Dr. Philip Crowley:

Several questions were specifically directed to me and I will attempt to answer them briefly. The HSE is committed to meeting the needs of the transgender community and I hope our presence here today alongside TENI is a clear demonstration of this fact. A question was asked whether we participated in the gender recognition advisory group. I understand it was an interdepartmental committee so the Department of Health was represented. We made submissions to it, as did a number of the specialists who work on our behalf to deliver services.

With regard to access to care, the medical card covers the services provided in Ireland to the community and should be provided with regard to people's needs without any discrimination. This is not to state access is not an issue and I will return to this point. It is fair to state services have developed through the pioneering efforts of a number of forward-sighted individuals who trained in the UK and gained expertise in the particular needs of the transgender community. We do not think this is adequate for the emerging community, which is why we have commenced the process to develop an agreed treatment pathway with more than one centre. At the same time we would not seek to have a huge number of centres where expertise becomes diluted. As with everything, and as we know from previous debates, there will be a balance between access and quality of care. We will try to increase access by creating more expertise and signing up other experts, particularly in endocrinology and mental health services outside of Dublin, which is critical for the community. This process is under way and we need to continue to dedicate ourselves to it. If asked we will bring to the committee the outcome of this process.

With regard to whether we fund TENI, we do not fund a large number of advocacy organisations but we do provide a small amount of funding to TENI to support the work of Ms Lacey because we see this particular community benefits hugely from the informed support someone such as Ms Lacey can bring, which is far ahead of what many of our staff could bring to members of the community. It creates a bridge between the community and the services which, as we start to develop them on more competitive basis, is critical. This is why we provide funding for the post.

Ms Lacey asked about laser therapy and voice therapy. It is easy not to take such therapies seriously. Ms Lacey can explain much more eloquently how critical such services are to making a successful transition. I understand we do not fund these therapies at present and they may be the victim of a sense they are purely cosmetic. I certainly understand this is not the case and it will be part of what we must examine in developing an agreed treatment pathway.