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Update on the Welsh Gender Service Surgical Referral Pause – 4th September 2026

The NHS Wales Joint Commissioning Committee (NWJCC) has taken the decision to pause referrals for gender affirming surgery from the Welsh Gender Service.  

The NWJCC recognises that this pause will cause uncertainty and worry for patients waiting for surgery and their families. The decision has not been taken lightly. Our priority is to ensure safe, high-quality care. This pause is to allow an urgent independent clinical review to take place, a precautionary step taken on clinical advice to ensure referrals for gender affirming surgery are supported by arrangements that help make sure care is safe and of a high standard. 

To emphasise, this is a pause and not a permanent change to the service.  

Other than the pause in surgical referrals and surgery, the care provided by the Welsh Gender Service remains unchanged. Assessment services, psychological support, endocrine support, hormone therapy and speech and language therapy continue to be available.  Alongside this clinically necessary follow-up care for patients who have already undergone surgery, those progressing through a planned series of surgical procedures as part of their transition, patients requiring treatment for complications, and those who need other clinically necessary aftercare is unaffected by the pause. 

The decision follows information identified through NWJCC's routine checks on the quality and safety of services in July and August 2026. Data from the Gender Dysphoria National Referral Support Service (GDNRSS), the NHS England-commissioned service that manages, validates and routes referrals for gender affirming surgery, showed that referral rates from Wales in 2025-26 were significantly higher than those recorded by Gender Identity Clinics in England. In addition, for some forms of surgery, including masculinising genital surgery (also referred to as bottom surgery), a significantly lower proportion of Welsh patients were progressing to surgery following referral compared with patients referred from English Gender Services. This raised questions about why more patients were being referred from Wales and whether some patients who were not going on to have surgery had been appropriately assessed before referral. 

Furthermore, information provided by clinicians and correspondence received raised concerns about whether some aspects of the assessment process before referral had been completed appropriately. These concerns included whether some patients met the basic requirements for surgery, including factors such as BMI and overall surgical fitness, and whether wider health needs had been fully considered before referral.  

The Quality, Safety and Outcomes Committee (QSOC), which oversees the quality and safety of commissioned services, considered this information and concluded that the safest course of action was to move the Welsh Gender Service into Level 3 escalation and that the following actions should be taken:  

  • Pause referrals from the Welsh Gender Service for assessment by surgical providers;  

  • Pause assessment by the surgical providers;  

  • Pause surgery; and  

  • Undertake an urgent independent clinical review, by experienced gender clinicians, of patients on the surgical waiting lists. 

 

NWJCC is working with experienced gender specialists to start the review as quickly as possible and minimise any delay for patients.  

Patients affected by the pause are being contacted directly and dedicated arrangements are in place by Cardiff and Vale University Health Board to provide patient, staff, and referrers with information, advice and support.  

It is important that any information shared about this matter avoids speculation and remains accurate, factual, and grounded in the clinically led decision and review process underway. 

NWJCC will continue to work closely with Cardiff and Vale University Health Board, clinical leaders, stakeholders, and service partners as the review progresses.  

Further information, including frequently asked questions and support resources, are all available on the Cardiff and Vale University Health Board website. 

Read the FAQs here. The FAQs will be updated as further information becomes available.