Annie Hoey (Labour)
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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.

Ossian Smyth (Dún Laoghaire, Green Party)
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The provision of proper, appropriate and integrated gender healthcare services is something that the Minister, Deputy Donnelly is anxious to see put in place for persons who are questioning their gender identity or are experiencing gender incongruence or gender dysphoria. The Minister has previously acknowledged that they do not currently have access to that in Ireland and that he is determined to change that. In that context, I can confirm the HSE has recently appointed Dr. Karl Neff as clinical lead for the multidisciplinary team, MDT, which will lead the development of a new model of care under the auspices of the national clinical programmes. The Department of Health has provided €100,000 in funding for the establishment of this team. Now that this appointment has been made, the HSE is initiating a new clinical programme for gender healthcare over the next two years, an updated clinical model and implementation plan for gender healthcare services will be developed.

This work will be informed by the best evidence based clinical care for individuals who express gender incongruence or dysphoria. Now that the full Cass report has been published, it will be reviewed along with other emerging and evolving international evidence as part of this work. There is a clear and well established approach to the development of this model of care which, as well as reviewing the best available clinical evidence, will also incorporate input from healthcare professionals, patient advocates and those with lived experience. A key part of this development of this model of care will be consultation with stakeholders. It is particularly crucial that the people who are and will be availing of gender healthcare have their voices heard in this process. I can assure the Senator that the Minister is anxious to ensure that all stakeholders are fully consulted on the development of this model of care.The model of care will incorporate a multi-tiered approach, where care will be delivered at the most appropriate level of medical complexity. While the model of care is being developed, people will continue to receive healthcare in the community and under the endocrinology service in the adult and paediatric centres in Ireland East Hospital Group and Children’s Health Ireland.

With regard to current services, children and young people who require specialist psychological and psychiatric assessment and support are now referred to the children and young people gender national referral support service in the UK, who will triage these referrals to one of the newly developed services in London and Liverpool-Manchester. This service will work with CHI if endocrine review is required. The adult gender service based in St. Columcille’s Hospital in Loughlinstown provides services for people over the age of 16 years.

The Minister, Deputy Donnelly, is committed to the development of a well governed and patient-centred healthcare service for adults and children in the transgender community.

Annie Hoey (Labour)
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I note the mention of the Cass report. I will not go too much into it but there were questionable methodologies in the research of that report. It is disappointing that there has been wilful misrepresentation in the media and by some bad actors of the report. It is being used to deny, restrict and cut off services to very vulnerable people. I hope that is borne in mind as well.

Trans people, like all of us, need healthcare services that are centred on the principles of bodily autonomy, person-led decision-making and informed consent; adhere to the rights of safe, equitable, accessible and quality healthcare; are facilitated by healthcare professionals to provide individuals with care, respect, empathy and accuracy; and uplift decision-making according to each person’s individual needs. I am worried that the response does not take into account that we still do not have trans healthcare in Ireland. With this response, I am not sure that we will get it in the way that we need it.

Ossian Smyth (Dún Laoghaire, Green Party)
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I take on board all issues raised during this discussion. I note that all of us in this House want to ensure that the transgender community is given the proper, appropriate and integrated care and support they need to live their authentic, fulfilling lives. The new model of care will aim to do just that.

The development of the new model of care for gender healthcare services is expected to be a complex process and the HSE and the Department of Health will work closely to support the process to ensure transparency and keep the patient at the centre of the process.

As I said in my opening statement, consultation with stakeholders will be a crucial part of this work. However, 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 persons with gender incongruence or dysphoria.

It is not possible to pre-empt the outcome of this process by determining at this stage what this model of care will look like once developed. The long-term aim is to provide a wide rage of services for all people with gender incongruence or dysphoria, from care locally in the community to more specialised and complex care. I am committed to building a service based on experience, clinical evidence, respect, inclusiveness and compassion.

Please rest assured that the Minister, Deputy Donnelly, is committed to the development of a well governed and patient-centred healthcare service for the transgender community.