Lynn Ruane (Independent) | Oireachtas source

I thank the Minister of State for his time today. I am raising the issue of health care for transgender people in Ireland and the widespread deficiencies that exist in terms of standards, access and trans-specific knowledge in the Irish health service. As the Minister of State will be aware, Ireland ratified the current version of the European Social Charter 18 years ago, and submits regular reports to the Council of Europe's European Committee of Social Rights, which determines compliance with the charter. In Ireland's 14th national report on the implementation of the European Social Charter, submitted for 2017, transgender issues are not mentioned even once. When the Irish Human Rights and Equality Commission commented on the report, it said that health care for transgender persons in Ireland is inadequate, in terms of meeting their needs, reflecting complex processes, inadequate provision of services and inadequate levels of knowledge and awareness among health professionals.

This analysis was agreed with by the European Committee of Social Rights, which reiterated these concerns in its 2017 annual conclusion. That two respected human rights bodies have come to the same conclusion regarding transgender health care in Ireland today is why I have tabled this Commencement matter. The bottom line is that we are failing transgender people in Ireland under article 11.1 of the European Social Charter by not providing guaranteed access to health care in practice. This needs to change, and I would appreciate it if the Minister of State would outline in detail the steps being taken by the Government and the Department of Health to rectify this.

Transgender people have a very specific range of health care needs. It is critically important that relevant and appropriate services are available in order to facilitate and meet those needs. These include: gynaecological and urological care, reproductive options, voice and communication therapy, mental health services, and hormone and surgical treatment. The World Professional Association for Transgender Health lists these as essential services to assist transsexual, transgender and gender non-conforming, with safe pathways to achieving lasting, personal comfort with their gendered selves. It also lists the importance of social and political climates that provide and ensure social tolerance, equality and the full rights of citizenship, and in this respect at least, there have been great improvements in Ireland recently.

It is four years since the enactment of the Gender Recognition Act 2015, and we can all feel collectively proud of that ground-breaking legislation, as Ireland became one of the first countries in the world to enshrine self-declaration of gender into its law. That law told transgender people in Ireland that we respected their identities, their autonomy and valued and included them as equal citizens in this State. However, legal recognition is only the beginning of the realisation of true equality for transgender people in Ireland.We need appropriate and accessible health care at a minimum to allow for greater realisation of trans identities.

With the Gender Recognition Act, we rejected stigmatising and unnecessary medical diagnostic models for the legal recognition of gender. Yet such models are still in place in determining access to trans-specific health care, and this must end.

In terms of hormone replacement therapy, the unacceptable waiting lists were highlighted in this House by Senator Warfield a number of weeks ago. However, delays are not the only concerning part of such provision in the Irish context. There is a clear reliance on a psychiatric diagnosis which falls outside the World Professional Association for Transgender Health, WPATH, guidelines, which instead advocates for best practice in line with an informed consent model. This over-reliance on psychiatric diagnosis, as distinct from a psycho-social analysis, of how the State treats trans-people for hormone replacement therapy is problematic and needs to be changed.

I understand there is currently only one diagnosing psychiatrist and prescribing endocrinologist operating in Ireland. While I understand a recruitment process is under way, the concern is that simply hiring more psychiatrists for this area will reinforce the medical diagnostic model which I have outlined, and this is not international best practice. This service should be opened up and decentralised. The World Professional Association for Transgender Health recommended that general practitioners be empowered to dispense the therapy as they are all trained to do so. General practitioners administering hormone replacement therapy to assist gender people is a common occurrence. Will the Minister of State give a commitment today to investigate the feasibility of this even on a pilot basis?

I also understand that despite the HSE claiming that no separate list exists for transgender individuals seeking hormone replacement therapy that, in practice, such a separation does exist, and this is one of the root causes of the huge delays. Will the Minister commit today to investigating this claim and ending that practice?

I met representatives of the This Is Me transgender health care campaign last week who outlined these concerns to me in detail. Will the Minister of State or the Minister for Health, Deputy Harris, meet representatives of the campaign, hear their concerns and consider their constructive proposals on how this could be resolved.