What do tennis legend Martina Navratilova, British Olympic swimmer Sharron Davies MBE, British athletics heroines Dame Kelly Homes and Paula Radcliffe MBE, feminist academic Germaine Greer and Meghan Markle, Duchess of Sussex, all have in common?
And what has it got to do with the health insurance and protection industry?
Well, they’re all currently embroiled, in one way or another, in the ongoing culture wars around gender and trans identity – and it’s got more to do with our sector than you might think.
Greater awareness of trans and gender issues – the subject has never been far from the headlines in recent years – is to be welcomed. The abuse – whether physical, vocal, emotional, online, financial or other – still suffered by some individuals who feel they do not fit the traditional binary concept of gender is both vile and shameful. But it is still going on.
The most recent research for LGBT lobby group Stonewall makes for grim reading. A survey for the charity, carried out by YouGov, found that last year six times as many trans people were physically attacked at work than LGB people who aren’t trans. The same survey shows that one in eight trans people (12%) have been physically attacked by customers or colleagues in the last year because of being trans. And yet one in five trans people (21%) wouldn’t report transphobic bullying in the workplace.
Fewer than half of LGBT staff (46%), meanwhile, agree that there are equalities policies in place to protect trans people at work.
Discrimination on the grounds of gender identity either in or out of the workplace is, of course, abhorrent. But before we go any further, let’s be clear at the outset; this article isn’t about the rights or wrongs of trans or gender issues in themselves. In fact, it’s actually about corporate healthcare because, as in so many other areas, the NHS is struggling to cope with the fallout of the gender culture wars – and employers and the private sector will need to be on the ball when they step in to help.
Last year, Dr James Palmer, the medical director for specialised services at NHS England, said nearly two million Britons could question their gender in the coming years; in the future he expected up to 3% of the population would make contact with transgender health services at some point in their lives.
Reporting that referrals to adult services have increased by 240% over the last five years, Dr Palmer said: “There are currently 7,500 adults waiting for an appointment with our services. No other specialist service has seen this growth, anywhere near. As a result, there is absolutely not sufficient capacity in the system.”
And so, in steps our sector to fill the gap. Large employee benefits consultancies and insurers – and smaller specialist healthcare trust administrators too – have been developing healthcare schemes for clients who wish to fund private treatment for employees who have been medically diagnosed with gender dysphoria.
They have been – rightly – feted by some LGBT groups and others for taking steps to ensure that corporate clients can, if they choose to, set up healthcare schemes that will better meet the needs of trans employees.
If only it were that straightforward though.
Since the first corporate private healthcare schemes designed to “cover gender dysphoria” were developed – just a few years ago – there still remain big questions that employers and their advisers need to ask themselves.
What, for example, about detransitioning – the cessation or reversal of a gender transition? Should a healthcare scheme that has funded the original gender transition fund the reversal too? The trans lobby says detransitioning is less common that some “scaremongering” stories in the tabloids suggest. But it is hard to know, given the ideologically-driven shutdown of supposedly “transphobic” academic research into it. What, in any case, should an employer do in that particular scenario?
And what about egg and sperm freezing for individuals about to transition? As the Human Fertilisation & Embryology Authority, the regulator, says: “Understandably, many trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you have treatment without preserving your fertility and then realise later on that you want a biological family.”
So should an employer’s healthcare scheme fund “fertility preservation” – in other words, egg and sperm freezing – in addition to any transitioning procedures? It is an issue that those running a self-funded corporate healthcare scheme may need to consider. And if a healthcare scheme paid for fertility preservation or treatment for a transitioning employee, would it be obliged, then, to pay for fertility preservation or treatment for “cis” – a word for the majority traditional male/female binary – employees too, in order to avoid being discriminatory?
What if an employee, whose mental health was suffering due to gender identity issues, said that a purely cosmetic procedure would help? Should an employer fund that? And if for them, then should they fund cosmetic procedures for “cis” employees with mental health concerns?
When the first healthcare schemes to “cover” surgical gender transition came onto the market just a few years ago, the societal distinctions were more straightforward. If a member of a healthcare scheme wanted to transition from male to female – or vice versa – they could do so within the limits of the scheme, based on a medical diagnosis of gender dysphoria.
But those phrases – “medical diagnosis” and “gender dysphoria” – are now being rendered essentially meaningless.
So what is “trans” in today’s currency? According to Stonewall’s online glossary: “Trans: An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, gender-queer (GQ), gender-fluid, non-binary, gender-variant, crossdresser, genderless, agender, nongender, third gender, two-spirit, bi-gender, trans man, trans woman, trans masculine, trans feminine and neutrois.”
That could confuse even the most woke HR manager or employee benefit consultant.
But the key words here – for the purposes of this article at least – are “may describe themselves”. In other words, an individual should be able to self-certify their gender (or non-gender) without the need of a medical diagnosis; a doctor’s report to confirm gender dysphoria, for example, may soon be a thing of the past.
According to Stonewall, the Gender Recognition Act 2004 – which back then was “groundbreaking”, the lobby group said, in the way it enabled trans individuals to have their identity legally recognised – is now “seriously out of date and needs reform”.
Stonewall said it supports a reformed Gender Recognition Act that: “requires no medical diagnosis or presentation of evidence for trans people to get their identity legally recognised”; that “recognises non-binary identities”; and that “gives all trans people, including 16-17-year-olds, the right to self-determination, through a much simpler and more streamlined administrative process”.
Again, let’s be clear; I’m not concerned here about the rights or wrongs of the trans debate. But the emergence of self-determination or self-certification could have important implications for corporate healthcare.
To help us understand why, let’s turn back to Centre Court and the views of Ms (or Mx in a current lexicon) Navratilova and her fellow celebs mentioned above.
Recent months have seen controversies where self-certifying transgender women – individuals born in the traditional binary sense as men but who have not surgically transitioned – have won “women’s” sporting events, often to the chagrin of their competitors.
Writing in The Sunday Times recently, Navratilova suggested that it was “insane” and “cheating” that “hundreds of athletes who have changed gender by declaration and limited hormone treatment have already achieved honours as women that were beyond their capabilities as men”.
Inevitably, those comments were labelled “transphobic” by trans rights group Trans Actual, which tweeted at the time: “If trans women had an advantage in sport, why aren’t trans women winning gold medals left, right & centre?”
The 18-time Grand Slam champion said she had “stumbled into a hornets’ nest” but added that while she was sorry for “suggesting that transgender athletes in general are cheats” there was no “perfect solution” to this issue and that if “everyone were included, women’s sports as we know them would cease to exist”.
British sporting heroes/heroines (?) Davies, Radcliffe and Dame Kelly were among those athletes quick to air similar concerns about an increase in self-certifying transwomen competing in women’s events.
Of course, the inevitable online pile on began, Navratilova was dropped as an ambassador by LGBT group Athlete Ally and the more militant members of the trans lobby steamrolled on to their next target.
Somewhat bizarrely, the increased rhetoric around the trans debate has pitted former sisters-in-arms – feminists and transwomen – against each other. The feminist academic Germaine Greer, for example, was famously criticised by some trans groups for saying she did not regard transgender women as women. Some other feminists, meanwhile, object to transgender rights as a symptom of “female erasure”.
The old rules no longer apply; the complexity of the issues and their inherent tensions are clear to see.
Indeed, the chief executive of Stonewall itself is stepping down amid claims that its traditional support base of lesbian and gay – and indeed transsexual – individuals and donors is increasingly concerned about the organisation’s engagement with the more militant elements of the trans lobby.
Meanwhile, last month a governor of the NHS trust that runs England’s only gender clinic for children, the Tavistock Clinic, resigned amid claims youngsters are being rushed into transitioning without being given enough guidance. And researchers from Oxford University have also just warned that young transgender people are being let down by the “terrible” quality of evidence underpinning their treatment and care.
But despite widespread concerns around the pace of change and about the militant approach of some trans activists, the mainstream direction of travel is clear: like it or not, issues around gender and trans identity are on school curriculums, the consensus in Whitehall and Westminster is set and corporates are increasingly desperate to hit constantly shifting diversity targets.
So, if Dr Palmer’s predictions are right and millions more individuals begin to question their gender in the coming years – and if self-certification becomes an accepted norm, regardless of whether or not it is enshrined in a reformed Gender Recognition Act – how should employers, corporate healthcare providers and employee benefit consultants respond?
Surely, if self-determination in terms of gender becomes the new norm, employees who self-certify as a different gender (or otherwise) without a medical diagnosis will be entitled to the same access to private treatment to deal with that as if they had received a formal, independent diagnosis from a healthcare practitioner.
While the US is very different from the UK when it comes to employer-funded healthcare, there have been some pretty costly pay-outs made to employees there who have been denied access to trans and gender identity treatment – and perhaps it’s no secret that a lot of the headway made in this space on this side of the Atlantic has been made by organisations with parent companies based in the US. The risk of multi-million dollar lawsuits tends to focus the mind and direct the strategy.
Many in this sector may see the trans and gender debate as at best a niche, but growing and important area of consulting; some, sadly, may see it simply as a bemusing sideshow.
But this is an increasingly mainstream issue and a growing number of corporate clients are asking for advice and guidance around these complex, sensitive subjects.
Those corporates are hurtling down a foggy direction of travel that is not yet clear and as healthcare technologies and societal attitudes develop at an ever more rapid pace, advising employers about their healthcare schemes looks set to become a cultural maze as well as a legal minefield.
Surely the flexibility of self-funded corporate healthcare should help. But leaving the trans and gender question to one side, what should a scheme cover – and what shouldn’t it? And why for that individual but not for that one?
What about genetic testing? What about abortion? Or sterilisation? Or assisted suicide in Switzerland? Or stem cell storage?
After all, a self-funded healthcare scheme is just that; it’s the corporate’s own money and so it should be able to spend it as it sees fit.
That may all sound far-fetched, but the idea of an employer paying for surgery and treatment for an employee to change gender may have seemed far-fetched years ago. Not so now.
Oh, and speaking of far-fetched, let’s not forget recent reports that the Duchess of Sussex – Meghan – is planning to raise her children as “gender-fluid”. Could that be the new norm?
Kensington Palace has flatly denied those particular reports. But then again, who knows? After all, we live in fast-moving times; times, indeed, of transition.
Are you ready? Your clients are looking for answers.