Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I sincerely thank Deputies from the Labour Party for raising this important issue. It is an area on which I and the Minister of State, Deputy Butler, are placing a strong and deliberate focus. As I listen to Deputies from the Labour Party going back over the history of this, I recall that they did so in partnership with Fine Gael and that we stood together to introduce many important social changes. In many respects, it might have been slightly harder for Fine Gael to do that with the Labour Party. A broad balance that changed in society achieved the changes we all wanted to make, which brought about a much more compassionate society for women and LGBT people. I am very proud of that work.

I sat beside Deputy Frank Feighan and recalled having a debate with him before I became Minister when he was a Minister of State in the Department of Health. The debate in question took place in March 2022. I asked him what we were doing to support transgender people in terms of healthcare. I decried in particular the divisive debate that seemed to be seeping across from the United Kingdom at that time. We could see it coming. I recall speaking with trans people prior to that debate, who told me about the fearful things that were being touted at that time, namely that people would come into changing rooms, for example, and dress up as men. We all know the sheer nonsense that a man would dress up as a woman and come into a changing room for the purposes of attacking me, as though with all of the conversations we have had about femicide in this room we ever needed a man to dress up to attack a woman. Did you ever hear such nonsense? Did you ever have examples of it from any time since the Gender Recognition Act was passed? A different movement seeped in somehow in 2021 and 2022 and changed the narrative. It made the narrative cruel for trans people and other people. I have never understood why that happened. I always regretted that such attitudes seeped over here. I hope we can stand together to take steps that help to seep that away and remove any of that divisiveness from the House, as Labour Party Deputies have said.

Notwithstanding the divisiveness in the debate and our desire to set that aside, I recognise that we have an awful lot of work to do on healthcare. I have worked with LGBT Ireland, TENI, BeLonG To and Spunout for many years. I was the vice chair of the Fine Gael LGBTI group. I stand alongside the Minister of State, Deputy Butler, who is a leading advocate for change in the approach to healthcare to bring about much more inclusive, compassionate and respectful healthcare provision for gender-diverse people.

Let me be very clear, even if I do not get to all of the points in my speech, that the Minister of State, Deputy Butler, and I are standing together to work in a very practical and pragmatic way to try to re-situate the balance, the dynamic and the compassion in healthcare for gender-diverse people. Along with the Minister of State and the Government more broadly, I recognise that gender diversity is absolutely part of the human experience and that gender-diverse people should be respected in their identities and in their right to express themselves. They may choose to transition from the gender assigned to them at birth to being recognised and identified as another gender. Of course that is what the Act we are celebrating ten years of does today. They may also explore their gender and socially or legally transition without needing healthcare services.

Some people, including children and young people, may experience gender dysphoria, which refers to the psychological distress that results from an incongruence between one's sex assigned at birth and one's gender identity. In that respect, we, first and foremost, try to address many of those psychological, anxiety and mental health needs young children have. The debate has swung as though people are trying to treat them in one way when, in fact, they are trying to treat anxiety and psychological distress in the first instance, as is completely appropriate.

Nevertheless, the Minister of State, Deputy Butler, and I are determined to ensure that a comprehensive, appropriate and integrated gender healthcare service is available for those individuals who require it. The Government is committed to ensuring that people of all ages have access to appropriate pathways to gender healthcare for them at the time and space they are in and that they are treated with kindness, dignity and compassion.

As in other countries, it is true to say that demand for gender-affirming healthcare services has risen significantly. The Minister of State, Deputy Butler, and I fully accept and acknowledge that the current public services are not meeting people's full range of needs. We also recognise the urgent need to establish more appropriate and comprehensive services. It is in that context that the HSE has established a new national clinical programme for gender healthcare to develop an updated clinical model of care. The Minister of State, Deputy Butler, and I take a very direct interest in the work that is going on there and the stages and reflections happening throughout the development of that model of care. It aims to design clinical pathways to deliver safe and effective health and social care services for those seeking gender-affirming services. This work will also inform an implementation plan for its delivery. My Department has provided funding of €770,000 for the development of the model of care for 2025 and the work is expected to conclude in 2026.

The approach to developing the model of care is clear and well established. It involves reviewing the best available clinical evidence, as well as incorporating insights from healthcare professionals, patient advocates and individuals with lived experience. The model of care will consider all available information. It will not be aligned with any one study, report or one way of thinking. The Minister of State, Deputy Butler, and I are very alive to the considerations that have to inform a fully comprehensive analysis.

A cross-speciality clinic advisory group, which was established in collaboration with the RCPI and convened in June 2025, is supporting the design and development of the model of care. In addition, a working group, comprising several representatives with direct lived experience, has been formed and its first meeting was last week. The groups are a standard component of all medical models of care. The clinical advisory group operates as an independent body within the RCPI, reviewing proposals drafted by the working group to ensure they are clinically safe.

To advance the model of care, the HSE has commenced a systematic review of the evidence base with respect to coexisting clinical needs in gender-diverse people, with support from the HSE library service. The interim results of that review were made available for public consultation in August this year. The HSE is now reviewing the submissions and completing the evidence review.

A key aspect of the development process is stakeholder and public consultation. We want to get people's views. Incorporating the views of people with lived and living experience is absolutely essential in any medical model of care that is going to be effective, grounded in evidence and compassionate. Their insights will illuminate gaps that clinical data alone cannot capture, such as the emotional, cultural and practical challenges that people face when navigating any healthcare service, including gender healthcare services.

It is crucial that we avoid developing a model of care for a group of people without involving them and considering their perspectives. Their input is indispensable, and the Minister of State, Deputy Butler, and I are firmly committed to ensuring that stakeholders are heard and actively involved in the process. I want to assure the transgender community that all efforts were made to hear from you, that we want to hear from you and we are trying, in every way, to incorporate your perspective directly into the development of the model of care, as we do with every other model of care, as is appropriate.

It is our sincere hope and expectation that this approach will not only strengthen the relevance and inclusivity of the final model but could also lead to improved outcomes by ensuring services genuinely reflect the needs of the populations they are designed to serve. It is a complex process. HSE and Department officials will work closely together to do it quickly, transparently and effectively. Given that it will take some time to complete the work, the Minister of State, Deputy Butler, and I have requested that the HSE examine all avenues to improve interim care options while the model of care is being developed.

In terms of the proposals on conversion practices, I want to emphasise that the programme for Government contains a commitment to advance legislation to ban conversion practices. Very clearly, it is for the Department of Children, Equality and Disability to deal with this, and it has been carefully reviewing key policy principles to underpin it and to ensure individuals are protected from harmful conversion practices, while safeguarding access to necessary and appropriate services for those seeking support.

It is true that, as Deputy Bacik has said, there is complexity to some of the regulation around counsellors and psychologists. We are going through that with CORU. It is very important that these professions are regulated to a particular standard, as would be expected. That work is progressing. I might speak to the Deputy about it separately.

In relation to gender recognition, the Minister for children published the national LGBTIQ+ inclusion strategy in June 2025 along with the associated plan for 2025 and 2026. The remaining actions from the gender recognition review of 2025 are included in that strategy. A steering committee has been established comprising all of the important representatives. The Department of Social Protection will be participating and progressing relevant actions in line with its strategy and action plan. The national strategy also includes a commitment in the first action plan to develop national clinical guidelines for medical nursing and health and social care professionals delivering paediatric care to infants, children and young people with differences in sexual development. These are due to be published in quarter 2 of 2026.

I am glad to have the opportunity to discuss this issue this morning. Ten years on, it is appropriate to recognise the work that has been done by so many people in this House to advance equality. As we all know, equality is a broad house. Advancing one person's equality beyond where it has been in the past does not mean taking from somebody else's. I reflect in particular on Deputy Bacik's point about feminism and equality more broadly. There is no threat to me or to the Deputy as feminists in advancing somebody else's equality. That is the way we have all come to our work here and I hope it is the way we will continue to work here. I hope we will stand together to continue to work for a compassionate and inclusive society, as we have done over the last ten years.

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