NHS Wales halts gender-affirming surgery referrals over assessment concerns

Gender-affirming surgery was halted because of concerns from an NHS committee over whether patients had been "appropriately assessed".

After meeting Welsh government ministers on Friday the NHS Wales Joint Commissioning Committee (NWJCC) said data showed the rate of surgery referrals made by the Welsh Gender Service was "significantly higher" than in England.

It also said the proportion of Welsh patients progressing from referral for some types of surgery was "significantly lower" than across the border.

The NWJCC is the body which instructed Cardiff and Vale University Health Board to halt new referrals and planned surgeries.

The health board is responsible for the running of the NHS gender identity clinic which provides specialist care and support for adults in Wales.

It confirmed on Tuesday that some patients who had been awaiting gender-affirming surgery were already in hospital for their procedures when they were told of the suspension.

The Welsh Gender Service provides referrals for patients living in Wales, but all NHS surgeries are carried out in England.

Gender-affirming surgery includes both masculinising and feminising procedures. They are not reversible.

The NWJCC said in some cases patients did not meet "the basic requirements for surgery".

Having an unsuitable body mass index (BMI) - a value derived from an adult's height and weight, was a factor.

There were also worries about whether wider health needs had been fully considered.

Some clinical professionals, it said, had concerns about whether parts of the referral assessment process had been done appropriately.

The NWJCC said it would commission an independent review of the service, and was "working with experienced gender specialists to start the review as quickly as possible".

Health minister Mabon ap Gwynfor and deputy first minister Sioned Williams attended the meeting with the NWJCC.

After the Welsh government said: "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."

The decision to pause surgeries last week was prompted by data which indicated "significantly higher rates of referral for gender affirming surgery... compared with English gender services" in 2025-26, according to the health board.

First Minister Rhun ap Iorwerth previously said the review into surgery services must be quick.

Ap Iorwerth said while the committee at the heart of the row had taken the decision "for the right reason" on service quality grounds, he wanted a "resolution quickly".