‘HSE must act on child gender care safeguards in wake of Cass report’
» Irish medic » Psychiatrist tells of worries in warning over over treatment web dispensing
ONE of the country’s most experienced clinicians in transgender care has called on the State to implement a raft of safeguards in child gender care in Ireland.
Dr Paul Moran from the National Gender Service, urged the Government to ensure kids’ care is overseen by a child psychiatrist or paediatrician in the wake of the Cass report.
The NHS review said children have been let down by gender care with “remarkably weak evidence”.
Dr Moran, a consultant psychiatrist, said the Irish State should follow dozens of Cass’s recommendations from having qualified clinicians oversee social transitioning to warnings on prescription dispensing.
He added: “I think the HSE should examine its own record and philosophy in light of this report and change their approach.
“I think the point has already been made about Tavistock and their poor clinical assessments and we’re seeing the results of this in Irish people.
“There was insufficient assessment and the decisions were made too quickly. Hilary [Cass] is highlighting what needs to be done to correct it.
“Action on this should be taken immediately because our children are currently receiving bad care.”
Dr Moran, who repeatedly raised concerns about fast-tracked gender care at the Tavistock clinic where hundreds of Irish children were treated, said Irish pharmacists should stop dispensing foreign gender health care hormone prescriptions.
He said this week: “There are Irish people, both children and adults, getting prescriptions from private online companies and having them dispensed.”
In the report, Cass said doctors are typically cautious in implementing new findings but “quite the reverse” happened in gender care.
She said kids “deserve very much better” and also asked authorities to consider the “implications of private healthcare” in child gender care.
Dr Moran, who treats over 16s in Loughlinstown, said the Department of Health in Ireland should also consider the implications of private gender health care.
He added: “I believe there is an inherent conflict of interest.
“The quality of care is much lower in private gender health care.
“If private providers do not provide hormones on demand, they will lose their business because of social media.”
The NHS report stated a paediatrician or child psychiatrist should take overall clinical responsibility for patient safety within the service. Dr
Moran said: “This means that the idea of delivering gender health care for children in primary care is out, the idea of psychology-led gender health care is out according to Cass. We’re aware that there are GPS in Ireland who are prescribing based on advice from private psychologists or specialists outside the country.” He also agreed with the UK report on the need to have experts on neurodiversity involved in children’s gender health care. Dr Moran added: “There’s neurodiverse people in every clinical population, but the huge overrepresentation of neurodiversity in patients referred for gender healthcare really started with the surge in numbers over the last five to 10 years.”
One of Cass’s 32 recommendations is when families or carers are making decisions about the social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a professional.
Dr Moran said schools should not take the lead in the social transitioning of children.
He backs another key Cass recommendation that there should be oversight at a national level of any decision to start kids on treatment.
Dr Moran added: “There needs to be regulation of psychological therapies and counselling. There should be competencies and qualifications specific to gender health care.”
The medic, who has been treating adults who passed through Tavistock, said they are seeing more patients who are looking to detransition.
Dr Moran added: “We are looking at developing services for people who are detransitioning, and it’s very important that these people are offered the same level of care as people who want to transition.”
The HSE said they do not refer children to Belgium for treatment with puberty blockers, adding less than 10 patients are receiving the medication. They said they were prescribed in 2023/2024 and “only for children who were already on treatment”.
The HSE added: “The prescribing of puberty blockers for any young person is a clinical decision made by the treating endocrinologist.
“Prescribing puberty blockers for gender healthcare is an evolving area of medicine and evidence for the outcomes for young people is still emerging.
“The HSE will soon have a Gender Health National Clinical Programme which will develop guidance for those working in gender healthcare.”
Children are currently receiving bad care