Report Date


Case Against

Betsi Cadwaladr University Health Board


Clinical treatment in hospital

Case Reference Number



Upheld in whole or in part

Mr B complained that, from 2017, the Health Board failed to conduct appropriate assessments and make suitable referrals following his request to be referred to the Gender Identity Clinic. He also complained about the standard of communication about progress on his request, and said that the Health Board failed to maintain appropriate records.

The Ombudsman found that there were failures to conduct an appropriate assessment in 2017,that an assessment in 2018 failed to identify that Mr B met the criteria for a referral, and that a challenge to the 2018 assessment outcome was not dealt with appropriately. He also found that Mr B had been misled to believe that a referral had been made when it had not, and was not kept fully informed about the process of referral or the decisions the Health Board was making. Finally, the Ombudsman found that the records did not reflect the appropriate diagnostic terminology (which might have contributed to the confusion around Mr B’s eligibility for referral) and demonstrated that clinicians failed to refer to Mr B using his preferred name and pronouns.

The Health Board agreed to apologise to Mr B and offer him £2000 within 1 month, in recognition of the distress caused to him as a result of these failings. As the referral process had changed since the time of the events, it also agreed to remind relevant staff of the current appropriate referral process for individuals who require gender healthcare. The Health Board also agreed to provide training to relevant staff within 6 months, on the current NHS approach to diagnosis and symptoms relating to gender healthcare, trans-inclusive diversity awareness and meeting the needs of transgender individuals.