Correspondence from IHREC to the National Clinical Programme for Gender Healthcare

Name: IHREC
Price range: $

Dr Karl Neff,

Clinical Lead for the National Clinical Programme

Health Service Executive

Re: The National Clinical Programme for Gender Healthcare - a new Model of Care for Gender Healthcare

A chara,
I am writing to you from the Irish Human Rights and Equality Commission (‘IHREC’) regarding the recent open consultation on developing a new Model of Care for Gender Healthcare in Ireland, led by the HSE National Clinical Programme for Gender Healthcare.

The right of transgender and gender diverse people to access healthcare is of particular interest to us as the ‘A’ status National Human Rights Institution and the National Equality Body for Ireland. We are mandated to keep under review the adequacy and effectiveness of law and practice in the State relating to the protection of equality and human rights. We are also mandated to recommend to the Government the measures we consider should be taken to strengthen, protect, and uphold equality and human rights in the State.

We welcome the ongoing work to update gender healthcare services in Ireland by producing a new Model of Care for Gender Healthcare. We also welcome the opportunity for individuals and civil society organisations to share their lived experiences and expert views of accessing healthcare through consultation surveys. We recognise that this work is intended to deliver on the commitment from the Programme for Government 2025 to “ensure a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion.”¹ We recognise as well that an updated clinical model of care for gender healthcare services for adults and young people is also action for the HSE under the National LGBTIQ+ Inclusion Strategy II 2024 – 2028.²

The development of the new model of care must prioritise a human rights and equality-based approach and partnership with the transgender and gender diverse communities, and avoid perpetuating toxic narratives, the ‘instrumentalisation of prejudice’, and pathologising approaches.³ We emphasise the importance of ensuring that human rights and equality standards underpin the design, implementation, monitoring and evaluation stages of the new Model of Care for Gender Healthcare. The transgender and gender diverse communities have a right to the highest attainable standard of health without discrimination of any kind under Article 12 of the International Covenant on Economic, Social and Cultural Rights.4 The European Social Charter, the human rights treaty on social and economic rights, guarantees the right to the highest possible standard of health attainable under Article 11, which complements Articles 2, 3 and 8 of the European Convention on Human Rights.⁵ We would draw attention for the purposes of your work, the recommendations of the Council of Europe Committee of Experts on Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (ADI-SOGIESC) in ensuring trans-specific healthcare is accessible, affordable, respective and of high quality.⁶ Particularly, we note the recommendations to ensure that trans-specific healthcare is reimbursed by public and private health insurance schemes, and ensuring a decentralised model of care which includes a range of service points including independent practitioners, multidisciplinary clinics, and community-led initiatives.

Recommendations and comments to Ireland on transgender healthcare by international human rights bodies should inform the development of the new model of care. The UN Committee on the Rights of the Child (‘CRC’) recommended that Ireland ensure transgender children’s access to adequate healthcare.⁷ The European Commission against Racism and Intolerance (‘ECRI’) noted that LGBTIQ+ organisations in Ireland were concerned about the lack of consultation in the new model of care and the long waiting lists for adults and the absence of services for children and young people.
⁸ We also note that ILGA-Europe has recommended that Ireland depathologises trans identities and ensures access to timely, adequate gender-affirming healthcare through the public health system.⁹

We have previously expressed our concerns nationally and internationally that the failure of the State to provide universal, affordable, gender-affirming care for transgender people is a violation of the right to health. We also raised with the State that a lack of timely access to gender affirmation services can create mental health issues, due to the added stress of waiting lists, not fit-for-service gender clinics, transphobia, and delayed intervention. We reinforced these concerns in our submissions to the UN Committee on Economic, Social and Cultural Rights,¹⁰ the UN Convention on the Elimination of All Forms of Discrimination Against Women,¹¹ and the European Commission against Racism and Intolerance.¹² In these submissions we called on the State to develop and adequately resource rights-based, evidence-based gender-affirming healthcare for transgender children, young people and adults as a matter of urgency.

We recommend that the new Model of Care for Gender Healthcare is informed by the use of human rights and equality impact assessments and by adequately resourced and meaningful consultation with individuals and civil society organisations. We draw your attention to the Collaborative Governance approach.¹³ This is in line with our recommendations for implementation of the statutory obligations under Section 42 of the IHREC Act 2014, the Public Sector Human Rights and Equality Duty (the Duty).¹⁴ The Duty is a statutory obligation that complements existing public policy, strategies, and procedures as they relate to progressing equality and human rights. The Duty provides a medium to ensure effective delivery of any commitments agreed to provide appropriate healthcare to transgender and gender diverse people. Implementing the Duty also provides a coherent framework for a consultative approach to assessing and understanding the intersectionality of issues faced by transgender and gender diverse people.

Thank you for your consideration of the issues raised in this correspondence. We look forward to engaging further on the development of the model of care and I and the IHREC team are available to meet with you to discuss the matters raised above.

Yours sincerely,

Liam Herrick

Chief Commissioner

Irish Human Rights and Equality Commission

Liam Herrick

Chief Commissioner

Irish Human Rights and Equality Commission

Footnotes

1 Programme for Government, (2025), p. 89.

2 National LGBTIQ+ Inclusion Strategy II 2024 – 2028, p.22; National LGBTIQ+ Inclusion Strategy II Action Plan 2025-2026, p. 11. We are a member of the National LGBTIQ+ Inclusion Strategy II 2024 – 2028 Steering Committee.

3 IHREC, Ireland and the 6th Monitoring Cycle of the European Commission against Racism and Intolerance (2024) p. 22.

4 International Covenant on Economic, Social and Cultural Rights; Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, The right to the enjoyment of the highest attainable standard of physical and mental health of persons, communities and populations affected by discrimination and violence based on sexual orientation and gender identity in relation to the Sustainable Development Goals, A/HRC/50/27 (22 November 2022).