Paul Murphy (Dublin South West, RISE) | Oireachtas source

Our healthcare system in general is in crisis. Almost a million people are on public hospital waiting lists. It is even worse for trans people. We have the worst trans healthcare in all of the European Union, according to a recent report by Transgender Europe. There is denial of services in primary care settings and a ten-year waiting list to access public services. Those people who seek to access services through the public service are faced with intrusive psychiatric assessments. There is inadequate care, discrimination and the exclusion of transgender people from policy development. The healthcare situation is getting worse for trans people in this country, not better. People report that it is worse now than it was 15 years ago. We have no national gender-affirming healthcare policy or guidelines and no services for trans young people in Ireland, leaving many in extreme distress.

All of that is in contradiction of the programme for Government. I will ask a clear question. The programme for Government states it will:

Create and implement a general health policy for Trans people, based on a best-practice model for care, in line with the World Professional Association of Transgender Healthcare (WPATH) and deliver a framework for the development of National Gender Clinics and Multidisciplinary Teams for children and adults.

Has this commitment been abandoned or replaced? The very opposite to what is outlined in respect of WPATH is taking place. That is meant to be a non-pathologised approach to care based on informed consent. Instead, what is happening is a de facto, hyper-centralised system in the form of the National Gender Service, NGS, and the setting up of massive roadblocks to deny people the healthcare they need and should be entitled to. The standards being applied are in direct conflict with people's rights to bodily autonomy, self-determination and healthcare.

To look at that in some detail, I will take the issue of waiting lists. The NGS likes to claim it has a three-and-a-half-year waiting list, which would be bad enough, but it has more than 1,600 people on the waiting list and has never handled more than 160 people in a year. It is, therefore, clear it has a decades-long waiting list. If somebody can manage to get through that ten-year-long list, and does not have access to private resources to go abroad for healthcare, that person is faced with incredibly intrusive and invasive psychiatric assessments.

The things people are asked are appalling. One person reported: “For over three and a half hours my psychological evaluation took place. I was asked about masturbation. I was asked about my parents’ divorce. I was asked how I performed specific sexual acts. All of these questions made me feel completely dehumanised." A trans woman said: “She asked me about what porn I like, what role I take during sex, do I prefer men or women, did I play with dolls as a child, did I play sports.” This is a 26-year-old woman whose mother was invited and involved in this process. This woman is an adult; there is no role whatsoever for a mother here. It is absolutely scandalous.

This starts at GP level, where it is very clear that GPs are not being empowered or informed and, in fact, are being told that they cannot provide the healthcare that is needed. There is an example of an Ukrainian trans man, who after doing all the necessary tests and so on, was denied the blood tests and medication he needed because the GP told him he had to go to the NGS and will, therefore, have to wait on this long list.

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