---
title: Letter Resigning from the Model of Care for Gender Healthcare Working Group
description: PATHI has resigned from the Working Group tasked with developing a new Model of Care for Gender Healthcare. PATHI shares this letter openly for transparency and accountability.
---

[News | Professional Association for Trans Health Ireland](https://pathi.ie/news)

# [Letter Resigning from the Model of Care for Gender Healthcare Working Group](https://pathi.ie/news/letter-resigning-from-the-model-of-care-for-gender-healthcare-working-group)

 Written by [PATHI](https://pathi.ie/news/author/pathi) | 9 October 2026, 10:39:16 Z

Following the Professional Association for Trans Health Ireland's resignation on 2 September 2026 from the Working Group tasked with developing a new Model of Care for Gender Healthcare, the PATHI Governance Committee sent the below formal resignation letter on 8 October 2026 to Dr Karl Neff, HSE National Clinical Lead for Gender Healthcare. PATHI shares this letter openly for transparency and accountability.

 

It is with great disappointment that the governance committee of the Professional Association for Trans Health in Ireland (PATHI) has decided to withdraw from the Working Group tasked with developing a new Model of Care for Gender Healthcare. This decision was made after careful consideration of the development process and current proposed draft Model of Care. We cannot in good faith continue to participate as we do not feel the draft Model of Care thus developed aligns with the values of PATHI or what we envision as the future of gender healthcare in Ireland.

#### Concerns with Development Process

From the outset, the HSE maintained that the development of the Model of Care for Gender Healthcare would be guided by two key pillars: the evidence base and the experience base. In keeping with this, systematic reviews and experiential data collection were undertaken by the HSE. However, the draft Model of Care was not only produced but also circulated to members of the working group before the processes informing these two pillars were complete and, therefore, failed to incorporate the ongoing data into review. Most notably, this left out important voices as they relate to the provision of gender affirming care for children and young people as well as perspectives from GPs.

Secondly, the evidence base - the current document describing the draft Model of Care makes few references to international evidence-based standards (ie, WPATH) and existing models of care and, worryingly, 3 out of the 7 references in the document are related to the Cass Review, which is widely criticised by international medical bodies, academic voices, and LGBTQ advocacy groups. Moreover, there is reference to evidence in the draft, of which sources have not been made available to members of the working group in advance of this draft being developed. Overall, given lack of incorporation of international standards beyond the heavily disputed Cass Review, lack of transparency of sources of evidence, and lack of incorporation of community feedback overall suggest a disingenuous tokenistic approach to both of the key pillars named at the outset - the evidence base and the experience base.

Up until this point, the gender healthcare model in Ireland has been one rooted in medicalising and pathologising trans identities and trans care, largely by basing care on the psychiatric assessment of patients, rather than the more evidence-based model of informed consent. Unfortunately, the largest failure of the development process is a fundamental misunderstanding of the meaning of depathologisation. As defined by the current draft Model of Care, depathologisation is “taking a sensitive approach to the process of clinical assessment and intervention, and basing clinical services in community settings, as much as possible”. As outlined by Suess Schwend (2020), depathologisation has a much more specific meaning in this context and requires explicitly committing to a conceptualisation of trans and gender diverse people, and the process of transition, that is not grounded in an understanding of “bodily characteristics, habits, practices, living forms, gestures, people, and groups of people as mentally disordered, ill, abnormal, or malformed”. Depathologising gender healthcare therefore requires that there is no diagnostic classification of trans and gender diverse people, no psychiatric or psychological assessment as gatekeeping, and that gender diversity and self-determination is recognised as a human right. Again, Suess Schwend (2020) provides clarity here by explaining that depathologisation suggests a “model of trans health care based on information, counseling, accompaniment, and informed decision making”. This should be the aspiration in addressing the concerns with the draft Model of Care that we outline next.

#### Concerns with Draft Model Care

The draft Model of Care reinforces the pre-existing centralised consultant-led approach and misses the vital opportunity to expand the role of primary care in delivering gender healthcare in local communities, a very common and sustainable approach evidenced in other countries. The structure of the proposed clinical pathways is overly complicated and the amount of clinical time required is likely to result in significant delays to care and waiting lists that may potentially cause harm. The number of appointments involved and the extent of assessment amounts to not only an unacceptable level of gatekeeping but also a strictly unnecessary and pedantic approach. It also does not appear to encourage clinicians to continue treatment protocols commenced elsewhere, which may further restrict care and cause delays. All of these concerns echo the same issues with the existing public gender healthcare service which as it stands has failed in its duty to provide trans people with their human right to medical care.

In addition, any model of care is only as good as the accountability and diligence it takes in building trust with and listening to the community it services. Unfortunately, the current draft Model of Care is at best vague in the commitment to collaboration and does not include community involvement in governance. Given the degree to which trust has been broken with the trans community by the current model, PATHI strongly believes a collaborative governance approach is needed if there is to be a positive relationship between the HSE and trans communities across Ireland. There is also a stark lack of emphasis on the provision of education of healthcare trainees and professionals specifically and as part of multiprofessional learning. Trust is best built by committing to training a healthcare workforce that is trans-inclusive and culturally competent, in line with the HSE’s Public Sector Human Rights and Equality Duty obligations.

In short, what is being proposed will not significantly improve the quality of gender healthcare in Ireland because it does not address the core limitations of the current approach. For the reasons outlined above, we cannot continue to be part of the development of this draft Model of Care. We note that we are not the only members of the working group to express opposition to its process and outcomes, and not the only members to see resignation from the working group as the only option given the limited incorporation of both expert and community feedback into the development of this draft Model of Care. We note too the recent letter sent to you from the Chief Commissioner of the Irish Human Rights and Equality Commission, Liam Herrick, particularly its reminder of the obligation of the HSE “that human rights and equality standards underpin the design, implementation, monitoring and evaluation stages of the new Model of Care for Gender Healthcare”. There is no explicit reference to this obligation or how it will be met in the draft Model of Care.

PATHI will continue to advocate for a future where all trans and gender diverse people in Ireland have full access to appropriate healthcare and all healthcare providers have access to information and resources which enable them to provide appropriate healthcare. By appropriate healthcare, we mean care that is free, safe, timely, person-centred, accessible in community and primary care settings, based on informed consent, and self-determined — following the needs of the community and international best practice. We would welcome the opportunity to work with the HSE, the Department of Health, community and professional groups, and most importantly, the prospective service users, to develop a model of care grounded in these principles. This working group has not provided that opportunity.

[View full post](https://pathi.ie/news/letter-resigning-from-the-model-of-care-for-gender-healthcare-working-group)

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