A LONG-AWAITED report on transgender healthcare in Ireland has been published by the HSE.

The report makes a number of recommendations including that psychological support for those under the age of 18 should be provided and delivered by the Irish health service, rather than in the UK as was previously the case.

The document was submitted by the National Trans Healthcare Steering Committee in February but only published on Christmas Eve.

On 2 December, Taoiseach Micheál Martin said it was “not satisfactory” the report hadn’t been published, adding that the delay could not be due to the Covid-19 pandemic alone.

At the time Martin said he would “follow up” on why there had been a delay in publication. He also committed to publishing the report and ensuring an implementation plan for its recommendations will be put in place.

The HSE said the report was due to be published earlier this month but this was again delayed, before the report was finally published online last week.

The steering committee was formed in May 2019 to address specific issues in relation to the development of Transgender Identity Services.

Siobhán Ní Bhriain, the HSE’s National Clinical Advisor and Group Lead for Mental Health, led the committee. It included a number of stakeholders including representatives from the Transgender Equality Network Ireland (Teni).

The specific remit of the committee was to work on “the development of seamless interfaces between the agencies delivering Gender Services and to develop a job description for a Consultant Psychiatrist in Child and Adolescent Psychiatry who would be dedicated to the development of the service for those aged under 18″.

The committee held its first meeting in July 2019 and met three times. The group submitted an interim report in October 2019 and a final report in February 2020.

Recommendations

The committee made a number of recommendations:

• Move from the current system of psychological support provided by Tavistock Clinic (in London) for those under the age of 18 to ensure services are provided and delivered by the Irish health service.
• Develop a full multidisciplinary team within mental health services to support the delivery of the National Gender Service (NGS), led by the new CAMHS Consultant Psychiatrist.
• Develop terms of reference of a Clinical Governance Committee for the NGS (to include representation from adult and paediatric services, as well as service users) that will operate across all services delivering transgender care to ensure clear clinical and corporate governance structures are in place.
• Develop a Service User Forum for the NGS, with advice from the HSE Head of Mental Health Engagement & Recovery in relation to service user involvement and representation.
• Consider revisiting the current Model of Care, as developed by Dr Philip Crowley (National Director of the HSE Quality Improvement Division) under the auspices of new guidelines published by the Department of Health, noting that additional resources are now available to deliver more comprehensive programme of care.
• Continue to rollout Gender Identity Skills Training (GIST) nationally to all relevant staff members across the continuum of care, through primary care, secondary care and tertiary care, including Jigsaw and Counselling in Primary Care (CIPC) staff providing services at a local level.
• Consider the establishment of academic partnerships to provide longitudinal evaluation of the service as it develops, and appropriate key performance indicator (KPIs) for ongoing monitoring of the service, to best ensure service provision develops along with need.

The HSE said most of the recommendations are now in progress, and it is considering updating the current model of care. 

The report notes that services for transgender healthcare in Ireland “have evolved organically over the last number of years”.

Adult services are based in St Columcille’s Hospital (SCH) in Loughlinstown in Co Dublin, and children’s services are located in Children’s Health Ireland (CHI) at Crumlin in Dublin 12. Endocrinology and psychological support services are delivered on both sites.

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Tavistock

Patients receiving treatment in Crumlin previously received psychological services via the Tavistock Clinic in London, which was funded by the Treatment Abroad Scheme (TAS).

Tavistock’s contract with the HSE has ended and is not due to be renewed. A recent UK High Court case involving Tavistock, which runs the UK’s only gender-identity development service, does not affect Irish people.

Fewer than five patients in Ireland were referred to Tavistock this year, down from 20 in 2019, 46 in 2018, and 40 in 2017.

In SCH, the psychological services are led by a liaison psychiatry team, which falls under the governance of St John of God Community Services.

Noah Halpin, who was appointed as the steering committee’s ministerial representative in 2019 when then-Health Minister Simon Harris, previously told TheJournal.ie it was “extremely regrettable” that the publication of the report had been delayed for almost a year “despite a three-year long waiting list for transgender healthcare services in Ireland”.

The full report can be read here.