We call upon the HSE to implement a human rights-based approach to transgender healthcare adhering to international best practice through a co-production with the trans and gender diverse community.

The signatories would like to express our serious concerns regarding the HSE’s posting for a Clinical Lead for Transgender Services (Model of Care and Implementation Plan Development Lead for Transgender Care), to close on 12 October 2023.

In this posting, the HSE has failed to state that a model of care and implementation plan for transgender care in Ireland should be compliant with international human rights standards. Transgender and gender diverse (TGD) people have the right to the highest attainable standard of healthcare, including gender-affirming care, without discrimination on the basis of gender identity (World Health Organization, 2017; International Commission of Jurists, 2007). TGD people, like all other people, have the right to access healthcare that respects their individual bodily and mental integrity, autonomy, and self-determination as well as their free and informed consent when making decisions about their medical treatment (Transgender Europe, 2019; European Union, 2012). The UN Sustainable Development Goal 3 aims to “Ensure healthy lives and promote well-being for all at all ages” and the HSE should endeavour to make this a reality for the TGD community in Ireland by advancing access to human rights-based healthcare services (United Nations, 2015).

Though Ireland is a signatory on key human rights charters, including the Yogyakarta Principles and the Charter of Fundamental Rights of the European Union, the state currently follows practices that violate the human rights principles they claim to uphold. In 2022, Ireland was ranked the worst country among the 27 member states of the European Union for the lack of availability and accessibility of trans-specific healthcare by Transgender Europe (Transgender Europe, 2022). The report goes on to state that “The monopoly and centralisation of care in countries like Ireland, Finland, and Denmark make it difficult for trans people to see a healthcare professional on time" (Transgender Europe, 2023). The barriers to human rights-based healthcare access cannot be maintained in a new system.

Further, in seeking a new Clinical Lead, the HSE has failed to specify that the model of care should adhere to international best practice in transgender healthcare. Any new system for transgender healthcare should follow the World Professional Association for Transgender Health (WPATH) Standards of Care Version 8, along with the World Health Organisation’s guidelines through the ICD-11, both published 2022, as these standards were developed using an evidence-based approach built upon the best available science and expert professional consensus with input from over 100 global medical professionals and experts (World Professional Association for Transgender Health, 2022; World Health Organization, 2022). However, despite representing the foremost evidence-based guidelines for the provision of gender-affirming healthcare, the WPATH Standards of Care are not mentioned within the job posting.

The HSE should not be following the NHS England model when building a system in Ireland, as WPATH has expressed major reservations about the interim service specification released following the publication of the interim report of the Cass Review (WPATH et al, 2022). In their statement, WPATH alongside its regional organisations expressed that the NHS’s outlined approach “reasserts the outdated ‘gatekeeping model’ of access to gender affirming care,” and this lack of adherence to evidence and the right to the highest attainable standard of health is likely to cause serious harm. A new system for transgender care in Ireland should instead seek to make progress in alignment with international standards, focusing on ​​supporting GPs and other community medical practitioners to provide evidence-based care to TGD people through a patient-centred, informed consent model.

The HSE did not attend the conference of the European Professional Association for Transgender Healthcare (EPATH) held in Ireland in April. This conference was an opportune moment to collaborate with and learn from experts in transgender healthcare from across the EU and beyond, as well as with members of the TGD community and TGD-led organisations in Ireland who were also present. Without engaging with the broader medical community and international best practice in the field of transgender health, the HSE will be unable to craft an evidence-based model of care.

Finally, the HSE has failed to consult the TGD community in the development of this role and have not shared how they will directly involve the TGD community in the hiring decision. The HSE must prioritise meaningful engagement with the TGD community in decisions which impact their healthcare outcomes, such as the hiring of key staff and development of a model of care for transgender healthcare. In 2015, the Parliamentary Assembly of the Council of Europe called on states to “involve and consult transgender people and their organisations when drafting and implementing policy and legal measures which concern them,” yet the HSE has not done so in developing this position and its scope (Parliamentary Assembly of the Council of Europe, 2015). Earlier this year, the HSE held a workshop billed as “The Future of Transgender Care in Ireland” but did not have any representation from the TGD community. While we welcome the creation of an advisory group inclusive of TGD service users and TGD-led advocacy groups as outlined in the role description, each step of the process in developing a model of care for transgender services should be a co-production with the TGD community.

We therefore call upon the HSE to

1. ensure that the model of care and implementation plan for transgender healthcare adheres to human rights principles;

2. follow international best practice in transgender healthcare, specifically the WPATH Standards of Care Version 8; and

3. directly engage and consult the TGD community throughout all stages of hiring for this position and creating the model of care and implementation plan for transgender healthcare, giving TGD people decision-making power.

We urge the HSE to reassess its approach to hiring a Clinical Lead for Transgender Services and to build a model of care and implementation plan for transgender care through an inclusive co-production with the TGD community that upholds the human right to self-determination in healthcare.

Signatories

Trans Healthcare Action

International Organisations

European Professional Association for Transgender Health (EPATH)

GATE: Global Action for Trans Equality

International Trans Fund

Transgender Europe (TGEU)

Transgender Professional Association for Transgender Health (TPATH)

Irish Organisations

Abortion Rights Campaign

Anti Conversion Therapy Coalition

Bi+ Ireland

Dublin LGBTQ+ Pride

Gay Project

GOSSIP Galway

Intersex Ireland

LINC - Advocating for Lesbian & Bisexual Women

Outhouse LGBTQ+ Centre Sex Workers Alliance Ireland (SWAI)

ShoutOut

Small Trans Library

The Switchboard

Trans & Intersex Pride Dublin

Transgender Equality Network Ireland (TENI)

Union of Students in Ireland (USI) 

Sources

1. World Health Organization, Human rights and health (2017) online at https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health

2. International Commission of Jurists, Yogyakarta Principles: Principles on the Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity (2007) online at https://yogyakartaprinciples.org/principles-en/

3. Transgender Europe, Guidelines to Human Rights-Based Trans-Specific Healthcare (2019) online at https://tgeu.org/wp-content/uploads/2019/12/TGEU-Guidelines-to-Human-Rights-Based-Trans-specific-Healthcare-EN.pdf

4. European Union, The Charter of Fundamental Rights of the European Union (2012) online at https://www.europarl.europa.eu/charter/pdf/text_en.pdf

5. United Nations, Transforming our world: the 2030 Agenda for Sustainable Development (2015) online at https://sdgs.un.org/2030agenda

6. Transgender Europe, Trans Health Map 2022: The State of Trans Healthcare in the EU (2022) online at https://tgeu.org/trans-health-map-2022/

7. Transgender Europe, The State of Trans-Specific Healthcare in the EU, Looking Beyond the Trans Health Map 2022 (2023) online at https://tgeu.org/wp-content/uploads/2023/09/TGEU-Trans-Health-Map-Report.pdf

8. World Professional Association for Transgender Health, Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022) online at https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

9. World Professional Association for Transgender Health, Methodology for the Development of SOC8 (2022) online at https://www.wpath.org/soc8/Methodology

10. World Health Organization, International Classification of Diseases – 11 (2022) online at https://www.who.int/standards/classifications/classification-of-diseases

11. WPATH, ASIAPATH, EPATH, PATHA, and USPATH Response to NHS England in the United Kingdom (UK) Statement regarding the Interim Service Specification for the Specialist Service for Children and Young People with Gender Dysphoria (Phase 1 Providers) by NHS England (2022) online at https://epath.eu/wp-content/uploads/2022/11/25.11.22-AUSPATH-Statement-reworked-for-WPATH-Final-ASIAPATH.EPATH_.PATHA_.USPATH.pdf

12. Parliamentary Assembly of the Council of Europe, Resolution 2048: Discrimination against transgender people in Europe (2015) online at https://pace.coe.int/en/files/21736/html