skewing anomalous spike, but there was a decrease in the number of referrals from 2019 (512 referrals) to 2020 (433 referrals) which may be of interest.

We can then also see the number of individuals that were seen at the Sandyford GIC, and the number of individual attendances each month (slightly higher as some people will come to multiple appointments in one month):

We can clearly see the Covid-19 effect on the data in March to April 2020, where individuals seen fell from 103 to 51 people seen. Otherwise, it is relevant that we have not seen a long-term increase in the number of people seen at the clinic, although this data is not disaggregated into first/second/post-first appointments, or discharges, which would let us see a broader picture.

We do know the number of adults that were waiting for their first appointment at the start of 2019 (964 people) and the start of 2020 (527 people), which is a positive move for the GIC.

This FOI also revealed that the number of full-time-equivalent staff has been relatively stagnant:

• January 2019 = 2.8 FTE
• January 2020 = 2.3 FTE (with an 0.5 FTE vacancy)
• January 2021 = 3.1 FTE

They also note that an aim of the service is to increase this to 3.6 FTE through 2021.

Devon Partnership Trust (the Laurels, Exeter)

Jan 21 FOI

At the start of 2021, this FOI was released which found that there were:

• 2592 people on the Laurels’ waiting list
• The longest time that any one had waited on the waiting list was 2092 days (85 months, 7 years)
• Between December 2019 and December 2020:
• 495 referrals were accepted
• 14 people were discharged
• 2 people were assessed

C Turner March 2021

A slightly later FOI by C Turner found that between December 2019 and 08/04/2021 there were 12 initial assessments. This means that between January 2021 and April 2021, there were 10 people seen for their first appointments.

This FOI looked into the number of initial assessments from 2014–2020 and found the following:

This shows the sharp and worrying drop in phase one assessments from a peak of 350 a year to just 12 in 2020–2021. It shows that the majority of this decline happened between 2017 and 2018, and that this has remained low prior to and during the Covid-19 pandemic.

J Cook March 2021

J Cook asked some further interesting questions of the Devon Partnerships NHS Trust about the number of patients that were referred in each year, and the number of people from each referral year that have now been given a date for their first appointment:

This shows that, unsurprisingly, people seen past 2016 have not yet been given a date for their first appointment, but crucially shows that the numbers of people has decreased slowly from 2015–2020, from a peak of 738 people referred in 2015 to 500 people being referred in 2020 (the drop in 2021 is because it is an incomplete year).

J Cook also found that the person that had been waiting the longest for an appointment was referred on 27/10/2015, which is 64 months, or 5.35 years.