Pádraig Rice (Cork South-Central, Social Democrats)
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115. To ask the Minister for Health if her attention has been drawn to a series of investigative reports into transgender healthcare in Ireland (details supplied); if she will commit to reclassifying trans healthcare as part of sexual health rather than mental health, in line with the World Health Organization; to provide an update on the new model of care currently being developed; and if she will make a statement on the matter. [24053/25]

Pádraig Rice (Cork South-Central, Social Democrats)
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I am deeply concerned about the state of transgender healthcare services. In 2022, Ireland was found to have the worst transgender healthcare services in all of the EU by Transgender Europe, TGEU. The only dedicated gender clinic has approximately 2,000 people on the waiting list. Only 162 were removed last year. Waiting times are between three years and ten years, which is not acceptable. The journal.ie recently published a harrowing report on those services. One patient described feeling traumatised after going to the services. Another said it felt like an interrogation. People are being forced to go online to access hormone replacement therapy, HRT. Has the Minister seen these reports? Will she commit to reclassifying transgender healthcare under sexual health instead of mental health, following the model of the WHO? Will she provide an update to the Dáil on the model of care?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The programme for Government commits to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. A new model of care is currently under development to strengthen and standardise care, ensuring safety and best practice. My Department provided €770,000 in budget 2025 to support this. The clinical lead has been appointed, a cross speciality clinical advisory group has been established and a review of the evidence base is under way. A community pilot project to identify the needs of children and young people who are gender questioning will also commence in the coming months. The model of care will be developed in a consultative way, engaging with healthcare professionals in gender healthcare, stakeholders, including people with lived and living experience and the families of people who use and receive support from services.

It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for people with gender dysphoria based on respect, compassion and understanding. As the Deputy may be aware, the WHO’s international classification was updated to its current version, ICD-11, in 2019 and gender identity-related health diagnoses were moved from the chapter on mental and behavioural disorders into the new chapter on conditions related to sexual health.

It is important to note that the ICD-11 is not clinical guidance for gender healthcare. It is a system of classification where criteria for various diagnoses are described. From our perspective, we want a holistic, compassionate, respectful service at every stage of a young person's or adult's journey, at every point of contact. That is the approach I will take as will everyone in the Department of Health, including all the Ministers of State, to this issue and I know it is the approach of this House.

Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister. The pace of change is far too slow. This issue has been going on for many years. We need an acceleration and the delivery of high-quality services for people across the country. The current system is operating on an outdated model. As the Minister said, in 2019 the WHO reclassified transgender healthcare as a sexual health issue. Despite this, the services are still being treated here under mental health. Being transgender is not a mental health condition but not having access to these services has an impact on people's mental health. Transgender healthcare services are lifesaving services. In 2013, a Transgender Equality Network Ireland study found that 78% of transgender people had considered suicide, but after they accessed services, that dropped to 4%. These are crucial and lifesaving services.

The Minister spoke recently about a framework to think about services with some that are operating well, some that need to be improved and some that are causing harm. I genuinely believe these services are causing harm to people and need to be improved.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I fully hear what the Deputy is saying. His feedback is important to me, as is everyone's. I did not congratulate him on his new position as Chair of the Oireachtas Committee on Health. I look forward to working with him on this and many other issues. We have a similar approach to these issues.

It is important to recognise that demand for transgender healthcare services has increased and I acknowledge that the current public services are not meeting people's full range of needs. For that reason, the HSE is developing the new model of care for gender healthcare services. The Deputy is right to identify that it is not a mental health condition. Of course, it is not. What absolutely is the case is that a multidisciplinary approach, including endocrinology, psychology, appropriate counselling, psychiatry if and as needed and the support of social workers if required, offers the best pathway of support and that is certainly the approach I hope the model of care will lead towards.

Pádraig Rice (Cork South-Central, Social Democrats)
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I fundamentally believe that the new model of care must be in line with the WHO guidelines. It must use an informed consent model and be delivered in the community, which is crucial. There are models in place in other countries that we can look to, including in Australia, New Zealand, Iceland, Malta, Canada and parts of the United States. They are already operating this model of care. That is where we need to be looking for best practice. The development of this model of care must be accelerated and crucially, it must be done with engagement with the community, people who are directly affected and their families. To date, that has not happened and relationships between the national gender service and the community are poor and need to be improved. People need to have a say in these services and the voice of the people must be crucial in that. It also needs to align with the core principles of Sláintecare, which are community-based and patient-centred because ultimately we are dealing with people's human rights and the right to healthcare because trans rights are human rights.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree with the Deputy and the person-centred approach is what we want to get to. Everyone is entitled to healthcare. I agree completely with him on the points he raised and I hear his important perspective on the national gender service. It is important that it be articulated here this evening and I hear him clearly on it.

I do not want to get distracted by the WHO definition, which is slightly more technical and does not sit against what we are speaking about in any way. It is not a clinical guideline. It is a classification system. I can give the Deputy more information on that by way of background if it is of assistance. It will not cross over the sort of model of care I want to get to, which sounds like what he is describing. There is no reason to be at cross-purposes on it. Perhaps we can speak about it in more detail. The model of care we are talking about is intended to be based on a consultation - putting people at the centre - with stakeholders, healthcare professionals and crucially those who use and receive support from the services and their families.