Care pathways and priority assessment guidelines for gender affirming procedures

A J A MacRae made this Official Information request to Health New Zealand

The request was partially successful.

From: A J A MacRae

Dear Health New Zealand,

Currently gender affirming healthcare pathways listed publicly online, and on health district intranets accessible by practitioners, are not always consistent with the actual service provided (or not provided) by public hospitals. Information provided by practitioners and administrators within specialist departments often contradicts MoH guidelines for provision of gender affirming care. Patients and general practitioners encounter a lack of transparency in priority assessment and patient exclusion criteria when attempting to access certain procedures, which is immensely frustrating, and wastes both the patients' and practitioners' time. For example, a deferral letter for an orchidectomy from the Urology department at Wellington Regional Hospital provided a link to electiveservices.govt.nz, where the department claimed I could find the prioritisation guidelines for orchidectomy referrals. The link has been defunct for over a decade and the website appears to have never contained the gender affirming guidelines the department claimed it did.

In light of this lack of transparency or clear pathways, I would like to request the following information from Te Whatu Ora,
1-What are the pathways for accessing gender affirming:
-Orchidectomy
-Hysterectomy
-Oophorectomy
-Mastectomy?

2-What are the priority assessment/triaging processes for:
-Orchidectomy
-Hysterectomy
-Oophorectomy
-Mastectomy?

3-Are these pathways/guidelines/practices different for different hospitals or different health districts?

5-If funding or resources are not available at a certain hospital or in a health district, is there a process for referring patients to other hospitals?

6-How many of the above procedures have been performed by each hospital/health district within the last 5 years for gender affirming reasons?

7-How many referrals for these procedures have been deferred/declined by each hospital/health district?

I would appreciate it if this information could be verified by the specialist departments themselves, as my experience has shown what is listed online/on an intranet and what actually occurs in practice are not the same thing. I understand that this may be a time consuming process, but in this situation verification is necessary in order to provide correct information.

Yours faithfully,
A J A MacRae

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From: hnzOIA

Tēnā koe, 

 

Thank you for contacting Health NZ, Te Whatu Ora. This is an automatic
reply to confirm that we have received your email.  Depending on the
nature of your request you may not receive a response for up to 20 working
days.  We will try to respond to your query as quickly as possible.

 

 

Ngā mihi

 

Health NZ, Te Whatu Ora.

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From: hnzOIA


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Tēnā koe A J A

Thank you for your email of 29 May 2024, asking for the following
information under the Official Information Act 1982 (the Act):

Currently gender affirming healthcare pathways listed publicly online, and
on health district intranets accessible by practitioners, are not always
consistent with the actual service provided (or not provided) by public
hospitals. Information provided by practitioners and administrators within
specialist departments often contradicts MoH guidelines for provision of
gender affirming care. Patients and general practitioners encounter a lack
of transparency in priority assessment and patient exclusion criteria when
attempting to access certain procedures, which is immensely frustrating,
and wastes both the patients' and practitioners' time. For example, a
deferral letter for an orchidectomy from the Urology department at
Wellington Regional Hospital provided a link to electiveservices.govt.nz,
where the department claimed I could find the prioritisation guidelines
for orchidectomy referrals. The link has been defunct for over a decade
and the website appears to have never contained the  gender affirming
guidelines the department claimed it did.
In light of this lack of transparency or clear pathways, I would like to
request the following information from Te Whatu Ora,
1-What are the pathways for accessing gender affirming:
   -Orchidectomy
   -Hysterectomy
   -Oophorectomy
   -Mastectomy?
2-What are the priority assessment/triaging processes for:
   -Orchidectomy
   -Hysterectomy
   -Oophorectomy
   -Mastectomy?
3-Are these pathways/guidelines/practices different for different
hospitals or different health districts?
5-If funding or resources are not available at a certain hospital or in a
health district, is there a process for referring patients to other
hospitals?
6-How many of the above procedures have been performed by each
hospital/health district within the last 5 years for gender affirming
reasons?
7-How many referrals for these procedures have been deferred/declined by
each hospital/health district?

This email is to let you know that Health NZ needs more time to make a
decision on your request.

The Act requires that we advise you of our decision on your request no
later than 20 working days after the day we received your request.
Unfortunately, it will not be possible to meet that time limit and we are
therefore writing to notify you of an extension of the time to make our
decision, to 8 August 2024.

This extension is required because the consultations necessary to make a
decision on your request are such that a proper response cannot reasonably
be made within the original time limit.

If you have any questions, please contact us
at [1][email address]

If you are not happy with this extension, you have the right to make a
complaint to the Ombudsman. Information about how to do this is available
at [2]www.ombudsman.parliament.nz or by phoning 0800 802 602.

Nāku iti noa, nā

Vicky 

Government Services
Office of the Chief Executive

Health New Zealand | Te Whatu Ora
Statement of confidentiality: This email message and any accompanying
attachments may contain information that is IN-CONFIDENCE and subject to
legal privilege. If you are not the intended recipient, do not read, use,
disseminate, distribute or copy this message or attachments. If you have
received this message in error, please notify the sender immediately and
delete this message

References

Visible links
1. mailto:[Health New Zealand request email]
2. http://www.ombudsman.parliament.nz/

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From: hnzOIA


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Kia ora,
 
Thank you for your request under the Official Information Act 1982 (the
Act) for:
 
Currently gender affirming healthcare pathways listed publicly online, and
on health district intranets accessible by practitioners, are not always
consistent with the actual service provided (or not provided) by public
hospitals. Information provided by practitioners and administrators within
specialist departments often contradicts MoH guidelines for provision of
gender affirming care. Patients and general practitioners encounter a lack
of transparency in priority assessment and patient exclusion criteria when
attempting to access certain procedures, which is immensely frustrating,
and wastes both the patients' and practitioners' time. For example, a
deferral letter for an orchidectomy from the Urology department at
Wellington Regional Hospital provided a link to electiveservices.govt.nz,
where the department claimed I could find the prioritisation guidelines
for orchidectomy referrals. The link has been defunct for over a decade
and the website appears to have never contained the  gender affirming
guidelines the department claimed it did.
In light of this lack of transparency or clear pathways, I would like to
request the following information from Te Whatu Ora,
1-What are the pathways for accessing gender affirming:
   -Orchidectomy
   -Hysterectomy
   -Oophorectomy
   -Mastectomy?
2-What are the priority assessment/triaging processes for:
   -Orchidectomy
   -Hysterectomy
   -Oophorectomy
   -Mastectomy?
3-Are these pathways/guidelines/practices different for different
hospitals or different health districts?
5-If funding or resources are not available at a certain hospital or in a
health district, is there a process for referring patients to other
hospitals?
6-How many of the above procedures have been performed by each
hospital/health district within the last 5 years for gender affirming
reasons?
7-How many referrals for these procedures have been deferred/declined by
each hospital/health district?
 
Pursuant to section 15(1)(a) of the Act, Health New Zealand | Te Whatu
Ora, is writing to advise you that a decision has been made on your
request; however, it will take us some time to prepare the information for
release. 
 
We apologise for the delay, and will endeavour to send you the information
as soon as possible.
 
Under section 28(3) of the Act you have the right to ask the Ombudsman to
review any decisions made under this request. The Ombudsman may be
contacted by email at: [1][email address] or by calling 0800
802 602. 
 
Ngā mihi, 
 
Health New Zealand | Te Whatu Ora 
 
Government Services
Office of the Chief Executive

Health New Zealand | Te Whatu Ora
Statement of confidentiality: This email message and any accompanying
attachments may contain information that is IN-CONFIDENCE and subject to
legal privilege. If you are not the intended recipient, do not read, use,
disseminate, distribute or copy this message or attachments. If you have
received this message in error, please notify the sender immediately and
delete this message

References

Visible links
1. mailto:[email address]
mailto:[email address]

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From: A J A MacRae

Kia ora,

Thank you for making a decision about my request for information. Are you able to indicate how long it may be before the information will be prepared? It has been over 80 days since I first made my request. I understand that I have asked for a lot of information from multiple sources so I am willing to be patient, but that waiting would be much easier if I had a sense of how long that wait will actually be. I hope to hear back from you soon.

Yours sincerely,

A J A MacRae

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From: hnzOIA


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Kia ora A J A MacRae,
 
Thank you for your request for information regarding gender affirming
care on 29 May 2024. Please find attached our response to your request.
 
If you have any questions, please get in touch at
[1][email address].
 
If you are not happy with this response, you have the right to make a
complaint to the Ombudsman. Information about how to do this is available
at [2]www.ombudsman.parliament.nz or by phoning 0800 802 602.
 
 
Ngā mihi, 
 
Health New Zealand | Te Whatu Ora 
 
Government Services
Office of the Chief Executive

Health New Zealand | Te Whatu Ora
Statement of confidentiality: This email message and any accompanying
attachments may contain information that is IN-CONFIDENCE and subject to
legal privilege. If you are not the intended recipient, do not read, use,
disseminate, distribute or copy this message or attachments. If you have
received this message in error, please notify the sender immediately and
delete this message

References

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1. mailto:[Health New Zealand request email]
2. file:///tmp/

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