Annie Hoey (Labour) | Oireachtas source

I thank the Minister of State for coming in. I am raising the need for the Minister for Health to address issues relating to the state of trans healthcare in Ireland and the need to move to informed consent, gender affirming care at community and primary care level.

I will give some context of our trans health care here in Ireland, although frankly, that is something that I do not think we really have. We are ranked worst in the EU for availability and accessibility for trans health by TGEU, despite the fact we have some of the most progressive laws. Unfortunately, our health system does not match that. We are rated F for timely and adequate access to trans health care by LGBT Ireland and we have a de facto centralised gender clinic model. There are no national gender-affirming healthcare policies or guidelines. It seems people must wait ten years and more to be able to access healthcare. By any measure, that is a de facto non-existent healthcare system and is not good enough.

Some of the issues with the system include a lack of access to quality care, as I said; a decade-long waitlist for the primary public service; non-existent youth services; denial of services and primary care; little to no availability of surgery within Ireland; and, a failure to adhere to international guidelines. I am sure the Minister of State will have seen people fundraising in order to get the healthcare they need in another country.

Another issue with the system is a severe lack of bodily autonomy. There are incredibly invasive psychiatric assessments. Some of the questions I have heard people being asked are unbelievable. Incredibly invasive questions are being put to people who know their own mind and their own body but are put through the wringer about very intimate personal details, borderline Freud kind of stuff, which does not really tie in with what we have, which is a consent-based, self-ID model. The healthcare does not match what we have in legislation which is “we believe you when you say who you say you are”. By contrast, the health system puts them through all these questionable things.

There is discrimination, stereotyping and an exclusion of trans people from policy development. The message comes across from all the trans organisations that I have met with and work with which say they do not feel they are at the table in any meaningful way on the decisions that have been made about trans people. There is no path for any young trans person to access gender-affirming medical care in Ireland and young trans people throughout the country are suffering. They deserve to be treated with dignity and, if they want it, access to safe medication so they have time to explore their gender identity without the pressure of dysphoria from their bodies changing. Trans youth need the acknowledgement that their lives matter, just as much as if they were cisgender children. We need a new system which is based on an informed-consent model for gender-affirming care, community and primary care based and co-production with the trans community, an affirming approach to care for youth and one that upholds the human right to bodily autonomy.

I will say a little about the informed consent model. This is grounded in accurate, evidence-based education on transition. It is led by the person's own free and informed decisions about their body and their treatment. It is facilitated through discussion on the expectations, benefits, risks and limitations of any treatment, and it is free from gatekeeping, pathologisation and discrimination. The community and primary care model is facilitated by primary care general practitioners and nurses. It is easy to access locally with over a decade-long waitlist. It is tailored to the person's needs. It is integrated into guidelines of trains for GPs and nurses and it is accessible to trans people in rural communities. We need to recognise and respect each person's gender identity without questioning or judging it and we need to acknowledge that there is no medical, psychological or psychiatric tests that confirm or deny gender identity.

I just want to know from the Minister of State today, what the Government and the Minister for Health will do about trans health care in Ireland. We simply do not have trans health care in Ireland if it means one must wait ten or more years to get any of it.