In line with international trends, the demand for transgender services in Ireland has increased exponentially over the last number of years. Services for transgender care have evolved organically over the last number of years, with adult services based in St. Columcille’s Hospital (part of Ireland East Hospital Group) and children’s services located in Our Lady’s Hospital for Sick Children, 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.
It is recognised that waiting times for scheduled appointments and procedures have been impacted as a direct result of the COVID-19 pandemic.
In response to the Covid-19 pandemic the HSE had to take measures to defer most scheduled care activity in March, April, and May of this year. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the National Public Health Emergency Team (NPHET) in accordance with the advice of the World Health Organisation.
If the National Gender Service (NGS) identifies someone who is at high risk of harm with regard to their social health as a result of hormone therapy, then an individualised care plan is formulated to reduce this risk.
This care plan may in some very specific instances include family meetings (with relevant family members such as parents). The NGS offers a variety of interventions to address any social health risk involving personal relationships. This can include family meetings at HSE offices, home visits from a member of the NGS team, family therapy, or/and individualised social work intervention (e.g. securing independent housing or income). The rationale of the care plan is explained to the individual during and following assessment. At all times during this process, data protection regulations are fully observed and all clinicians work in line with the relevant professional guidelines.
This care plan can be experienced by the person attending the service as an insistence that they bring their parents with them to approve their plans for hormonal or surgical transition. However, parents have no say in the person's care. As long as the person has capacity to consent then they can proceed to medical intervention once they can say, based on clinical assessment, that the benefits will exceed the risks.
If parents of patients are not supportive, or if the person does not want to involve their parents in their care, then the HSE works with them to secure independent income and housing prior to proceeding to a medical transition.
Irish health insurers are required to have a standard minimum level of cover in every health insurance policy. These requirements are set out in the Minimum Benefit Regulations, made under the Health Insurance Acts. In addition to this minimum level of cover, it is open to insurers to provide cover for procedures beyond the requirements set out in governing legislation.
The Minister for Health and I are committed to the development by the HSE of a well-governed and patient-centred health care service for adults and children in the transgender community. We will support the HSE in ensuring that people wishing to transition their gender have timely access to treatment that accords with international best practice.
