Former minister for justice repeats call for investigation into gender service

Former government minister Charlie Flanagan has described an internal HSE review of its gender identity service for children and young people as “wholly inadequate and insufficient”, and repeated his call for an independent investigation.

Fine Gael TD Mr Flanagan, who has served as minister for justice and minister for children in the past, said the HSE review, which he has read, was “commissioned by the HSE, written by the HSE, proofed by the HSE, and published by the HSE. It is lacking in any independence, and I repeat my call for an independent review.”

The review was commissioned by the HSE’s chief medical officer, Dr Colm Henry, in response to an independent report the English NHS commissioned from UK consultant paediatrician Dr Hilary Cass into its own gender identity service.

[ No evidence young people with gender dysphoria ‘fast-tracked’ to hormonal treatments – HSE ]

Following the report by Dr Cass, it was announced that the Tavistock gender clinic in England, to which Irish patients have been referred for psychiatric and psychological assessments, was to be replaced by a number of regional centres. Since then, most young Irish patients are sent for assessment to regional centres in England, though in some cases patients may still be sent to the Tavistock clinic.

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In August of last year, Mr Flanagan wrote to Minister for Health Stephen Donnelly saying he understood the Tavistock clinic was being sued by up to 1,000 families alleging young children were the subject of “rushed treatment into taking life-altering puberty blockers” and placed on pathways that were damaging to their mental and physical health.

Mr Flanagan said he wanted an independent investigation into the “nature, form and practice of Ireland’s relationship with the Tavistock Gender Clinic”.

Mr Donnelly responded to Mr Flanagan in February of this year, pointing out the HSE was conducting a review in the wake of the Cass report. Mr Flanagan said he has now read the HSE review and is repeating his call for an independent inquiry. The HSE review said it found no evidence that Irish patients had been “fast-tracked” to hormone and other types of medical intervention.

In February, Dr Henry told The Irish Times that, following the internal HSE review, a decision had been taken to update the model of care for the treatment of gender dysphoria and that the ambition was to create an entirely domestic service. Among the reasons for reviewing the model of care, he said, was the changing “epidemiology” of gender dysphoria.

[ Time to Think, The Inside Story of the Collapse of the Tavistock’s Gender Service for Children: cause for concern ]

The patient profile for gender dysphoria internationally in recent years has seen an unexpected rise in the number of natal females suffering from the condition. Also, the proportion of patients presenting with the condition who are on the autism spectrum is greater than is the case with the general population.

In the decade since 2012, 233 Irish children and young people were referred to Tavistock, with funding coming from the Treatment Abroad Scheme (TAS), according to the HSE review.

There were 5,000 young people on the Tavistock waiting list at the time of the review, of whom 75 were Irish children and young people who had been referred at an earlier date. “Because the service is over capacity, a very low number of those referred from Ireland are being seen at any given time,” the review said.

[ Achieving a caring consensus on gender issues requires a broad national discussion ]

The HSE’s efforts to create an entirely domestic gender service for young people has been hampered by difficulties in appointing qualified staff, it said.

“In the past year, a very small number of (n<5) children/young people living in Ireland have availed of services at a centre in Belgium and Germany through the Cross Border Directive (CBD) and TAS schemes. This is in accordance with EU entitlements. Because of the very low numbers involved (n<5), further detail is not available.”