This time last year, Lillith Ferreyra-Carroll published an article in GCN titled, ‘A state of collapse: Trans healthcare in Ireland is a national emergency’. Recently she highlighted that in the year since publication the situation has deteriorated further. We wish to echo her sense of urgency and offer our assessment of the situation facing Trans people today. We are particularly concerned with understanding the limits of contemporary organising around Trans healthcare in the Republic of Ireland.

Ferreyra-Carroll’s article placed particular emphasis on documenting issues with the current system and persuading cis people, particularly within the LGBTQ+ community, to take action. In her words, “the time has come for the wider LGBTQ+ community to use their campaigning expertise and resources to assist their Trans brethren”.

We do not disagree that the wider support of the LGBTQ+ community is needed, nor do we disagree that after decades of neglect of the ‘T’, an opportunity has presented itself in Trans healthcare for gay, lesbian, bisexual, queer and Trans people to work together for something good and necessary. However, there are important strategic questions which remain to be addressed regarding what tactics we adopt, who should lead such a movement, and what agenda we ask cis allies to rally behind.

Ferreyra-Carroll’s article, and other similar forms of Trans healthcare activism, do valuable work documenting the problems with the existing Trans healthcare system, but such tactics can only achieve so much. Many of those reachable through social media and outlets such as GCN will already be broadly supportive of demands for improvements in Trans healthcare but are lacking clear channels through which their support and energy can be directed.

Successful movements also generally involve a combination of tactics, including raising awareness and use of the media in conjunction with more direct forms of action including protests, pickets and occupations to bring their demands to a wider audience and increase the pressure on those responsible for the problems they wish to address. We believe our movement has overemphasised the former and urgently needs to embrace more direct and confrontational tactics.

Secondly, while we support the call for increased awareness and support from cis allies, it is also the case that, if it is to be successful, any movement for Trans healthcare will need to be directed and led by Trans people. We cannot expect cis people to initiate a movement, make strategic decisions and negotiate on our behalf without detailed understanding of the issues involved. Wider support can only come when a movement and leadership emerges from within the Trans community that could then direct how our allies might act. Such a movement will obviously require an enormous amount of effort to bring together and develop, but this cannot be sidestepped.

If we want cis supporters to row in behind us, we also need a clear programme and set of demands. At present there is a lack of clarity regarding what ‘we’ as a community are asking for in terms of healthcare. We must know what we want, and we must know what we are asking our allies to do.

In order to achieve this, we must address the lack of organisation and leadership that exists within the community. The Transgender Equality Network of Ireland (TENI) has taken a leading role in public conversations regarding Trans healthcare but, we would argue, is badly positioned to make the necessary demands for change due to its close relationship to state agencies and poor relationships with sections of the Trans community. Beyond this, there are many small-scale Trans healthcare groups that are primarily focused on sharing information and raising awareness through social media.

We, as authors of this article, are organisers of a grassroots network that supports Trans people who are self-medicating, in other words accessing healthcare without oversight from accredited medical professionals. Issues surrounding self-medication are generally disregarded in discussions of the need for changes to healthcare, except as a cautionary tale to underline the failures of the current system. Any Trans healthcare movement will have to recognise the existence of self-medicating Trans people, advocate for them and bring them to the table.

In the interests of setting out a framework whereby we could arrive at shared demands for Trans healthcare in Ireland and begin to build a movement to deliver this, we suggest the following.

1: We need to agree upon a Trans healthcare platform that has the backing of a representative range of Trans organisations and that could act as a rallying point and a source of leadership for our allies.

2: We need a mechanism by which Trans organisations and Trans people who want to tackle the healthcare crisis can come together with the expressed purpose of agreeing on such a platform and then pursuing a programme to realise it.

3: This would necessarily include grassroots Trans groups, meaning those not in receipt of state funding, and it would preclude leadership being taken exclusively by state-funded organisations.

4: All participating organisations that have previously undertaken negotiations with the state or gender clinic in Loughlinstown on behalf of the community would be required to make the nature and outcome of those negotiations known to all participants.

5: Once a platform had been agreed upon, consisting in the first place of demands, then a coalition of those interested, including cis allies, could emerge.

6: Should such a coalition emerge, it would be vital that it accept the need for direct action to put pressure on the HSE and other targets to address its demands.

In the last few years we have seen that there is tremendous support among the general public for Transgender people and our politics. The COVID-19 relief fund, run by the Small Trans Library, redistributed tens of thousands of euros across Ireland (North and South) and Scotland, all of it made possible by donations; support for the Trans Writers Union’s boycott of the Irish Times has been overwhelming across college campuses. And in July, thousands of Trans people and supporters marched through Dublin for Trans Pride, demonstrating the depth of support available.

Our cis allies, especially those who are LGB+, abhor the radicalisation of anti-Trans groups, and they see that Trans politics matters. We must ask ourselves, have we failed to produce a common platform and programme for our liberation that we can point our allies to?