13 May 2019
Gloria Fraser
Via FYI.org.nz
E-mail:
[FYI request #10075 email]
[email address]
Dear Ms Fraser,
Official Information Act (1982) Request
I write in response to your Official Information Act requests, on related matters regarding services for
our transgender community, received by us on 15 and 16 April 2019. We are providing information on
both your requests in this single response.
You requested the following information, as a follow up to a similar request you made in May 2018. At
that time, we provided you with information on the scope of the regional Hauora Tāhine services
provided across metro-Auckland and access to these services.
Request 1: Could you please advise whether the following gender-affirming healthcare services are
funded by the Counties Manukau District Health Board for transgender patients, and whether the
services are currently available?
- Puberty blockers
- Hormone therapy
- Mastectomy
- Hysterectomy
- Orchidectomy
- Facial hair removal
- Breast augmentation
- Voice training
- Facial feminization surgery
Publicly available information on the Hauroa Tāhine and
Northern Region Transgender Health Services
(NRTHS) service can be accessed via the HealthPoint website at the following link, and may answer many
of your questions:
•
https://www.healthpoint.co.nz/public/sexual-health/northern-region-transgender-
healthservices/
•
https://www.healthpoint.co.nz/public/paediatrics/kidz-first-centre-for-youth-health/
Please refer to these NRTHS services links (above) for information on the available services, including
current information on provision of the procedures you have listed, and availability of a range of other
supportive services and resources. This includes hormone therapy, nursing, medical, psychology and
counselling services.
Counties Manukau District Health Board
19 Lambie Drive, Manukau, Auckland 2104 | Private Bag 94052, Manukau, Auckland 2241
T: 09 276 0000 | cmdhb.org.nz
As part of general elective services, a small number of elective surgical procedures are provided,
primarily for upper body plastic surgery. Counties Manukau does not allocate specific funding for
surgical interventions for gender re-assignment procedures, and referred cases are assessed and
managed in line with our standard elective surgery prioritisation criteria.
Specialist services for youth across Auckland are provided via the Centre for Youth Health service, which
is part of CM Health.
Could you please also advise:
1. Are transgender healthcare providers under the Counties Manukau District Health Board
encouraged to follow “Oliphant et al’s (2018)
“Guidelines for gender affirming healthcare for gender
diverse and transgender children, young people and adults in Aotearoa New Zealand”?
If not, which guidelines do they follow, if any?
The Centre for Youth Health services follow the medical guidelines as outlined in the “Guidelines for
Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults”
(Oliphant, October 2018). These Guidelines were developed with support from the Northern Region
Clinical and Consumer Advisory Group
. https://www.healthpoint.co.nz/download,830236.do
2. Is a ‘readiness assessment’ required to access gender-affirming healthcare services? This is an
assessment of readiness for treatment from a medical and psychosocial perspective, as well as
whether the client understands the risks and benefits of treatment, and is sometimes referred to as
a ‘mental health assessment’.
If a readiness assessment is required to access gender-affirming healthcare services, who carries
out this assessment?
Is this assessment funded by the Counties Manukau District Health Board?
Does the assessment use an informed consent model?
Referrals to the Centre for Youth Health (and to regional Hauora Tāhine services) are received/ accepted
from primary care, other DHB specialist services, school health services, and direct self-referral by
individuals. When young people are referred to the Centre for Youth Health, a comprehensive
assessment is completed. This usually involves family members and/or other support people. This
assessment process may occur over several visits.
Comprehensive assessments are done over a period of time, to allow this full engagement and a good
understanding by all involved, before treatment options are addressed and progressed. Young people
are always seen on their own, to allow expression of independent views apart from family/ carers.
Not all young people will proceed with medical transition.
All young people, when considering whether to proceed with cross-hormones, are offered a specific
“readiness for hormone” assessment, including contact with a mental health professional. The
assessment is achieved via clinical assessment and discussion, and covers a range of topics including (but
not limited to) - gender identity and feelings about their body, patient goals (treatment specific and life-
long), health history and assessment, support networks and strategies, the effects of feminizing/
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masculinizing medications, understanding of long-term health risks, and the informed consent
processes.
This assessment process is funded by the DHB, and at no cost to the young person/ family.
The Centre for Youth Health focus is on respecting individual rights, and working with young people to
gain full informed consent. For all young people, we prioritise patient-centred care, alongside engaging
with family/ whaanau or caregivers, in order to build a strong relationship to facilitate positive health
outcomes, and for the young person to have an active role in decision-making.
3. What steps is the Counties Manukau District Health Board taking to improve healthcare provision
for transgender New Zealanders?
Counties Manukau DHB currently chairs the Northern Region Transgender Clinical Governance Group.
The role of the Clinical Governance Group is to provide oversight of transgender health service provision
in the Northern Region, with a particular focus on equity, consumer satisfaction, access, safety,
timeliness, quality and service Improvement.
There are a number of regional initiatives underway to improve healthcare provision for transgender
people in the Northern region. This includes the implementation of two new service enhancements:
•
Northern Regional Transgender Peer Support Service
Peer Support has been associated with improved access to healthcare, reduced risk of self-harm/
suicide, is effective at engaging people into care, reducing the use of emergency rooms and hospitals
and reducing substance use, reducing the use of crisis services and feelings of isolation, increasing social
networks and wellness, and has a valuable role in quickly connecting with people typically considered to
be among the most alienated from healthcare.
The Northern Region District Health Boards are in the process of contracting for a provider, following an
open tender process.
The new Northern Regional Transgender Peer Support Service will use a multi-faceted approach to
service delivery, including:
−
Peer Support Workers (PSW), who are trained, and working in a locally informed, intentional Peer
Support model;
−
Peer Volunteers, who receive training to run peer-led groups, and other low-level interventions;
−
Moderated online channels, to increase access to peers and information outside of formal
appointments.
Peer Support Services will be available for transgender people aged 12 years+, and their family/
whaanau.
•
Key Worker - Auckland Sexual Health Service
A Key Worker will be appointed shortly, to work within the Auckland Sexual Health Service. The purpose
of this role is to provide health and social service navigation support to Auckland Sexual Health service
users who are accessing gender affirming medical treatment. A key focus of the work with service users
involves connecting them into good primary care services and supporting non-clinical aspects of
transitioning (social transition).
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Request 2: Could you please advise how many transgender people received each of the following
services, specifically for gender-affirming healthcare purposes, within the 2018 calendar year?
-
Puberty blockers
-
Hormone therapy
-
Mastectomy
-
Hysterectomy
-
Orchidectomy
-
Facial hair removal
-
Breast augmentation
-
Voice training
-
Facial feminization surgery
We are not currently able to provide all of the data you have requested, as the information is held in
individual medical files.
Collating the data for each of these interventions for gender-affirming health care only would require a
clinician to be diverted from patient care to complete a manually intensive review of numerous patient
files. The CfYH medical files currently do not have a mechanism for electronic flags to indicate which
files would need to be reviewed to isolate this level of treatment detail.
However, we are able to provide the following regionally consistent data:
1) The data below (table 1) provides to the
total number of active cases under the Centre for Youth
Health service for gender affirming care for the entire Metro Auckland region (patients domiciled in
Waitemata, Auckland and Counties Manukau DHBs).
DHB of domicile
CM Health
ADHB
WDHB
Total number of active cases under CfYH
89
68
70
Table 1. Period: 01 July 2018 - 31 December 2018
2) Data provided by Auckland Regional Sexual Health services on adults
seen for initial assessment for
gender affirming health care, identified forty-four (44) adults who were residing in Counties
Manukau were seen in the 2018 calendar year.
3) The data below (table 2) is taken from a national dataset, and details surgical procedures delivered
as part of the general elective services for the Counties Manukau population in 2018, that related
to transgender cases. Caution is advised, as these procedures may have related to other health
needs for the individuals, as distinct from exclusively gender-assignment.
Transgender surgical procedures
CM Health
Orchidectomy
1
Breast Surgery
3
Total
4
Table 2. Period: 01 January 2018 - 31 December 2018
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We note that this is unlikely to a complete dataset of procedures related to gender assignment, as there
is currently no differentiation in the national datasets for transgender-specific surgical events.
Counties Manukau does not currently allocate specific funding for surgical interventions for gender re-
assignment procedures, and any referred cases are assessed and managed in line with our standard
elective surgery prioritisation criteria. We are working regionally to improve the clinical coding for all
surgical events, to be clearer in the future as to those for gender-affirming care.
We are also providing a copy of a recent (November 2018) response to Radio NZ prepared on this topic
(attached:
OIA 04102018 HILL – Gender affirming Services), which outlines further information on
referrals, age and numbers of female to male, male to female and non-binary patients for services, as
this may be pertinent to your request.
I trust this information satisfactorily answers your query. If you are not satisfied with this response you
are entitled to seek a review of the response by the Ombudsman under section 28(3) of the Official
Information Act.
Please note that this response or an edited version of this may be published on the Counties Manukau
DHB website.
Yours sincerely,
Fepulea’i Margie Apa
Chief Executive
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