On Tuesday this week, 29 year old Sion Jewell told the BBC about the cancellation of her double mastectomy. “It was just the most heartbreaking feeling in the world” said Jewell, “to know I can’t be in the body I’ve always been in my head… the dysphoria is a pain like nothing… nothing imaginable can describe that pain.”
Jewell’s surgery was cancelled 24 hours before she was due to go under the knife. We are now finally starting to get a bit more information as to why NHS Wales’ senior body, the Joint Commissioning Committee (JCC) decided to cancel all surgeries referred by the Welsh Gender Service, the only NHS adult gender clinic in Wales.
We know, as per the JCC, “referral rates from Wales in 2025-26 were significantly higher than those recorded by gender identity clinics in England”. What we didn’t know until Friday 4 Sep was that a significantly lower proportion of Welsh patients were progressing to surgery compared with patients referred from English gender services.
This is an obvious red flag. As NHS Wales JCC says, the statistical disparity “raised questions” as to “whether some patients who were not going on to have surgery had been appropriately assessed”.
Specifically, “concerns included whether some patients met the basic requirements for surgery, including factors such as BMI [body mass index – how fat you are] and overall surgical fitness, and whether wider health needs had been fully considered.”
Other examples given were “smoking status” and “unmanaged health conditions”. This latter point echoes a concern from one mother I spoke to who felt her son’s glaring co-morbidities were completely disregarded by the zealots at the Welsh Gender Service.
Basic Clinical Competence
This is no longer just a debate about the ethics of the NHS helping unwell people chop up their genitals or slice off their breasts. This is about basic clinical competence. And it looks like the Welsh Gender Service couldn’t even manage that.
The JCC has decided to “pause” all surgery referrals, all scheduled surgeries and all scheduled assessments by surgical providers, pending an “urgent independent clinical review”.
On Friday we were told that the “urgent independent clinical review” is being undertaken by “experienced gender clinicians”. If you’re wondering how independent those clinicians might be, NHS Wales’ Cardiff and Vale University Health Board (C&VUHB), of which the Welsh Gender Service is part, has made clear it remains committed to “high-quality, evidence-based and person-centred gender affirming care“. [my italics]
It is “gender-affirming care” which, on the face of it, has potentially placed unsuitable patients on a conveyor belt to high-risk, and possibly unnecessary surgery. The practice has been re-affirmed by NHS Wales C&VUHB before any outcome of the supposed “independent” urgent JCC review – a review which is being carried out by “gender clinicians”, who overwhelmingly practice gender-affirming care.
In words you will not see me write for the Sunday Times, this is utter f****** madness.
Picking Fights
Whoever took the decision within the JCC last week to bring the shutters down was a brave individual. They had to be certain that doing so was lower risk than letting any surgery or surgery referral go ahead. That suggests – in their view – that the scheduled surgeries were potentially more likely to cause harm than not.
They would have known they would have to deal with disappointed patients, outraged activists, internal warfare, national media interest and a political s*** fight as a consequence. Yet they chose that over business-as-usual.
The last two weeks have seen several battle lines being drawn. C&VUHB is currently telling people “No immediate patient safety concerns have been identified by the JCC, and therefore they are not concluding that patients have come to harm.”
Trans activists think this is all a confection. Speaking to Dazed magazine, “Shash”, who is the co-founder of Trans Aid Cymru, said “Wales just seems to be better at doing their job than the English gender service.” Shash believes the pause in gender surgeries is “against the Hippocractic oath”
The JCC has not only picked a fight with the C&VUHB, and trans activists, it is also taking flak from the Welsh government.
According to the BBC, Plaid Cyrmu ministers met with the JCC yesterday. They apparently “sought and received assurances” that the decision to cancel surgeries “is a pause, not a stop”. Once appropriate clinical assessments are in place, the government wants WGS to go full steam ahead so that “individuals will progress to surgery at the earliest possible opportunity”.
Sort it, lads, Sharpish
Wales’ first minister, Ap Iorwerth, has said he will be led by “the clinical point of view”, but he too wants a resolution “quickly”. The message coming from the top is clear. Re-start the conveyor belt as soon as you can. It will take a brave doctor who doesn’t care much for their career to face that pressure down, no matter how much evidence they have.
Once the short term dust has settled, we might see the beginning of the wholly separate, long-promised, independent review of the Welsh Gender Service, which was commissioned in July 2024. I hope whoever is in charge takes a hard look at what has been happening in the round. Hormones are serious drugs. Gender surgeries are expensive, high risk, brutal procedures. How many people really “need” them?
This is the only field of medicine which advocates for the removal of healthy body parts to assuage mental distress. The patients for these procedures are unwell (permanently on the verge of suicide, if you believe the campaigners). Even if everything goes swimmingly, its recipients are likely to be infertile and remain on lifelong medication. The long term consequences of carrying out these surgeries at scale are unknown. Yet left-wing politicians and activists keep cheering the bandwagon on, insisting taxpayers pick up the bill whilst washing their hands of the consequences.
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