Statement on the National Gender Service’s Attempt to Close Its Waiting List

Following the breakdown of services in the North and TGEU ranking Ireland as worst in the EU for the provision of trans healthcare, the National Gender Service’s attempt to close its waiting list—as announced on Thursday 11 December—marks a further deterioration of gender-affirming care service provision for the trans community in Ireland. This action and the fact that the HSE has stated that it contravenes the “National Waiting List Management Policy and associated HSE protocols” underscores that the National Gender Service is not fit for purpose. 

This development reinforces the urgent need for a new model of gender-affirming care in Ireland—one that is free, safe, timely, person-centred, accessible through community and primary care settings, based on informed consent, and aligned with international best practice and the needs of the community. We welcome that the Minister for Health Jennifer Carroll MacNeill has “emphasised the importance of ensuring that health services are delivered consistently to those that need them, as is expected of all health services.” Achieving this will require a systemic change to how care is delivered, not additional funding and resourcing of the current system. 

The reported limitations of the current model are harming trans people, not least by delaying access to care. Research demonstrates that the risks of such delays “can result in worsening health and more extensive healthcare needs” (van de Grift et al., 2024). Simply re-opening the National Gender Service’s waiting list is not enough. Additional reported limitations move far beyond extensive wait times to include the paternalistic, overly invasive, psychiatric-focused assessment. 

Trans healthcare in Ireland must be decentralised and delivered according to the informed consent model. The informed consent model can be delivered in community and primary care settings across Ireland as it does not mandate the involvement of mental health professionals to determine eligibility for gender-affirming care. This could dramatically reduce waiting times for gender-affirming care in Ireland. 

The HSE has been directed by the Department of Health to develop a new model of care and the National Clinical Programme for Gender Healthcare has been set up to accomplish this. It is imperative that this new model of care responds to community needs and the international evidence base that supports the informed consent model in primary care. We can look to the successful implementation of this model in countries such as Canada, Malta, Spain, Iceland, Australia, and New Zealand for evidence of how this model can cater to more people with shorter—or non-existent—wait times, while using fewer resources.

However, this development of a model of care should not be used as a justification for delaying interim action. While this work is underway, immediate interim measures are required to support trans people in accessing safe, affirming healthcare. These measures must be developed with the trans community and should prioritise the decentralisation of care. This may include, but should not be limited to, the HSE contracting private providers of gender-affirming care to address current gaps until a functional public service is established. This method has been employed by the HSE previously for a number of services that have experienced similar issues. This is not about providing special treatment to the trans community, but about ensuring equitable access to care.

PATHI advances quality care for trans and gender diverse people in Ireland by uniting professionals of all identities across healthcare, law and policy, advocacy and organising, research and education to strengthen community health, rights and wellbeing. For those committed to ensuring trans people in Ireland can access the care they need, PATHI provides a collaborative space to connect across areas of practice, support one another, learn together, and drive change. We stand ready to support the development of an informed consent model for gender-affirming care in Ireland by sharing evidence-based expertise to inform policy and practices and by training healthcare workers in the delivery of such care.