Marie Sherlock (Dublin Central, Labour)

I move:

That Dáil Éireann:

recalls that it is now a decade since the passage of the Gender Recognition Act 2015;

notes that:

— trans healthcare in Ireland is consistently ranked as the worst in Europe, with over 2,000 people on a waiting list for healthcare;

— stories from transgender people constantly highlight how Ireland's flawed healthcare system is not working, with invasive and insensitive scrutiny from the current National Gender Service; and

— the previous Programme for Government committed to a stronger model for trans healthcare in line with the World Professional Association for Transgender Health (WPATH) international best practice guidelines, but the current Programme for Government has watered down those commitments to the point where they are meaningless;

recognises that:

— there is a need to change the current approach to transgender healthcare in Ireland; and

— the Health Service Executive has initiated a new clinical programme for gender healthcare, is developing an updated clinical model, and has established a Clinical Advisory Group; and

calls on the Government to:

— provide a model of gender-affirming care in primary care settings, with a focus on General Practitioner-led (GP) care, based on informed consent as per WPATH and world Health Organization guidelines, and international best practice;

— replace the National Gender Service with a new national clinical programme for trans healthcare in Ireland, with integrated care pathways, recognising a key role for GPs, and the major need for recruitment of specialists providing gender affirming care;

— ensure that the new national clinical programme: — is developed in collaboration with transgender people;

— has specific responsibility and oversight for governance and training, alongside ensuring transgender healthcare is based on informed patient consent;

— provides comprehensive training for healthcare professionals in gender-affirming care;

— has a comprehensive network of GP's providing that care in primary care community-based settings; and

— further provides appropriate resourcing of specialist gender affirming care and the expansion of gender affirming surgical services, so that the majority of trans persons requiring surgery do not have to travel abroad; — confirm a timeline for the introduction of the new clinical programme for trans healthcare;

— establish guidance and facilities to allow for trans healthcare for young people aged under 18;

— implement a ban on conversion therapies that is inclusive of trans identities and healthcare;

— implement the recommendations of the 2018 Government Review of the Gender Recognition Act 2015, including to allow for the recognition of non-binary people and simplified non-medicalised gender recognition for young people under 18; and

— ensure that the bodily autonomy of intersex children and adults is respected.

I am very proud to be moving this motion today on behalf of the Labour Party. It is ten years since the passing of the Gender Recognition Act in 2015, and a decade since the Labour Party in government introduced legislation to formally recognise and afford dignity to trans people in this country. This came after many years of campaigning. I want to pay particular tribute to all those who fought for it over a long period of time. Today, in the Visitors Gallery, we have many guests who have been fighting for better healthcare and human rights for trans people for a long time - BeLonG To, LGBT Ireland, TENI, Trans Healthcare Action, AMLÉ, IADTSU, Mammies4TransRights, Labour LGBTQ+, Spunout, ShoutOut and those from the trans community themselves, who have come here today for this important motion.

It is fair to say that it is far from guaranteed that the 2015 legislation would be progressed so smoothly today. The war on LGBTQ+ rights has taken a devastating and disgusting turn in recent years across the world, with rising hostility by Governments in Hungary and elsewhere across eastern Europe, and attacks here at home and, indeed, within this Chamber and in the Seanad. All of this reminds us that progress cannot be taken for granted. It needs to be actively protected and supported.

For us in the Labour Party, gender recognition was only ever one part of the jigsaw. For us, a compassionate, caring system of healthcare is the other part of the social contract that we owe trans people in this country. While there are many debates about models of care and the rights and wrongs of various institutions, all we want is that young, vulnerable trans people out there are afforded compassionate, appropriate and timely healthcare.

I appreciate that the Minister of State with responsibility for mental health, Deputy Mary Butler, cannot be here today. I pay tribute to her work in this area in recent years. I very much hope that she makes progress.

I know that we stand here today very angry and distressed at what is available in this country. We are angry that vulnerable young people are being forced to wait four and a half years before they can even get an initial appointment with the National Gender Service. That is a lifetime to a young, vulnerable person who desperately needs support. We are angry that so many people had to go down the DIY route. It is estimated that some 30% are self-medicating with medicines bought on the black market, with no proper GP or clinical monitoring, and all the risks that entails. We are frustrated that so much care has been centralised through the National Gender Service here in Dublin and that GP care is non-existent in many parts of the country for trans people. We are aghast that there has been little or no recruitment since 2020.

At the heart of all of this, we are concerned about the actual model of care itself. I have spoken to a significant number of trans people in recent months about their experiences. I have also reached out to the staff of the NGS to understand their perspective on the service they provide. To be frank, the whole provision of services is an absolute mess. We desperately and urgently need a reset in how those services are provided in this country. The stakes are so high. For too many trans people, the wait time of four and a half years makes them feel like there is no service.

Is it any wonder that so many suffer crippling mental health issues because of the lack of supports? We know from research by BeLonG To and Trinity College in 2024 of the very real impact, which is summed up by that feeling of hopelessness. The lack of supports can have deadly consequences. During the summer, The Journal reported research by Trans Healthcare Ireland that 75% of trans people have self-harmed, 82% of trans people have experienced suicidal thoughts and, shockingly, 39% of trans people have had a suicide attempt. For many others, the lack of health and social support is having a devastating impact on their education, work and family and social life. That is why we in the Labour Party are bringing forward this motion today. These are our young people, sons, daughters and siblings, and, for some, it is their parents, colleagues, neighbours and friends.

I know a review of the model of care is currently under way and that the findings will be published next year. I want to set out our belief in the Labour Party about what needs to happen. We need a new model of care, a model that is rooted in informed consent, self-determination and respect for the bodily autonomy of individuals. We do not need to start from scratch. There are models out there in other countries that we can take guidance from. As the Minister knows, there is a lot of hurt and terror out there due to the assessment process and the invasive line of questioning. From a clinician’s perspective, I understand that in order to prescribe medication, there has to be a careful process but the current model is simply unacceptable. It makes no sense. We have to start trusting people when they say they are trans. We have to stop traumatising them at the assessment and stop pathologising so much of the trans experience. Yes, it is complicated, and yes, hormonal treatment may not resolve all the issues but we have to move away from what appears to be a paternalistic, judgmental model of care. We have to put forward something that puts the patient at the heart of decision-making. That involves informed consent. All too often, we hear clinicians dismissing informed consent as a person going in there and demanding whatever they believe to be appropriate. That is not what it is about. It is about seeking the appropriate hormonal treatment and being informed about the consequences - not being interrogated but being informed.

There is an irony here that people who have been living as trans for the past four years, waiting for their appointments with the National Gender Service, have had many years to think about what they are, who they are and what they need. They do not wake up some morning and say that this is what they want to be. Nothing could be further from the truth. Yet, far too often, their experience with the National Gender Service is just that.

Second, we need to ensure that multidisciplinary teams play a much greater role, in particular given the role of psychologists and medical social workers in their interaction with the National Gender Service. Third, we need a continuum of care from teenage years into adulthood. It is a huge dereliction of duty on the part of the Department of Health that there is no service at all for trans youth or adolescents in this country right now, or for their parents who want to support their children. Right now, CAMHS is the only service, and it is so wrong that children would be directed there.

We need GPs to be a critical part of the new framework. There needs to be specific training on the importance of hormonal blood tests, safe prescribing of HRT and the handling of referrals. Far too few GPs are being trained at this point in time, or are showing an interest. We need to actively ensure we have a good distribution of care across the country.

No country is perfect but we can learn a lot from Iceland, Malta, Spain and Australia. Malta is a small country like our own. It has shown the way. Its model is a de-pathologised model, building on maximising the health and psychological well-being of the individual. There is a very similar model in Iceland that operates with minimal wait times. Australia has developed a comprehensive and evidence-based model that puts significant emphasis on multidisciplinary care. It relies on the input and support of GPs, community-based healthcare and telehealth. It ensures a continuum of care, something that is so desperately lacking in Ireland.

I thank all those who have come here today. I am very proud that we in the Labour Party are bringing forward this motion. As I said earlier, I thank the Minister of State, Deputy Mary Butler, because she has played a very important role in the conversation.

I will end with the words of Sarah: "If you'd just let us live our lives in peace, with the right medication, with the right time, we would be fine".

See this speech in context