A SENIOR CLINICIAN with Ireland’s National Gender Service (NGS) is to be appointed as the HSE’s new clinical lead for transgender services in Ireland. 

The Journal understands that an offer has been made for the role to Dr Karl Neff, and that appointment formalities are underway. 

Speaking last week, Health Minister Stephen Donnelly indicated the impending appointment was an important step in the development of an “agreed model of care” for transgender people in Ireland.

Neff is an Endocrinologist with the National Gender Service, Ireland’s only clinic that provides specialist support for people who are seeking medical or surgical “interventions to affirm their gender”. 

He is also the clinical lead at the Loughlinstown-based clinic, which is on the grounds of St Colmcille’s Hospital. 

The operational model of care at the National Gender Service is based on comprehensive multidisciplinary assessment covering all aspects of people’s health and not just their gender identity.

Neff has has stated that “comprehensive psychosocial assessment” is “vital…prior to medical transition so that clinical needs that require support prior to or during medical transition can be identified”. 

Transgender rights campaigners argue that a requirement to undergo extensive assessment as a precondition for gender-affirming treatment is stigmatising and discriminatory, and they favour an alternative model of care sometimes described as “informed consent”.

When the position of national clinical lead for gender services was advertised earlier this year, transgender advocacy groups stated that “a new system for transgender care in Ireland” should focus on “supporting GPs and other community medical practitioners to provide evidence-based care to transgender people through a patient-centred, informed consent model”.

Transgender advocacy groups including Transgender Equality Network Ireland (Teni) and Trans Healthcare Action further criticised the fact that the HSE’s job description for the clinical lead did not make any reference to the World Professional Association for Transgender Health (WPATH) model of care, which is referenced in the Programme for Government.

They also criticised the HSE for failing to consult the transgender community in the development of the role.

On an edition of RTÉ’s Prime Time last week, Dr Donal O’Shea, a consultant endocrinologist at the National Gender Service criticised the WPATH model, a gender-affirming model based on informed consent.

Lack of resources

Neff has previously outlined a number of concerns about the state of health services for transgender people and those experiencing gender identity issues in Ireland. 

Writing in the Irish Times last year, he said Ireland’s only gender clinic didn’t have the capacity to see the 300 trans people being referred to it each year due to being short-staffed.

He said that this issue has meant that people have experienced longer waiting times, and that the clinic was not in a position to always offer a full range of supports to those going through medical transition.

Neff also noted that a lack of resources and provision in Ireland has “sadly” seen many transgender people forced to travel abroad for surgical procedures. 

Hiqa complaint

In an interview with The Journal last Friday, Health Minister Stephen Donnelly responded to the news reported in an RTÉ Prime Time programme that two of the most experienced clinicians with the NGS have lodged a complaint with Hiqa over the HSE’s treatment of children experiencing gender identity issues. 

Appearing in the programme, Professor Donal O’Shea and psychiatrist Dr Paul Moran expressed their concerns over the HSE referring children in Ireland to services in the UK that follow a model of care which they claimed is associated with a greater readiness to initiate medical treatment. 

Dr Moran told Prime Time that the complaint lodged by himself and O’Shea cited a number of cases of Irish children who availed of services abroad being at risk. The HSE has denied that the allegation that children were put children at risk.

Donnelly told The Journal that the “core issue” at hand here is “a pretty fundamental disagreement between that team [Moran and O'Shea] and another clinical team in the HSE”.

“I’ve met both and listened to both. I will be led by the clinical advice. This is a clinical decision, and a clinical service for very vulnerable young people,” he added.

Dr Moran told The Journal that his team in the NGS is the only clinical team providing gender care in Ireland. 

Speaking of the new clinical lead for transgender services, Donnelly said: “Whoever comes in, I want them to listen carefully to both groups. I will want them to take on board the new evidence. This is a fairly new area of medicine.

“Then I want an agreed model of care for Ireland,” he added. 

Tavistock

The Health Minister said that following the Cass report on the Tavistock clinic, the NHS decided to set up regional centres for children’s gender care. 

“Two of those centres have now been set up, we are referring children and adolescents to those centres, but there’s a long waiting list. Ultimately they are only advisory, the clinical care still happens back here in Ireland,” he commented.

Donnelly further said that specialist services need to be offered here in Ireland, so children are no longer referred to clinics abroad. 

Dr Moran said that the two regional hubs the NHS has said will replace Tavistock have not yet been set up, as they have been delayed in opening.

A spokesperson for the Minister clarified this afternoon that no referrals have been made by the HSE to NHS gender identity clinics since Tavistock stopped accepting new patients last year, and added that once the new hubs are established, Irish children and adolescents will be referred to them. 

Dr Moran said that the Tavistock clinic in the UK stopped seeing new cases in August of last year, and that it is now only providing “bridging care” for existing patients until they are accepted by adult services. 

In April of this year the Sunday Independent reported that Neff has also internally voiced concerns about the need to assess the quality of care provided to children by CHI Crumlin and the Tavistock clinic. 

The newspaper reported that Neff wrote to Dr Orla Healy, who carried out the HSE review of Irish referrals to the UK’s Tavistock clinic, to say that she should carry out a full audit of the medical records belonging to patients who were referred to the NGS from Crumlin Children’s Hospital and Tavistock. 

Dr Healy declined the suggestion, and said that the quality and safety of the services provided by Crumlin was not being questioned. 

The Sunday Independent reported that Neff further wrote to Healy to express his view that there is a “problem” of people “[starting] hormonal treatment  in the absence of appropriate pre-intervention assessment”. 

With additional reporting by Christina Finn and Valerie Flynn.