Fintan Warfield (Sinn Fein)
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I thank the Minister of State for coming into the House to take this matter.

I commend the work of the Transgender Equality Network of Ireland, TENI, and the #ThisIsMe campaign which has been raising issues about a clinic for some time. I also commend the work of the Department and the HSE which have committed to the provision of additional resources for the clinic which should help to make an impact on waiting lists. However, there is currently only one full-time public endocrinologist who is based in St. Columcille’s Hospital, Loughlinstown with expertise in hormone replacement therapy, HRT, who serves the needs of adult transgender people in the State. The number of posts will soon be increased to two. There is also a part-time clinic in University College Hospital Galway, UCHG, with very limited hours. Owing to HSE policy, HRT is only administered to trans people at these two clinics, despite the fact that HRT prescribed for cisgender people or in any other instance can be administered and monitored by a local GP.

In the clinic in Loughlinstown there is a two-year waiting list. The waiting time has been attributed, not to service users but to the cancelling of clinics by consultants and the enforcement of the medical and diagnostic model by the HSE. The additional resources can be largely offset as the lead consultant within the clinic, Professor O’Shea, takes on the role of clinical lead for obesity. While I hope waiting times will improve, all of the indications point to the fact that the clinic will continue to be stretched beyond capacity. It is also worth noting that those aged 16 or 17 years who wish to apply for a gender recognition certificate must have supporting documentation from the clinic which will only accept referrals from certain psychiatrists who also have strained waiting times.

The model of a full-time Dublin-centric clinic meeting the needs of a community spread across the State is one that contravenes international best practice, namely, the World Professional Association for Transgender Healthcare, WPATH, guidelines which are the standard for most developed countries and also in keeping with the European Social Charter. It is not viable for a Dublin-centric clinic to support the needs of our island-wide trans community. It is fair to say the current position has led to a spike in mental health issues and the incidence of suicidal ideation among vulnerable persons and a rise in unmonitored self-treatment where individuals are forced or opt to buy hormones online.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for raising this issue.

The NTPF publishes the inpatient and outpatient waiting list figures by specialty and hospital each month. This information is available on ntpf.ie.The most recent figures published by the NTPF for January 2018 indicate that there is a total of 38 people on the national inpatient day case waiting list for endocrinology and a total of 9,339 on the outpatient waiting list for endocrinology. Of this figure, almost 1,900 are on the waiting list at St. Columcille’s Hospital. Figures show that 42% of these patients have been on the waiting list for 12 months or less. Almost 40% have been on it for 18 months or more. However, I am advised by the HSE that urgent referrals are usually accommodated within four to six weeks. It is important to highlight that the NTPF waiting list data are extracted from the overall waiting list figures for the specialty and do not differentiate specific procedures for transgender patients from procedures for other patients on waiting lists. Reducing waiting times for the patients who have been waiting the longest is one of the Government’s key priorities. Consequently, in budget 2018, €55 million was allocated for the NTPF. This significant increase in funding almost trebles its 2017 total allocation of €20 million.

To date, the transgender service in Loughlinstown has developed on an ad hocbasis and all referrals are managed within general endocrinology OPD clinics. The service is operated between the psychiatry services, primarily in Cluain Mhuire, and the endocrinology service in St. Columcille’s Hospital. Patients who require an endocrinology assessment must have been initially assessed and referred by a consultant psychiatrist. The psychiatry clinics are held weekly in St. Columcille’s Hospital and can accept only one new referral per week.

It is welcome that the HSE has, as part of its 2018 budget, allocated funding of €100,000 to St. Columcille’s Hospital which will ensure dedicated funding for transgender services and see increased capacity within psychiatry and psychology services. This will increase the capacity of the clinic to see additional referrals. The HSE has advised that recruitment to fill the additional new posts at St. Columcille’s Hospital will commence in early 2018.

The existing care pathway for transgender people in accessing HRT follows international best practice. The guidelines were devised by experts in transgender health care, with members of the international transgender, transsexual and LGBT community, and supported by TENI. The care pathway generally begins with an approach by an individual to his or her GP. The GP may refer the person to the local community mental health team for support and a diagnosis of gender dysphoria by a psychiatrist or a clinical psychologist. A thorough assessment is a prerequisite to commencing hormone suppressers. This is to ensure the correct path is being taken for the individual and comorbidity issues are identified and addressed.It would be inappropriate for me as Minister to comment on the assessment process as this is a matter between clinical personnel and the individual concerned.

Paul Coghlan (Fine Gael)
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Does the Senator wish to ask a supplementary?

Fintan Warfield (Sinn Fein)
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The waiting list time and the admission that this service has developed on an ad hocbasis proves that this model simply is not working or is not economical in the long term. I accept that the waiting list data are extracted and do not differentiate specific procedures for transgender patients. However, if we accept that there are 1,900 people on the waiting list and compare that figure with the number of people who have availed of a gender recognition certificate in this State, which would be about 300, although I do not know the number off the top of my head, those numbers are staggering in comparison with those who have availed of a gender recognition certificate, so that is a concern. As I said in my opening speech, it is not international best practice for a service to be so Dublin-centric and to not be available around the State.

Will the Minister of State commit to working with the Department and the HSE to ascertain if we can broaden access for hormone replacement therapy? What medical professionals would be able to administer and monitor the treatment? Will the Minister of State request that the Minister meet TENI and the This is Me campaign? The need to meet the Minister results from the fact that all the correspondence that TENI, the community or we get is from the Loughlinstown clinic itself. There is a bit of silence on the part of the Department, so that is a concern given that there were hundreds on the streets of Dublin at the beginning of this year.

Jim Daly (Cork South West, Fine Gael)
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I reiterate that recruitment is taking place, as I alluded to in my speech. This involves one consultant endocrinologist, one social worker, one speech and language therapist, two senior psychologists, one clinical nurse specialist and one grade five. Some of them will be whole-time equivalents and some will be part time. That should help the waiting lists but I will certainly pass on the Senator's concerns to both the Department and the HSE. I will also pass on to the Minister the Senator's request that he meet TENI at the first opportunity.