Dr. Philip Crowley:

First of all, I welcome the fact that we are having this debate. I also welcome the opportunity to participate in the debate. It is part of Ireland finally modernising itself in another important way. I am a GP and I lead in the HSE on quality and patient safety. In that role I have sought to work with transgender people to develop a better understanding with them of the issues the health service can meet and that it can sometimes create for transgender people.

In that role I have sought to bring together the leading professional groups who can provide services, support and care to transgender people, with representatives from the transgender community, to ensure we get a more co-ordinated and better model of care. The short answer to Deputy Ó Snodaigh's question is that we have services for transgender people. I do not believe they are well co-ordinated at this point in time. I do not believe they are numerous enough to be readily accessible, no more than other services we provide, but we are talking about services for transgender people today.

We fund a health and education officer to try to work with the transgender community on their own terms and support the community to advocate so that we can better meet their needs. Overall, our role as a health service is to ensure that we understand the extent to which we can both guarantee and ensure the psychological well-being of transgender people and not harm it in any way. We have issues about access to services. There are delays to access services. Some people choose not to access services.

The Deputy specifically mentioned surgery. Currently, surgery is provided in the United Kingdom and we support and fund that provision. The reason for that is, no more than other very specialist areas of care, we would want that surgery to be carried out to a very high level of quality and we do not believe the volume would develop a surgical team of that quality in Ireland. We are very much at one with the transgender community in that understanding but if the situation changed and the volumes developed to an extent that we could develop a highly competent service here, we would examine that.

Taking up the point about sports and hormones, I am not an expert on hormones. I understand an expert on hormones was before the committee yesterday but whatever we do we should seek again to look after the psychological well-being, normalisation and acceptance of transgender people. Obviously, we should ensure that whatever role the medical profession is asked to play they play it to enable people to participate in sport in an agreed fashion, whatever is that fashion. We must accelerate our work with the professional groupings to develop a co-ordinated model of care in partnership with the transgender people, and we will do so.