Background: This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care.Objectives: The main objectives were to understand: Which factors make services more or less accessible and acceptable to the variety of trans adults? How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved? Design, data sources and participants: An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups.Six case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed.Results: The following undermine person-centred co-ordinated care and can lead to experiences of harm: lack of respectful treatment of trans people by general practitioner practices; inadequate funding of services; lack of support during waiting; the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; lack of National Health Service psychological support for trans people. Case studies indicated ways to improve care, although each has significant unresolved issues: training in trans health care for general practitioners; third-sector peer-support workers for trans people who come to National Health Services; gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; psychology services that support trans people rather than assess them. Limitations: Some contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation.Conclusions and future work: The findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations.Study registration: This study is registered as Research Registry, no. 5235.Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full inHealth and Social Care Delivery Research; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.

Co-production in research offers the potential for multiple benefits, including amplifying the voices of the marginalised, reducing power inequalities between academic researchers and co-researchers outside of academia, increased likelihood of impact, and improvement in the research process. But alongside increased interest in co-production, there is increased awareness of its contextual constraints. Key amongst these are institutional orthodoxies in academia, including time-limited, project-based research and precarious employment for junior researchers. To examine how the potential benefits of co-production can be achieved within the constraints of current academic systems, a case study project was assessed against a documented set of expectations for the co-production of research with older adults. The case study was a research project conducted with seven almshouse communities in England on the topic of social resilience. The wider almshouse communities—staff, trustees, and residents—were involved in co-production. The assessment concluded that co-production led to rich data and deep understanding. Co-production aided the development of skills and experiences of the co-researchers, resulted in changes in practice, and challenged power differentials, albeit in limited ways, but could not ensure the sustainability of relationships or impact. Key elements for effective co-production included the approach to and governance of the project, the formation of a Residents Advisory Group, and planning for the limited commitment that individuals and organisations outside of academia may be able to contribute to research.

People experiencing homelessness (PEH) have extremely poor health outcomes including a lower life expectancy [1], high level of chronic illness [2], and a