Dáil Éireann Debate, Thursday - 21 September 2023
11. Deputy Neasa Hourigan asked the Minister for Health the revised care plan for those seeking gender identity services, taking into account World Professional Association for Transgender Health, WPATH, standards of care; and if he will make a statement on the matter. [40454/23]
View answerHow is the Department seeking to review services for gender-affirming care according to WPATH best practice?
The HSE National Quality and Patient Safety Directorate has reviewed the interim Cass report and how it applies to clinical pathways in Ireland. Based on the recommendations of the report, the HSE has identified the need to develop an updated and integrated model of care for transgender services, informed by the best evidence-based clinical care for individuals who express gender incongruence or dysphoria.
The HSE is establishing a team to lead the development of an updated model of care for the treatment of gender dysphoria. As an initial step, the HSE has advertised for the post of a clinical lead for transgender services, who will develop the model of care and implementation plan for transgender care. The HSE will consult a wide range of stakeholders in the development of the new model of care, including those who use the services and advocacy groups.
WPATH publishes the standards of care and ethical guidelines, which articulate a professional consensus about the psychiatric, psychological, medical and surgical management of gender dysphoria. The guidelines are designed to help professionals to understand the parameters within which they may offer assistance to those with gender dysphoria conditions.
The HSE is also working to identify an alternative pathway for children and young people experiencing protracted waiting times. Discussions are under way with the paediatric endocrinology service at Children's Health Ireland and also with a psychology service to work on an interim solution until a full, dedicated multidisciplinary service is established.
I welcome the development of a model of care that will deliver a high-quality, seamless and integrated service for people with gender identity issues, in line with the programme for Government.
I am wondering, given that the question was put to the Department in July, whether it is possible to get some sort of timeline for those with the issues in question. As the Minister of State knows, WPATH set out that part of best practice would be to respect patients, part of which would involve a workable service. It sets out the need for local, accessible services that are affordable and not overly centralised in a way that creates barriers for people. By that, I mean we should not make it that people have to travel very far to receive services and not have them on waiting lists so long that the service becomes ineffective. If the waiting lists are long, it is not an effective service. Timely service provision is required. These are all things set out by WPATH. It is not simply about medical practice but also about wider support for the service.
Could I get some kind of timeline as to when the changes will be made and when the response to the Cass report will be implemented?
I completely agree on the urgency. It is a priority of the Department of Health and HSE to provide a transgender healthcare service that is aligned with best practice internationally and meets the needs of children and adults.
Dr. Cass from the National Health Service came to Ireland at the start of this year and presented the findings of her interim report to a wide range of stakeholders from the HSE, the Department, Children's Health Ireland, Ireland East Hospital Group and others involved in providing services. This facilitated a really constructive and informative discussion about the challenges in developing gender services in Ireland, given the limited availability of data and evidence on which to base the clinical approach and also the recruitment challenges.
That meeting helped to inform the HSE on its next steps. I think that is what the Deputy is alluding to when she asks about timelines for developing the programme of work, including the development of a new model of care. It is important that supports are in place in psychology, psychiatry and endocrinology, especially for those with gender dysphoria. I will come back to the Deputy about timelines as I know the HSE is engaging in the next steps of this process.
I thank the Minister of State. She is right insofar as there is sometimes a dearth of clinical data. Most services are now linking up with that issue. We have good principles from WPATH, including dignity, equality, equity, justice and fairness. At the moment we have entered into a public debate around people's very right to exist, but in real life those services do not exist in Ireland. They are not accessible. The community and people like me are looking for some kind of timeline as these things can be dragged out. It is now urgent. It is time sensitive for people who require the service.
I thank the Deputy. On timelines and delivery, funding will be important. The delivery of this service is part of the Estimates discussions that are happening at the moment for the upcoming budget. We will keep the Deputy updated about this important issue.
