David Cullinane
Waterford · Sinn Féin · Ireland
“I met many of those patients and people with the illness yesterday. Many of them were here in Leinster House. They told me, as they have in the past, they cannot walk and they cannot swallow and, as the Taoiseach acknowledged, it is also very difficult for their families who have to watch as their condition worsens and the disease progres…”
“In fact, in the programme for Government the Government committed to reviewing that process because it was accepted it does not always work. The technical review group obviously now needs to be convened and needs to meet urgently. Emily cannot afford more delays.”
“Yesterday, as the Taoiseach knows, the HSE drugs group met to consider reimbursement of Skyclarys, the first approved treatment that can slow the progression of Friedreich's ataxia. Patients hoped for a positive decision. This process has been ongoing for years.”
“They were left desperately making phone calls, checking for updates, asking journalists and asking politicians if they had heard anything. They were treated appallingly. Then, when the news did eventually filter though, they were left devastated.”
“Richard Walsh, consultant neurologist and co-director of the National Ataxia Clinic, has described this drug as a ground-breaking development. He has said that he would prescribe it if it were available in Ireland and that it may reduce the rate of disease progression.”
“"We are not going to regain any of the abilities we've lost, but Skyclarys will give us time. Time when you're dealing with our progressive relentless disease is everything. We all deserve time with our loved ones." Those are the words of Emily Felix, a 28-year-old trainee solicitor from Kilkenny who is living with Friedreich's ataxia.”
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“The Minister of State is mixing up policy and policy targets, on the one hand, and statutory targets, on the other. That is the difference between what this Bill seeks to do and what he outlined. What we see routinely from this Government are HSE service plans. These are produced every year but are not worth the paper they are written on because the HSE does not have the capacity to meet any of the targets. Almost every target that is set is broken. The Minister of State cited all of the targets set out even in the most recent waiting list plan to reduce wait times in some areas by 50%. Nobody out there, not even the people who wrote the script for him, believe that is going to happen. All we have are these published fantasy targets.”
“If I was in government and was handed a script like the one the Minister of State was expected to deliver this evening - I assume by officials in the Department, but I do not know who crafted the speech - I hope that I would say, "No thank you, I am not going to read that out." It was embarrassing in the context of the reasons given for opposing this Bill. It is embarrassing for one simple reason, namely it is what the Minister of State and the Government signed up to. It is what we all signed up to when we agreed Sláintecare. An Teachta Rice is right. It is alarming that the Government is clearly stating that it is walking away from a commitment given to put in place statutory waiting list targets and maximum waiting list times.”
“Surely the Minister of State is going to respond by setting out a plan in relation to greater transparency with waiting lists, and a better way to manage them as well.”
“I have not spoken to the Minister of State and I do not know why the Bill is being amended but for whatever reason it is being amended, I hope he is coming with an alternative and not just coming again to say "No" to the solutions we are putting forward. I do not want to be here in five years' time again still talking about problems with managing waiting lists or about people waiting too long; still waiting for the elective hospitals to be built or the 3,000 beds that Stephen Donnelly promised, which we will not see delivered over the next five years; and still looking for transparency around mental health waiting lists, community waiting lists and so on, where I have to put in parliamentary questions again and again and ask them in a dozen different ways to try to get the information I want.”
“I will be interested to hear the Minister of State's speech and to hear exactly why the Bill is being opposed. There may be some good reason for it. This is a Bill we got a lot of help with putting together to ensure it was as fit for purpose as it possibly could be. I am sure the Minister of State may have been in opposition himself at some point. We do not have the resources a Department has or an army of civil servants to do a Bill, so we do our best, as the Opposition, to craft Bills that are as fit for purpose as possible. Even if they were not ideal or perfect, the reason we have Committee Stage in Bills is so that, if there are any issues, they can be discussed, amended and got to a point where we have more fit-for-purpose Bills. I will finish on this.”
“We forced them to have better engagement with the local private hospital, UPMC Whitfield, doing a lot of elective procedures and diagnostic work. They bought up beds in private nursing homes and contracted beds to ensure speedier discharges. They also put better systems in place to manage waiting lists and for better collaboration between consultants and staff for discharges and so on. Processes do work. Flow in a hospital is important. Flow in the healthcare system is important if you get it right. What is frustrating is we see evidence in other countries of the solutions we are proposing to fix the problem and to integrate and manage waiting lists in a much more productive way, yet we have a Government that simply will not accept them. It says all the right things and offers nice words when we raise this but then it does not happen.”
“Equally, if the processes are not working or are cumbersome or protective and create little fiefdoms where people control waiting lists and there is not freedom to move from one waiting list to another, that does not make sense. It does not make sense to me or to a patient waiting for a hip procedure in Waterford when there may well be an opportunity to be seen in Kilkenny, Wexford or somewhere else quicker. Why are those opportunities not being made available? Why are we not harnessing that potential and using the full resources of the health service we have? Again, there is evidence of good practice in this area. I go back to my constituency. I was part of a group of Oireachtas Members who met monthly with hospital management and the regional hospital group.”
“We could paper the walls of this place with all the winter plans and waiting list initiatives - money thrown at the system, money for insourcing, money for outsourcing. Yet when we look at the waiting list, we see people are still waiting far too long and we are nowhere near the Sláintecare targets. We have to start looking at outputs and asking why, with record investment in healthcare, we are still not getting the results we need or seeing waiting lists come down to the extent required. It is partly resources and capacity. If we do not have the staff, beds, physical space or equipment, we cannot provide the surgeries or procedures or make appointments as quickly as they need to be made.”
“If we have very good data, we can do so much more. I was at a meeting of the Oireachtas health committee a number of weeks ago. I am not sure if the Minister of State, Deputy O'Donnell, was at that session on digital transformation and the roll-out of the unique health identifiers and electronic health records, EHRs, all of which we are told will happen over the coming years. It will take six or seven years for the full bells and whistles of the EHRs to be in place and for this State to have digital hospitals. While that is being done, it is the perfect time for the State to get its act together on waiting lists. I have seen so many waiting list initiatives from Governments.”
“An example is in my constituency of Waterford, where the hospital is one of the better performing hospitals. Wait times are down. People are not waiting on trolleys in emergency departments in the same way they are in other hospitals. It is good for all of us to see what is and is not good practice. Transparency around waiting lists shows up that there are sometimes regional differences, not because management or staff in those areas are not doing their best but because we do not have the staff. We might not have the equipment, resources, capacity or whatever it might be. That is mostly the reason we have those types of regional disparities. If we do not have the waiting lists and cannot measure or compare, obviously that is not good. I have always said data is really important in the healthcare system.”
“We have to put in parliamentary questions to get that response. It is the same with dental treatment. I got a reply to a parliamentary question recently. I had to ask the question three or four times to get the information I was looking for. I eventually got it but that information should be transparent and clear and on the NTPF website with the other waiting lists for acute hospitals. It beggars belief that with all the new technologies in the healthcare system, we still do not publish all the waiting lists with wait times. They should be broken down by region, county and area. That would give all of us a chance to see which areas are performing and which are not, where pressures exist and where pressures do not exist. We can then praise those efforts which are achieving better results.”
“We saw recently with the scandal of insourcing the concerns, challenges and difficulties posed by single consultants managing waiting lists rather than their being managed by a hospital or hospital group or being centralised in some way. Having a local list but also a centralised list makes sense. We have been calling for that for so long, yet it has not been implemented. I also seek in this Bill to bring a greater degree of transparency to waiting lists. At the end of every month, the NTPF publishes some waiting lists. It publishes the acute hospital waiting list, which is very welcome, but it does not publish diagnostic waiting lists or community waiting lists. It does not cover mental health waiting lists, CAMHS or any of the other areas of social care and healthcare where people are waiting.”
“The Minister and Government will have to explain why they are so far behind their Sláintecare targets and why people are waiting so long. When we in opposition come forward with solutions, which we have done in this area, they get knocked back time and again. It does not make sense to me in relation to some of the proposals we have been calling for for years. They include an integrated waiting list management system to better utilise all resources across all hospitals so a person is not referred to a single doctor and waiting on that doctor's list unable to be seen by a different hospital or even a different doctor within the same hospital. Having that integrated system would mean patients could be offered procedures much quicker, yet that does not happen.”
“Instead, they are waiting years in some cases. What does our Bill seek to do? It requires the Minister to set priorities for the HSE with regard to maximum wait times and to set specific targets. We want those targets to be the Sláintecare targets we agreed to. The Bill specifies 12 types of service for which there should be maximum wait times and allows the Minister to specify any other service. The Minister must have regard to the Sláintecare report, best practice, outcomes and the effect on services of specifying maximum wait times. The maximum wait time targets are not specified in the Bill because we deliberately gave the Minister flexibility and allowed her to set what she might see as more realistic initial targets as we move incrementally towards implementing the Sláintecare targets. Why that is being opposed I have no idea.”
“Deputy O'Reilly was the representative of my party on the committee at the time. A huge amount of work by many people went into ensuring we set out a roadmap that could transform our health service and deliver the type of health service people want. That is one where people do not have to wait years for basic procedures, or for serious operations, which is also the case, or for speech and language therapy, occupational therapy or access to a dietitian. All those community waiting lists have also got very long in recent years. We currently have 250,000 people on community waiting lists. It is staggering. The vast majority of them have been waiting over 12 months and, in some cases, over two years. We have to juxtapose that with the Sláintecare targets, according to which people should be seen within a matter of weeks.”
“Patients come into my office almost daily for cataract, hip or hernia operations - very basic procedures. When I contact local hospital management, they say, unfortunately, the person could be waiting 12, 15 or 18 months. For a patient who needs a cataract procedure, that has an impact because it affects their sight and their quality of life. One gentleman I was dealing with needed two cataracts done. Thankfully, after a lot of lobbying of hospital management, we eventually got him seen through the NTPF and he will be seen that bit quicker. If he was left on the waiting list, we were told he would wait at least 15 months for that to be done. That is the reality people are dealing with. I make that point to reinforce what I am talking about here. There was a lot of excitement when Sláintecare was agreed.”
“It is troubling but not surprising that the Government will oppose this straightforward but very important legislation. The Bill seeks to do things: first, to acknowledge that waiting lists are too long and, second, to bring a degree of transparency to those lists that does not currently exist. Going back to what I said a few moments ago, almost every Member of the Oireachtas at the time Sláintecare was put in place signed up to that plan. We signed up to a roadmap, in essence, to deliver universal healthcare. It also set statutory timeframes for waiting lists that we are absolutely nowhere near meeting. I raised directly with the Minister for Health a number of weeks ago the situation with even very basic daycare procedures in my constituency of Waterford.”
“I move: “That the Bill be now read a Second Time." I am not surprised the Government has indicated that it will oppose the Bill. The previous Government signed up to Sláintecare a number of years ago. I was always suspicious of Fianna Fáil and Fine Gael signing up to a plan that delivers universal healthcare and seeks to streamline and reduce waiting lists. I contrast that ambition with the evidence of almost 1 million people currently on some form of waiting list, if we include acute, community, diagnostics and so on. In the past, my party put forward clear plans for an integrated waiting list management system. We had some favourable responses at the time from Simon Harris when he was Minister for Health but, of course, they never saw the light of day.”
“My fear is that the Government will say there is a planning application submitted and it will wait and see what happens with that before it comes to look at it. We may lose time. From my perspective, now is the time to take the bull by the horns. Let us get the work done and make sure, if the planning application is successful, that we can then immediately secure the funding and start the works needed.”
“There is a working group in place and I support and welcome that, but at this point it needs to be established into a much clearer multi-agency task force that can start to co-ordinate the planning, infrastructural investment and stakeholder engagement. It also needs to look at what will be needed down the road, which is a targeted funding stream for all of the upgrades and the buildings the Minister of State cited in his contribution. It also allows SETU to work with the port to invest in skills and training programmes for the south east. Therefore, there is a lot of potential, but the potential will only be realised if all of the stakeholders are working to a plan, which is why having a task force, with all of those stakeholders working to a strategy, makes sense.”
“I thank the Minister of State for his response. I agree that the submission of a planning application is obviously a very important first step and is a very clear statement of intent by Waterford Port in this area. The Minister of State echoed some points I made earlier by saying that Waterford should work closely with Rosslare Europort, and, indeed, Cork Port, because the DMAP for that whole area obviously creates huge opportunities for offshore renewable energy. While the planning application is going through, it is not a case then for the Department or Government to sit back. Now is the time to start planning. I have been calling, first, for the Government to designate Waterford Port as a regional ORE hub. That could be done and it would be important. Again, it would a statement of intent by Government and by the Department.”
“The ports and university could complement one another, create high-quality jobs and assist the State in meeting its crucial climate action targets.”
“I am a bit concerned that other ports seem to be ahead on the funding curve. I am not quite sure why that is the case. A lot of work has gone into plans. I have received PowerPoint presentations and other presentations from the board. Together with our MEP, Kathleen Funchion, my party leader and I visited the port and got a similar presentation. The port is certainly up and at it, lobbying and looking for funding, but it does not seem to be getting the funding that other ports have got. Will the Minister of State respond to that point and set out his perspective on the Government's plans to support the Port of Waterford and, indeed, Rosslare Europort? The Government should look at the whole region, those two ports and linkages with SETU as a really big opportunity for the south east to be a leader in offshore renewable energy.”
“Courses there could lead to the creation of very high-quality jobs in the south east for graduates coming out of this regional university. This is a no-brainer. When I met the port representatives, they were very enthusiastic about this. They want it to work. They know how important renewable energy is. Whether people like it or not, we all know that we are going to have to move away from dirty fuels. Renewable energy is the future. Smart countries, smart regions and smart investors are making those investments. The south east wants to be ahead of the curve and it wants to be part of that. The people I have spoken to in this area and in the port say that there is potential for hundreds of millions of euro of investment over a number of years if the right decisions are made.”
“It is seeking to create a regional supply chain ecosystem for marine engineering, fabrication and component servicing. Investment in the port and in offshore renewable energy is important for job creation and skills development in renewable technologies and maritime logistics. I have also spoken to the president of the South East Technological University, SETU. There is collaboration between a number of State agencies in relation to the Port of Waterford as well. If you have an offshore renewable energy terminal and offshore renewable energy potential, with Rosslare Europort and the Port of Waterford playing their different parts in that, there will also be huge potential for research and development. That is where the links to SETU come in.”
“The Port of Waterford is a critical infrastructural asset and has very important potential to support Ireland's growing offshore renewable energy sector. This would obviously create jobs across the south east but it would also ensure the State can meet its climate action targets. I have met the chairman and representatives of the port several times over the last number of years. They have very ambitious targets and plans. They are looking for State support. Like Rosslare Europort, it is a very important asset for the south east. I know Rosslare Europort also has plans in respect of offshore renewable energy but the two ports complement each other because the Port of Waterford is seeking to support offshore wind turbine staging, assembly and maintenance operations.”
“I listened to the Minister's opening speech and read today's announcement on the Department's website. We have seen a lot of this before - providing substandard assessments of need, yellow-pack assessments of need and shortcuts to what children require. That is what I hear. There are then the assessment officers. We do not really know what the assessment officers will actually do. I can tell the Minister of State that parents and children will judge this Government on its actions, not promises, because they have had a bellyful of those. I will very cautiously approach what the Government says on this issue, bearing in mind all of the false promises made to children and their families in the past.”
“At the end of the year, a composite report would then be given to the Government that looks at what is the overall ask and what resources or capacity needs to be put in place to meet that need. In reality, what has happened is not complex. It is Government failure to put in the capacity. We now have reached a crisis point, where neither the assessments nor the services are given to children. The excuse from the Government is that it is very complex, it is beyond the Government and it is more difficult than it thought. The problem is the Government did not train the therapists that were needed and it did not put in place the capacity. Children cannot be blamed for that. Parents cannot be blamed for that. The only people who can be blamed are the people who made a mess of it, which is the Government.”
“It will not be lost on anybody that this Government wastes no time whatsoever in showing up for those at the top. It does not waste a second when it comes to big tax breaks for corporate landlords, developers and banks. However, when it comes to children with disabilities, the Government comes in, as the previous Minister did, and talks about "complexity". The word "complexity" is actually shorthand for Government failure because this issue is not as complex as the Government presents it. In 2005, a previous government put in place an Act which set out very clearly what needs to be done for children with disabilities. Each child - I do not see how this is in any way controversial or complex - should have an assessment that examines and puts in place the health and education needs of each child.”
“I want to know what these assessment officers will actually do. I do not want to see this in any way as gatekeeping. We cannot substitute informal processes for what is a statutory right. That is what Cara Darmody is standing up for. Parents want the Government to deliver on its legal obligations but, as important or more important, to deliver on the health and education rights of every child.”
“All of that is really a distraction from the Government's failure, because the purpose of the original Act was to do two things. First, it was to have a robust assessment of need process that could determine the health and educational needs of each and every child and then allow the Government to plan to provide the services, which most children do not get. They go hand-in-glove. As Deputy Doherty said, because the Government could not do both, it tried to circumvent the assessment of need process, to come up with a yellow-pack downgraded version, called a preliminary teams assessment. The Government was caught out and parents brought it to the High Court. The Government broke the law and has been breaking the law ever since. I will carry out a careful, critical review of what was announced today. I want to see the detail of it.”
“I have attended dozens of meetings with parents of children with disabilities throughout the State. They are heartbreaking meetings because the parents are trying to do their best for their children. It strikes me that what really drives them mad, and I do not blame them at all, is hearing the Government say you do not really need an assessment to access services and you can access services without an assessment. Most of the parents I meet at these meetings do not get services. The services are almost non-existent. They are stuck on waiting lists for speech and language therapy or occupational therapy. Even for those children who get access to some services, it is patchy and only a fraction of what is actually needed for those children.”
“It does not have to be this way. I believe we have the ability in this country to build a modern service fit for purpose. What we lack is urgency. We certainly need the resources and the capacity put into the system. Our message today from my perspective is clear and simple, and needs to be said in that way. I insist on reform that is rights based, properly funded, clinically safe and genuinely shaped by the lived experience of trans people.”
“We have to publish clear guidelines and timelines, and expand capacity now. This is an urgent issue now for people. We need to train and recruit clinicians who understand the needs of trans people and build a modern service that trans people in Ireland deserve. I think we can do this with empathy, with respect and with a commitment to healthcare that is both compassionate and safe. I will finish where I began with people living this reality. Behind every number that we talk about is a person waiting for a first appointment, a person trying to get on with their education or job, a person trying to hold a relationship together, a person doing their best to stay well, a person just trying to live their life. A system that constantly delays and tells them they have to wait, in some cases for 14 years, is clearly not acceptable.”
“They are certainly failing the trans community and others. This failure is not abstract as was said earlier. It is measured in years of waiting, in distress and in lives put on hold. We need to support a new holistic model of care that is property resourced, clinically led, community delivered and grounded in rights and compassion. We support timely evidence-based gender-affirming care for adults. We support making the system more respectful, more assessable and far faster than it is today. We insist that reform must also be safe evidence based and built with appropriate safeguards for young people. I say to the Government that we have to stop the drift. We need to complete the review and not to rush it because it is important work. We must listen to the trans community. We also have to listen to clinicians.”
“In particular extending legal recognition to minors and introducing new statutory categories for non-binary recognition cannot be treated as add-ons to a health debate. These are changes with broad implications for law, education, data systems and the rights of others. They require very detailed legislation and careful whole-of-government consideration. We will not support sweeping legal changes brought forward without fully considering all potential consequences. Recognition matters and dignity matters but so do clarity and legal certainty. If reform was or is being considered in this area, it must form part of a separate robust piece of work that can be properly and fully scrutinised rather than through a healthcare motion. For me the central point is this. Ireland's gender-identity services are failing people.”
“Sinn Féin supports an effective ban on conversion therapy, including coercive practices targeting trans people. This is a rights and protections issue. Legislation must be drafted precisely and clearly. It must target abusive or ideological conversion practices while not creating unintended consequences that criminalise legitimate clinical practice or parents supporting a child through distress. I believe that a strong ban is achievable, desirable and should be put in place. It must be tightly drawn so that it protects people and supports appropriate healthcare. On the wider issue of legal recognition, we must be clear that the proposals set out in this motion go well beyond healthcare - I am sure the authors would agree with that. They raise serious legal and policy issues that have to be properly worked through.”
“We recognise the services for young people are inadequate and need urgent development because nobody benefits from a vacuum of care which is what exists at the moment. Under-18 pathways must be built with stronger safeguards, specialist oversight and an evidence-led approach reflecting the seriousness and complexity of these decisions. Our position is to ensure that the care offered is the most protective and clinically sound pathway possible. We also understand the impact that these long waiting times can have on the mental health of young people. We need services that are available, safe, specialised and properly supported. Those services need to respond quickly while ensuring appropriate safeguards. The motion also refers to conversion therapy.”
“Our job is to ensure that the Irish model, our model, is evidenced based, listens to the lived reality of trans people, is guided by clinicians and built on the outcome of Ireland's own ongoing review, alongside evolving international evidence. It should never be about resisting progress. It must be about ensuring progress is durable and safe for all. Respectful dialogue matters here which is why we need discussion that is calm, evidence based and rooted in rights. Trans people deserve to be heard in that debate. Families deserve clarity. Clinicians deserve space to do their job properly and society as a whole deserves public discussion that is humane, truthful and responsible. We need to be especially careful with children and adolescents. I recognise the profound distress that some young people experience.”
“This is how we build services that are both compassionate, which they should be, and clinically sound, which they should be. It means clear timely information. It means assessments that are designed not to delay but to improve. It means clinicians who understand trans lives and people, and provide care without stigma. I also want to address the important issue of international standards, which is subject to ongoing debate. I share the ambition to align Ireland with best practice which is what we should always do in any element of healthcare. However, we must be honest that there is active international clinical debate about elements of care particularly for young people. I do not believe we should lock Ireland into any one international model uncritically.”
“It is about ensuring the right care delivered safely for each person. Part of having a respectful debate is being honest about what good healthcare requires. This is why my party takes a measured position on the model of care. Informed consent is an essential principle in healthcare. People, of course, must have autonomy, clear information and real choice, and today trans people very clearly do not have that. It must never be the case that someone is put through needless barriers or treated without respect. However, informed consent on its own cannot replace clinical judgment. The best approach from my perspective is shared decision-making where a person's autonomy is, of course, fully respected and clinicians still determine what is clinically appropriate and safe.”
“The pathway for any person must be respectful and dignified but also clinically robust. I do not see this as a contradiction. The Minister made similar points earlier. It is what good healthcare looks like. Some people experience the current system as gatekeeping, as I said, and certainly distressing and very slow. We must listen to this, and we must act. I hear that clearly. I have met many trans people, groups that represent trans people and others. Those experiences we hear have to shape how services change. They have to be at the heart of how those services change. Clinical assessment is a legitimate and necessary part of healthcare, especially where decisions involve life-altering or irreversible interventions. This is not about denying care and should not be about that.”
“Trans people are experts in their own lives. They know where a pathway breaks down. They know what it feels like to be delayed, dismissed or treated as if their reality is up for debate. If we want a service that works, we must build that service with the people who rely on it. Listening also means recognising the emotional aspect of their lived experience. When trans people tell us the current pathway feels like gatekeeping, which it is, and feels unsafe, which for many it is, and feels designed to slow down rather than support them, we do not and should not argue that out with them. We have to accept what has been said, learn from it and fix it. At the same time, reform has to be done right. Healthcare must be guided by clinicians and grounded in evidence.”
“It is crucial that this review, and any review, into gender identity services and healthcare be carried out on the basis of genuine consultation and listening to the lived experience of the trans community. This review must be completed and its findings, where appropriate, implemented. However, we cannot allow review to become a substitute for action. I welcome the Minister's comments that interim measures can and should be taken as we await a new model of care. I understand that will take some time, but we can take steps now to improve the situation because the situation right now, today, is unacceptable. We need reform urgently. We also need investment and delivery, because any plan is only worth the investment that is behind it. I also underline the importance of listening. Consultation cannot be a box-ticking exercise.”
“It means equipping primary care with training, clinical guidance and the resources needed to support trans people safely and respectfully from the first point of contact. For many trans people, that is not the case, and they are not treated with respect. It also means publishing clear national standards so that people are not left guessing how the system works or where they stand within it. We would not accept that in any other part of the health service. I recognise that a clinical review of the model of care is under way and I commend everybody involved in that. I have also met senior officials involved in this area, so I know there is a significant body of work under way. I welcome that.”
“I want to see an holistic, properly resourced, modern service that is safe, accessible and delivered closer to people in their own communities. I support an expanded role in primary care in this area, but I also know it has to be resourced to meet the needs of the trans community. We want waiting lists to be cut dramatically. We want more specialist capacity, more trained clinicians and clear national pathways so that people are not left in limbo. That has to mean concrete change, not some vague aspiration as was talked about earlier. It has to mean properly staffing specialist teams so that the national gender service is no longer a barrier to care. It has to mean regional and community-based healthcare so that care is not centralised into a single overstretched pathway that simply does not work.”
“Appropriate healthcare is not some optional extra. For many trans people, gender-affirming healthcare supports their physical health, their mental health and their ability to participate in daily life. When people can access timely and well-supported care, it is in the best interests of that person, their families and society as a whole, but it also improves outcomes. This is what evidence-based healthcare is meant to do - help people to live healthier, safer and more fulfilling lives. We approach this as we should approach every healthcare issue, from the standpoint of need, evidence and human dignity. I support reform in this area, as does my party, and I support a new model of care for gender identity services.”
“This cannot be described as a humane system. In fact, it is the opposite. It is not a healthcare system worthy of the name and is certainly not an equal system. I say clearly that Sinn Féin approaches this issue from a foundation of equality, rights and compassion. Trans people are entitled to live safely and openly, to have their identities respected and to access healthcare on the same basis as everyone else. Our health policy in Sinn Féin is explicit about that. We recognise transgender people's right to recognition and to the best possible supports and care. We recognise that healthcare is a fundamental right for every citizen, including trans people, and we recognise that adult trans people must be able to access evidence-based gender-affirming care in a timely and respectful way. For me, this point really matters.”
“The national gender service in 2024 had a wait time that could range from between three and ten years and, as I said, I know of people who have waited longer. This is the reality that trans people and their families are living right now, and we should and must say it plainly. Those waits are completely unacceptable. They are a form of denying healthcare by delay. They push people into a prolonged period of uncertainty, distress and avoidable harm. What does it mean to a person who is added to a long list? It means that if a trans person is added to a list today, they tell us and they feel genuinely a sense of hopelessness. They know they are going onto a list where they may not ever be seen or will certainly not be seen for years. It leaves them in limbo and without adequate supports in the meantime.”
“I welcome the opportunity to set out Sinn Féin's position on gender identity and trans healthcare. I welcome all of the guests in the Public Gallery as well. Too many trans people in Ireland are being left waiting years for care. This is not about numbers or statistics. It is about people's lives, well-being and dignity being put on hold. The delays, the uncertainty and the sense of being bounced around a system that is not fit for purpose cause real harm and distress. We cannot, should not and will not stand over that. Let us be clear about the scale of the crisis. Trans people in this State can be left waiting years and years for appropriate healthcare - not days, weeks or months but years. I know of some people who were on waiting lists for 14 years or more. Over 2,000 people are now on a waiting list for gender identity healthcare.”