Seanad debates

Wednesday, 25 November 2020

Nithe i dtosach suíonna - Commencement Matters

Health Services Reform

10:30 am

Photo of Regina DohertyRegina Doherty (Fine Gael)
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I thank the Minister of State for his attendance in the Seanad this morning to discuss this issue. It is hugely important to the transgender community in Ireland, as well as their families, friends and supporters. Last year, the then Minister for Health, Deputy Harris, became increasingly aware of the difficulties faced by the transgender community in accessing essential healthcare in Ireland. He listened to that community and in taking on board their concerns, he set up and established the national transgender healthcare steering committee in May 2019. The committee was made up of members of the advocacy group Transgender Equality Network Ireland, TENI, clinicians, psychiatrists, endocrinologists and representatives from both the HSE and the Department of Health.

The overarching objective of the committee was to present a report to the Minister on how to develop a seamless and integrated service for those who present with gender identity issues, with clear pathways of care in order that the needs of the patients and their families are placed at the centre of the delivery of those services. This report was completed earlier this year and was received by the Department of Health on 28 February, which was unfortunately just one day before the first case of Covid was discovered in this country. While focus on tackling the pandemic understandably delayed the examination and publication of the report's recommendations in the first few months, the fact that no movement whatsoever has happened in the interim months is hugely disheartening.

The HSE and the Department of Health have done fantastic work to make sure normal healthcare services have for the most part resumed, yet the report remains shelved. According to some of the members of the steering committee, it is worse than shelved; it appears to be lost. It is an extremely important and valuable document which was developed at the request of the Minister for Health and was then submitted to the Department. That it seems to have just disappeared is baffling. The HSE maintains that it was submitted to the Department but the Department and the Minister of State - not Deputy Feighan - believe the HSE is still working on it. This passing of the buck is not good enough. It is a very serious report with very serious recommendations and it needs and deserves immediate attention and action.

What is even more worrying is the lack of engagement between the Minister for Health's office and his own ministerial appointee to the committee since the formation of the Government in June. That appointee has made six attempts to communicate with the Minister, all of which have been ignored. That is the main reason I am standing in this Chamber today. It is a real pity.

Members of the transgender community need to know their voices are being heard. As the previous Minister gave them a platform to speak, I hope their voices will not fall on deaf ears. The report must be examined and published without delay and a plan to introduce the recommendations in the report must be put forward immediately. Obviously, no one here has seen the report but given the wealth of expertise, personally and professionally, of the people on the committee, I have absolutely no doubt that the recommendations would improve the services for our transgender community and that this Seanad and the Dáil will support them.

Over the last few years I have had the privilege of working in a personal capacity with the transgender community, with TENI, and with members of the trans community seeking employment, where they face huge discrimination. We are making progress but it is slow. Often, some of the issues we highlight and some of the recommendations we make get ignored and are marginalised by governments around the world. This Government needs to make huge strides to represent this community, as did the previous one. This is a small community but it is large in its heart and even larger in the impositions its members face every single day. The future of transgender healthcare in this country is unclear.The current haphazard provision of services to our young people who are struggling with their identity is unreliable and potentially unsustainable in its current format. Two years ago, the people made a decision not to export our citizens for healthcare to other countries and yet this year alone, we have sent more than 80 patients under 18 years of age to the UK for health. In the space of four months from November 2019 to February 2020, the waiting time went from 12 months to 24 months. This issue is critical and needs an immediate response.

Has the Minister received the report? Has it been read? Has it been actioned? If not, when will it be actioned?

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Doherty for raising the issue. The National LGBTI+ Inclusion Strategy 2019-2021 sets out Government policy for promoting inclusion, targeting discrimination, and improving the quality of life and well-being for the LGBTI+ community in Ireland. It is supported by the LGBTI+ National Youth Strategy 2018-2020.

The strategy commits to ensuring that people can fully and equally avail of mainstream health services. In addition, the strategy recognises that targeted services are needed to support transgender people, including through the process of transition.

In line with international trends, the demand for transgender services in Ireland has increased exponentially over recent years. Prevalence studies suggest an increase in those experiencing gender dysphoria. In 1997 the World Health Organization reported a prevalence of 1:60,000 and in 2013, the fifth edition of the Diagnostic and Statistics Manual of Mental Disorders reported a prevalence of 1:20,000.

Services for transgender care have evolved organically over recent years, with adult services based in St. Columcille's Hospital, which is part of Ireland East Hospital Group, and children's services located in Our Lady's Children's Hospital, which is part of Children's Health Ireland. Endocrinology and psychological support services are delivered on both sites.

A model of care was developed to support the development of HSE gender identity services. The model of care was supported by the allocation of additional resources to enhance services. Recognising the need to develop gender identity services and to best use the additional funding, in May 2019 the HSE established a steering committee chaired by the national clinical lead in mental health, Dr. Siobhán Ní Bhriain, as the Senator outlined. The committee had the specific purpose to develop a seamless and integrated service for those people who present to the health service with gender identity issues. The committee brought together the various HSE transgender services, along with service users, as represented by Transgender Equality Network Ireland and ThisIsMe.

The committee concluded its work in January 2020 and issued its final report in February 2020. I recently had the opportunity to read the report. The report details the two outcomes achieved by the steering group, namely, the development of a job description for a consultant psychiatrist in child and adolescent psychiatry post to develop the transgender identity services for those aged under 18; and support for a governance committee across the Ireland East Hospital Group and Children's Health Ireland to ensure ongoing review of the national gender service as it develops.

The report notes the development of a strong sense of collegiality among the committee members and the commitment of all to develop a well-governed service for the transgender patient group. The report makes seven recommendations to enhance the model of care for the transgender community, all of which fall under the remit of the HSE. One of the recommendations is to develop a service users' forum within the national gender service. Most of the report's recommendations are in progress or ongoing.

I note the Senator's concerns about trying to get a meeting with the Minister and the Department. I will also bring those concerns back.

Photo of Regina DohertyRegina Doherty (Fine Gael)
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I genuinely thank the Minister of State for coming to the House to give us that information because the members of the committee have not been able to get it in any other format. I appreciate not only that the Minister of State said he had actually received the report but also that the seven recommendations have been read and some actions taken. I say on behalf of the transgender community that is greatly welcome.

I have two requests. I ask for the Department of Health, if not to re-engage with the entire committee, to absolutely return one of the six calls made by the Minister's advocate on that committee. He is a young gentleman who has worked his socks off to try to improve conditions in this country for himself and his friends. Having asked him to do that body of work, the very least we can do is to engage with him.

I ask the Minister of State to publish the report and outline the status of the seven recommendations. That will instil trust and restore faith in the transgender community and among the people who put this body of work together that they have been listened to and their recommendations have not fallen on deaf ears. I know the Minister of State might not be able to commit to those requests himself, but I ask him to bring them back to the Minister, Deputy Stephen Donnelly, and ask for a response to be issued immediately. I thank the Minister of State; I really appreciate his response.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I am committed to supporting the HSE in ensuring that people wishing to transition their gender have timely access to treatment that accords with the best practice. I note the Senator's welcome for the report. I want to see the HSE develop a well-governed and patient-centred healthcare service for adults and children in the transgender community in line with the programme for Government.

The report of the steering committee on the development of HSE transgender identity services is an important step in achieving this objective. Already the committee has achieved two tangible outcomes and its seven recommendations are in train. I am seeking a further update on the implementation of the committee's recommendation over the recent months from the new national clinical lead in mental health, Dr. Amir Niazi. I commend the work of the steering committee and I would welcome the early publication of its report by the HSE.

The six calls from the advocate for the group should be responded to. I know many people in the Department are working on Covid, as I have seen with people working in the sections dealing with alcohol and tobacco. However, they should be able to reply to a phone call. I will also bring that back.