Joint Committee on Health & Children

4th July 2013

Opening Statement

by

Dr. Philip Crowley

National Director

Quality & Patient Safety Directorate

Health Service Executive

Good morning Chairman and members of the Committee.

Thank you for the invitation to attend the Committee meeting.

I am joined by a number of my colleagues:

  • Ms. Caoimhe Gleeson, National Specialist in Accessibility
  • Ms. Louise Mullen, Senior Researcher Health Intelligence

Introduction

The HSE are working in partnership with Transgender Equality Network Ireland (TENI) the national voluntary organisation which supports transgender people in Ireland to establish a recognised treatment pathway for transgender people, to support the requirement for gender recognition legislation and to develop information for health and social care professionals working with transgender people.

Gender Recognition Legislation:

The HSE acknowledge that the decision to change one’s gender and subsequently apply for a gender recognition certificateis often twinned with social and familial rejection, loss of employment and resultant high degrees of social and economic hardship. Thus these decisions are not made lightly, arbitrarily or without considerable sacrifice. However the HSE also recognise that these decisions have life affirming benefits for the person and often complete a long and complicated journey of seeking to live legally and physically in their preferred gender.

The HSE considers that the decision to change one’s gender is one which requires a suite of clinical, surgical and psycho-social supports and interventions. The HSE considers this process, that of gender reassignment, and any resultant diagnosis or treatment to be a separate process from an application for a gender recognition certificate.

The HSEendorses a gender recognition process which places the responsibility for self declaration on the applicant rather than on the details of a medical certificate/diagnosis. In doing so the emphasis is placed on the process of legal recognition of that self declaration as opposed to the legal recognition of the medical certificate and/or diagnosis.The HSE considers this process to be simpler, fairer, pragmatic and may be easier to legislate for as it takes account of both transgender and intersex people with differing backgrounds and contexts. For example, this process is accessible for an applicant who may have transitioned years ago and who may not have any current medical interactions (nor wish to have such interactions) or applicants who may have accessed all of their care outside of the state (which is becoming an increasing phenomenon amongst the transgender population for reasons of cost and access). The HSE considers this process has the potential to minimise unnecessary stigma or hardship on the applicant.

An Agreed Treatment Pathway for Transgender People

There is currently no agreed treatment pathway in place for transgender people (including adolescents) and existing essential services to enable the transitioning process e.g. endocrinology, psychology, psychiatry, speech and language therapy are under-resourced, over-subscribed and are predominantly concentrated in Dublin. Certain surgical interventions are not performed in Ireland and can only be accessed in the UK or other jurisdictions.

The HSE, in collaboration with key advocacy groups and professional bodies, have begun the process of designing and agreeing a recognised treatment pathway for the transgender community (which includes children and adolescents). There are a number of principles which will underpin the treatment pathway:

  • The treatment pathway will take account of WPATH-7[1] recommendations particularly with regard to language and the contested area of diagnosis.
  • The treatment pathway will use the term ‘Gender Dysphoria’ rather than ‘Gender Identity Disorder’ in line with WPATH-7 recommendations.
  • The treatment pathway will take account of adult, adolescent and intersex issues.
  • The treatment pathway will be designed to ensure that both primary care services e.g. those services accessed through the G.P., community mental health teams, allied health professionals (e.g. speech and language, social work, Occupational therapy) and specialist services (psychology, psychiatry, endocrinology and certain surgeries) can be accessed on a local and regional basis.
  • The treatment pathway will be designed to empower professional bodies to provide services and supports through a clear, seamless and simplified process.

The HSE recognises and acknowledges that the lack of an agreed treatment pathway is problematic for transgender adults, children and their families and is committed to ensuring that this pathway is agreed and signed off by 2014.

Resources and information on Transgender Healthcare

In tandem with the development of an agreed treatment pathway the HSE will develop a suite of information and training resources to support health and social care professionals to provide informed care and treatment to the Transgender Community. The HSE is working closely with TENI in the development of these resources. The HSE will draw on forthcoming guidelines from the UK as well as from best practice in other jurisdictions.

In 2012 the HSE undertook a survey among staff to ascertain the level of understanding of transgender issues. 793 respondents participated in this on-line survey leading to the following key findings:

  • 90% have not had specific training in providing services to transgender people
  • 32% knowingly provided health or social care services to transgender people
  • 19% have a good (or expert) knowledge of transgender issues.
  • Provision of services to transgender people was greatest in the Mental Health or Therapy/Counselling areas
  • 74% want training
  • 75% want further information on transgender issues
  • 70% of respondents provided contact details for further correspondence
  • 26% provided qualitative data in the comments section

The HSE recognise that this is a new and emerging issue for many health and social care professionals which requires clear and consistent information and guidance in order to ensure that Transgender people receive safe, appropriate and quality care.

This concludes my opening statement and together with my colleagues we will take your questions.

Thank you.

1

[1] World Professional Association of Transgender Health, Version 7 (see attached)