Pádraig Rice (Cork South-Central, Social Democrats)

I thank the Labour Party for tabling the motion today and for giving us the time to debate this really important issue. I stand here today in defence of trans rights, trans equality and ultimately trans liberation. This is a crucial issue and one that we need to dedicate time and effort to during this Oireachtas term. As the Minister will know, this was one of the first issues I raised with her during my priority questions because for me this is a crucial issue and one that we need to work together on to deliver for trans, non-binary and intersex people in Ireland.

The Minister needs some time and support to develop a model of care and to get this right. It is really welcome that there has been good engagement so far with clinicians, with stakeholders and with the community. I think the interim measures that have been introduced are welcome but we need to see more work.

In the minutes afforded to me, I want to talk about who we are talking about, what we are talking about, where we are talking about it, when and why. When we talk about trans people, we are talking about our friends, family and colleagues. We are talking about people who work here in Leinster House. We are talking about the postman, the nurse, the teacher, the doctor. We are talking about everyday regular Irish citizens who are looking for recognition, for rights, for equality and just to be able to live their lives in an ordinary way like anybody else.

We are also talking about a very small minority - about 1% of population, if not less. This is a group that has existed in every society across time. It has existed in Irish society going back through history, as is being uncovered now through trans history projects. It is also a group that has been consistently demonised and attacked in the most outrageous way.

We must call out people who come into parliaments like this and demonise and attack a small minority group. It is outrageous and is a terrible place to be attacking a weak and vulnerable minority to try to look strong but actually it is just very weak.

In many ways, many of the attacks are very predictable. If we look across Europe, we see what is being said in other countries and the kinds of attacks we see on the LGBT community more broadly happened in other countries first. It is a far-right movement. The same attacks and lines are rehashed here in press releases, using the same language, words and playbook. They are also using the same play book from the 1980s. They are now saying the same things they said about gay and lesbian people in the 1980s about trans people. They will not get away with it. We will stand up against it because it is utterly outrageous.

With regard to the substance of what we are talking about, we are talking about people getting access to: gender-affirming care to alleviate gender dysphoria and improve their lives, hormones, surgery and mental health supports, where they need it in a timely and, as I said, lifesaving way. At the moment, we have one clinic in the National Gender Service in Loughlinstown. It is fair to say the system is broken, not working and failing people every single day in this country. As mentioned, there are 2,000 people on the waiting list. A study by Belong To, Being LGBTQ+ in Ireland 2024, found that one in three people waits at least three years for their first appointment. If we had any other service across the country where people had to wait three years to get their first appointment, there would be utter outrage in this Chamber. People are waiting years upon years, sitting delayed. Some people reported waiting up to ten or 13 years. The system is absolutely broken and needs to be fixed.

This morning, before I came in here, I was on Instagram and I came across released audio of someone’s clinical experience. I ask the Minister to listen to that audio because the kinds of questions that this individual was asked by a clinician are absolutely shocking. It would turn your stomach listening to the way invasive questions were asked and the way in which this person was treated by a clinician in our National Gender Service. It is absolutely outrageous and it should be setting off alarm bells. This is why we need to see urgent reform. It is why I fully support a new model of care based on informed consent and international best practice.

We need a regionalised service across the country in each of the health regions. We need it delivered in primary care and have GPs involved. GPs currently prescribe hormones to a lot of people, including older people, people with menopause symptoms and older men, who are prescribed hormone testosterone. GPs do this and they could do this for trans people as well. We need regional clinics where people can be given individualised care plans and then discharged back to the primary care services. We also need a national clinical programme for trans healthcare in partnership with the trans community. This would be a body responsible for governance, training, professional development of practitioners, policy and procedures.

We need to look at international best practice and what international guidelines are saying. We know what the World Health Organization has said in this regard. In 2009, the WHO reclassified trans healthcare as part of central health rather than mental health. WHO stated: "This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such [causes] enormous stigma." Australia, New Zealand, Iceland, Malta, Canada and parts of the US have implemented this change but Ireland has not. The new sexual health strategy published in June is almost silent on trans healthcare. At best, there are only passing references to trans people. We should integrate trans healthcare into our sexual health services. They exist across the country and they are trusted by the community. People access these services already. These services need investment and support and, as we build a model of care, delivering it alongside sexual health services is the way to go.

With regard to timelines, we need action as soon as possible. As I said at the start, the Minister needs time to get this right but that time cannot run on and on. We need action in the next year or so and we will continue to apply pressure to see that delivered. It is concerning that there was a commitment in the 2020 programme for Government that was not delivered on. I know there is another commitment in this programme for Government. We cannot have another commitment again in the next one going undelivered. We have to get this right. It has to be done in the lifetime of this Oireachtas. The Minister will have our full support in getting there and I know she will have it from colleagues as well. It is important we progress that.

Crucially, as to why we want to do this, we know that trans healthcare services are lifesaving. In 2013, TENI found that access to trans healthcare results in lower rates of self-harm, suicidality, depression and anxiety. It found that 78% of trans people considered suicide but after they accessed trans healthcare, it dropped to 4%. We will, therefore, save lives by doing this. This is why it is crucially important and those people who come in here to attack this for political gain are going to cost lives and they need to know that. This is crucially important. We absolutely need to get this right.

Beyond that, I support the calls on conversion practice and intersex rights. We need to set the goal of this to be the best place in Ireland to be LGTBQI+.

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