Statement on the Closure of the National Gender Service Waitlist

Yesterday, the National Gender Service (NGS) announced that it will be closing its waiting list to new referrals. This closure, with over 2,400 people waiting to access the service, is an admission of the failure of the service to meet the needs of our community.

This is not new—Ireland has consistently been ranked among the worst in the EU for trans healthcare. This crisis closely mirrors the experience of trans communities in Northern Ireland, where the local gender service operating on a similar model of care saw a complete breakdown in services over the past decade.

The issues with the NGS are due to its model, not solely due to a lack of resources. Patients report negative experiences and denial of care within the service, and a lack of clear, open communication with the trans community, which has resulted in conflict, trauma and harm.

Earlier this year, the Journal Investigates highlighted the negative experiences of people within the service – reporting that patients were “traumatised”, “uncomfortable”, felt “interrogated”, and did not trust doctors in the service. The line of questioning was refuted as “entirely inappropriate” by an international expert. The expert continued saying, “I can’t think of a justification for asking any of those questions”. Issues in care were highlighted in a Dáil motion on trans healthcare last week, where a recording of an assessment was quoted, which contained severely inappropriate and personal questions.

Increasing resourcing for a failing service will not create a sustainable service, it will not rebuild trust or meet the needs of trans communities, it will not improve working conditions for our healthcare providers, and it will not help build an effective healthcare system for the future.

Recognising these failures, the Department of Health has established a new National Clinical Programme for Gender Healthcare through the HSE, to design a new model of care for trans people. Trans and LGBTQ+ groups are participating in the design of a new model that will finally meet the needs of our community, work for patients and clinicians, and alleviate the crisis facing our community. This process must lead to meaningful changes in how trans healthcare is delivered in Ireland, rather than patching up a failed system. The success of this process requires meaningful engagement with the trans and LGBTQ+ community. This cannot happen if a model of care that has been harmful to their welfare continues to receive additional resources in their name.

Access to timely, safe, person-centred healthcare is crucial for all people to live safe, happy, healthy and fulfilling lives. Bringing trans healthcare services in line with other HSE services, with HSE consent policies and with international best practice means providing services on an informed consent basis, within primary care services with specialist services as needed. The informed consent model provides a higher quality of care while using fewer resources. It enables trans people to access treatment locally through community healthcare providers in a timely manner, centering self-determination, dignity, and bodily autonomy. The model is well-established, having been practiced as the basis of care in other clinical settings, and around the world in transition-related care for decades. This model has been successful in New Zealand, Iceland, Australia, Spain, Canada, and Malta. It reduces wait times, reduces costs, has better outcomes for patients, and increased work satisfaction for clinicians.

Ireland—including Northern Ireland—lags behind the rest of the EU in the provision of trans healthcare. The closure of the NGS waitlist is yet another recognition of this failure. The government must make immediate changes in the provision of trans healthcare to address the dearth of care and prevent these failures from repeating.

We urge the Department of Health and the HSE to:

• Rather than resourcing a failing service, focus efforts on improving healthcare for trans people through the National Clinical Programme;
• Commit to the development of a model of trans healthcare that is person-centred, informed by international best practice, based on informed consent and bodily autonomy, delivered within primary care, through the National Clinical Programme for Gender Healthcare;
• Continue to collaborate with LGBTQ+ organisations and community groups through the National Clinical Programme;
• Collaborate with trans organisations to develop interim healthcare measures that ensures access to healthcare while the National Clinical Programme is developing the new Model of Care.

Signed:

TENI

Trans Healthcare Action

Gender Rebels

Transgress the NGS

Professional Association for Trans Health Ireland

Belong To – LGBTQ+ Youth Ireland 

LINQ Ireland

LGBT Ireland

National LGBT Federation

Outhouse LGBTQ+ Centre

GOSHH Ireland 

Midlands LGBT+ Project

The Gay Project

ShoutOut

Mammies for Trans Rights

Intersex Ireland

The Rainbow Project

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