A “constructive and informative discussion” was held in Dublin on Thursday with Dr Hilary Cass, the head of an ongoing high-profile review of gender identity services for children and young people in the UK, a spokesperson for the HSE has said.
Dr Cass met a wide range of stakeholders from the Department of Health, the HSE, and services providers to discuss “the challenges in developing a gender service in Ireland despite limited availability of data and evidence on which to base the clinical approach,” the spokesperson said.
An interim report by the Cass review group in March of last year led to the decision to close the Tavistock gender identity clinic in England. Tavistock, which was cited for closure in the first quarter of this year, provided a visiting clinic to the Irish gender identity service for young people based in the children’s hospital in Crumlin, Dublin.
The Dublin service is currently looking for a way to replace the service formerly offered by Tavistock, which assessed children and young people suffering from gender dysphoria. The assessments could result in the patients being deemed suitable for puberty blockers and cross-sex hormones.
Psychiatrist Dr Paul Moran and endocrinologist Prof Donal O’Shea, of the adult gender service in St Columcille’s, Dublin, have long been highly critical of the quality of the work done by Tavistock on patients of the Irish child and adolescent service.
However, Dr Siobhán Ní Bhriain, the HSE’s national lead for integrated care, said in August of last year that the Tavistock Clinic was safe, and that if it had been deemed unsafe it would have been closed immediately rather than let continue for another year.
The HSE spokesperson said the visit by Dr Cass had involved discussion of the Interim Cass Report and “follows engagement between the HSE Chief Clinical Officer and Dr Cass since the HSE commissioned an internal review of referrals to Tavistock last year.”
The meeting will help inform the next steps in developing a programme of work to provide a model of care and service supports to develop the best possible gender service in Ireland, based on evolving evidence and best practice, the spokesperson said.
The review group headed by Dr Cass, a former president of the Royal College of Paediatrics and Child Health, recommended that Tavistock, the sole UK clinic for youth gender services, be replaced by regional centres.
It said young people with gender dysphoria do not see themselves as having a medical condition and are often anxious to start hormone treatment as soon as possible. There is often, it said, a sense of frustration at what they see as the “gatekeeping” medical model.
However, the report said, care for gender dysphoria should involve the same ethical, scientific, and professional standards as other forms of clinical care.
Once children and young people got access to the Tavistock clinic, “there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition that has developed due to the delay in service provision,” the interim report said.
The review group said the effort to develop a model of care for young people with gender dysphoria was affected by the polarity of debate about the issue and the lack of data on which to ground a clinical approach based on evidence.
Tavistock saw 107 Irish patients in the period from 2012 to January 2023, according to figures from the London clinic. The youngest Irish children seen were three natal girls aged seven at the time of their first appointment.
Separately, new figures from the Department of Social Protection show there was a significant increase last year in the number of people availing of the 2015 Gender Recognition Act.
There were 108 applications in 2020, 195 in 2021, and 321 last year. The total to the end of 2022 is 1,203. There were five applications by people who wanted to revert to their original gender since the law was introduced, the department said.
The law allows people aged more than 18 to apply for a certificate that in turn allows them change their gender on their birth certificate. It is not possible for people aged less than 16 to avail of the law, while those aged 16 and 17 require certain medical certificates and have to apply by way of a process overseen by the Circuit Family Court.
