Earlier this month, Labour filed a motion in the Dáil calling for an overhaul of Ireland’s trans healthcare system. In response, Trans Healthcare Action is calling for political and community support, and outlines the changes that must be made to ensure the services are fit for purpose.

On July 16, we witnessed 31 TDs share statements on Pride to the Dáil. Just days after a monumental 10,000 of us took to the streets for Trans & Intersex Pride Dublin, this wave of support marks a potential turning point for our community, but only if we act on it.

Many of these TDs elevated the real problems that the trans community continue to face in Ireland. Fianna Fáil’s Minister Mary Butler, Sinn Féin’s Deputy Donna McGettigan, and People Before Profit’s Deputy Ruth Coppinger all spoke with sensitivity, understanding, and power about their trans family members’ lived experiences navigating a system rife with barriers and harm. Deputy Coppinger revealed that her trans family member had been denied blood tests by her GP, pointing to the National Gender Service (NGS) as the source of this harmful decision. These speeches remind us that trans people aren’t a political debate–we are real people whose access to healthcare should be treated as a fundamental freedom, yet it remains contested, controlled, and conditional on cruel, traumatic and dehumanising practices.

Social Democrat’s Deputy Padraig Rice, Labour’s Deputy Marie Sherlock, and Independent Deputy Barry Heneghan all highlighted that conversion practices are still not banned in Ireland. Labour’s Deputy Mark Wall highlighted that gender recognition did not translate into improved trans healthcare. Labour’s Deputy Duncan Smith criticised the government for backsliding on the previous commitment to trans healthcare. These points show that current legislation simply does not do enough to protect trans people, our health, or our well-being.

Deputy Coppinger, along with Labour’s Deputy Conor Sheehan and Sinn Féin’s Deputy Shónaigh Ní Raghallaigh, recognised that the waiting list for public healthcare now exceeds 10 years. Deputy Ní Raghallaigh rightfully questioned whether the NGS is fit for purpose, given that people come out “worse off than when they went in.” She, along with Deputy Mark Wall and Deputy Conor Sheehan, reminded the Dáil that Ireland has the worst trans healthcare in the EU.

These speeches, coming from so many different parties, made it abundantly clear that Ireland cannot rest on previous milestones when there is so much work left to be done to transform trans healthcare.

But heed our warning: not every possible reform of the system for trans healthcare is a liberatory one.

Regional hubs that replicate the failures of the present, but just in a few more locations—that’s not the future we need. Four centralised public “gender clinics” bearing the same gatekeeping, pathologising model of care are not better than one.

Regional hubs that add value and support to a system based in primary care, rather than subsuming and controlling care; that are based in HSE primary care centres, rather than hospitals or mental health services; that practice the informed consent model centred on the autonomy and self-determination of trans people, rather than pathologisation and gatekeeping; that educate local healthcare workers on how to provide care directly, rather than telling them not to provide care; that provide access to care without a waitlist, rather than after 10 years if you’re lucky; that have multidisciplinary teams led by GPs, nurses, SLTs, OTs, social workers, and peer navigators, not psychiatrists or endocrinologists; that ensure the safety of self-medicating people by offering blood tests and supplies, rather than denying them care and relegating them to the margins; that are co-produced with and accountable to the trans community, rather than to no one; that collaborate with our trans organisations to provide holistic support, rather than refusing to ever meet with them—now that is progress.

As trans people, we have the knowledge, wisdom, and evidence to know what works best for our care. We have built upon the decades and decades of learning by those who came before us, and on our own years of research, listening, and collaboration with trans people and our healthcare providers around the world.

From this, we know the current system is not fit for purpose. It cannot be fixed by providing further funding or more locations to those who control it now; this will merely reproduce the very same harms that plague the current system and further consolidate control in the hands of a few. Nor can it be fixed by installing a replica of the UK’s broken system, whose regional hubs still suffer from functionally indefinite waiting lists, deny trans people bodily autonomy, and restrict access to treatment. We need a rewrite, not a copy-and-paste.

We know that the only way to ensure that trans people receive the healthcare we need is to fully embrace an informed consent model for gender-affirming care, facilitated by local community health workers like GPs and nurses, and centre the autonomy of trans people in our health, bodies, and lives. Trans healthcare is not new, experimental, or uniquely complex, and there are many examples beyond the UK that we can draw from to craft our own system.

We can look to our neighbours in Catalonia, whose public trans health service, Trànsit, has transformed the system with eight hubs across the region of 8 million people. By recognising that trans healthcare is not a specialist service but suited for primary care, employing the informed consent model, and educating local healthcare workers to provide this care, Trànsit has eliminated wait lists and provided the care trans people need.

We can look to Aotearoa New Zealand, where community GPs provide gender-affirming care based on informed consent directly within their practices, supported by national guidelines, rather than through psychosocial evaluations in centralised clinics.

Or, we can look to Victoria, Australia, where the Royal Children’s Hospital Melbourne eliminated its wait list by staffing a helpline to support GPs and promoting the development of the Orygen TGD Health Service. Orygen now provides gender-affirming care for young trans people (aged 12 to 25 years) across five community health centres and via telehealth, led by a team of peer navigators, GPs, nurses, and social workers. These hubs also deliver training to community GPs, helping to decentralise and expand access to care.

After the statements in the Dáil, Labour filed a motion on trans healthcare which echoes the vision we have crafted for the future of our care. The motion recognises the abysmal state of trans healthcare in Ireland, and backsliding in the Programme for Government. In short, it calls for:

• Replacing the NGS, which is held in disdain by the trans community it claims to serve.

• Gender-affirming healthcare facilitated by GPs in community settings.

• The national clinical programme to be designed in consultation with the trans community.

• Expanding surgical provision, so that people need not travel abroad.

• Facilities to care for transgender people under 18.

• A trans-inclusive ban on conversion therapy.

• Legal recognition of non-binary identities.

• Bodily autonomy of intersex people.

We, as trans people, have waited far too long for the liberation of our healthcare. We have endured harm after harm and broken promise after broken promise. This moment cannot become another in that long pattern of delay and denial.

We know what our care must look like, and we know what needs to happen. We call upon our community and allies to advocate for this motion’s passage and hold our representatives accountable. And we urge every TD who claims to stand with our community to prove it now: support this motion on trans healthcare and work alongside us to see it implemented in full.

If the government is truly on the side of our community, then it must act with urgency, with resolve, without hesitation, and without excuses.