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Statement on the HSE’s decision to appoint a Clinical Lead for Transgender Services without engagement from the trans community

Trans Healthcare Action is deeply disappointed to hear that the HSE has made a provisional offer for the new Clinical Lead for Transgender Services with no engagement from the trans and gender diverse (TGD) community. As we stated in our Open Letter to the HSE on the matter, signed by 22 national and international LGBTQIA+ and civil society organisations, meaningful engagement with the people who will be impacted by the services throughout all stages of the hiring process is critical to providing a functional service. The offer is reported to have been made to Dr Karl Neff, who currently leads the National Gender Service.

The TGD community has persistently advocated for inclusion in the hiring process for this position, yet we have been sidelined at every attempt. On 11 October 2023, Trans Healthcare Action shared our open letter with the Chief Clinical Officer, requesting that the HSE directly engage and consult the TGD community throughout all stages of hiring for this position and creating the model of care and implementation plan for transgender healthcare, giving TGD people decision-making power. In November 2023, we requested to meet with the Chief Clinical Officer of the HSE concerning defining the expectations for this role, yet we received no response. The HSE has stated that “It is recognised best practice to develop a Model of Care in a consultative way, engaging with all relevant stakeholders,” but this pattern of refusal to engage with the trans community contradicts their own statement. In responses to our outreach, the HSE has shared its Better Together: the Health Services Patient Engagement Roadmap which “supports the involvement of patients in the design, delivery and evaluation of Healthcare services,” while simultaneously ignoring the TGD community’s requests to be involved in the decision-making for the hiring of the Clinical Lead, a position that will have a far-reaching impact on the future of trans healthcare in Ireland.

We are deeply concerned that the hiring decision will reaffirm Ireland’s de facto adherence to the centralised “gender clinic” model based on the outdated notion that TGD people must endure invasive psychiatric assessments proving their transness to access care. In an article for the Irish Times in January 2022, Dr Neff stated that he believes a “comprehensive psychosocial assessment” is “vital…prior to medical transition.” However, this stance goes against the World Health Organization’s ICD-11, which reclassifies gender-affirming care as sexual health, eliminating psychiatric screening. Further, the current evidence-based Standards of Care developed by the World Professional Association for Transgender Health (WPATH) in late 2022 share that psychological assessments are not required, and instead support an informed consent model and patient-centred, GP-facilitated approach to care. In countries such as Aotearoa New Zealand, GPs and nurse practitioners can prescribe hormone therapy to TGD patients on an informed consent basis. By comparison, the current wait for the initial assessment at the National Gender Service that Dr Neff believes to be “vital” is more than 10 years. We believe that the lives, wellbeing, and bodily autonomy of trans people are what’s truly vital. 

In 2022, Ireland was ranked the worst country among the 27 member states of the European Union for the lack of availability and accessibility of trans-specific healthcare by Transgender Europe. The report goes on to state that “The monopoly and centralisation of care in countries like Ireland, Finland, and Denmark make it difficult for trans people to see a healthcare professional on time.” Without transformative change at the systemic level in the way trans healthcare is provided, this will not improve. That means the HSE must end the current outdated “gatekeeping” model practised in Ireland that prevents TGD people from receiving safe, quality trans healthcare based on the right to self-determination and bodily autonomy. Trans Healthcare Action envisions an Ireland where trans and gender diverse people can access gender-affirming healthcare within our local communities through an informed consent model of care. The development of this must be in co-production with the community, valuing the lived experiences, perspectives, and expertise of TGD people.  

We reiterate our call for the HSE to reassess its approach to hiring a Clinical Lead for Transgender Services and instead engage in all decision-making around transgender care through an inclusive co-production with the TGD community, upholding the human right to self-determination in healthcare. For too long, decisions about us have been made without us, and this must change.



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