The Opinion: The NZ Model

This is the third part of a series. Here are parts one and two.

The Question

How does the New Zealand model of child and teen gender services compare with the NHS model now being urgently overhauled? What a great piece of local investigative journalism that would make.

Great question! So let’s look at the NZ model. On the page from which they drew the comment about puberty blockers (which has since been changed, although the MOH has not changed its opinion on the safety or reversible nature of blockers), the next lines in that section say;

Already there’s a difference with the UK model of the single service provider. In the UK, there is a referral to GIDS (or its planned replacement service) from a primary care provider:

GIDS had 2 main clinics in London and Leeds. However, that’s one GIDS service for 60,000,000 people. In NZ, there are multiple outlets in each region that can help access and provide more information about blockers.

Also on that page is a link, on the left:

In Health care, an outline of the process of hormone prescription is given:

So, nice and clear. Importantly, also it aligns with what Dr. Cass recommends in the interim advice. Multiple outlets provide a holistic approach that addresses the needs of the individual patient.

In Resources, there’s a wide range of resources both NZ-specific and overseas. I won’t go into the detail there, but go have a look. It’s comprehensive.

More Information

I’ll go a bit further though, by clicking on the link that’s below the information about service providers, which is on the same page Dr. Donovan retrieved the quote about puberty blockers.

This provides clear information for health professionals in working with trans and gender-questioning patients, linking to the Professional Association for Transgender Health Aotearoa (PATHA) and other NZ-based organisations that support the inclusion of trans people.

PATHA themselves released a statement on August 22nd, supporting AusPATHA’s response to the interim Cass Report, stating:

In fact, the UK National Health Service’s response has focused on ways to “improve and expand the support offered to children and young people who are questioning their gender identity”. This approach would increase services as well as accessibility and be more similar to how gender affirming care is provided for children and young people in Aotearoa New Zealand.

So, there is further evidence that the NZ model is more aligned with what Dr Cass has said is the desired model for the UK’s trans and gender healthcare.

Even More Information

But, wait, there’s more. How do these services compare in terms of consent, international best practices, and what Cass recommends — beyond the PATHA statement? Let me take you to Hauora Tāhine — Pathways to Transgender Healthcare Services, the Northern Region services for NZ.

Here, publicly available on the page, are the Guidelines for Gender Affirming Healthcare. It’s a weighty, but understandable document, which lays out the processes and the evidence which supports the clinical approach taken for gender-affirming healthcare. Of note here is the supporting evidence for the position on puberty blockers, referencing Hembree WC et al. 2017.

It is of note because, in the Cass Report Interim Advice, Cass references this same document repeatedly when stating, on Pages 23 and 71;

Standards for decision making regarding endocrine treatment should also be consistent with international best practice.

When it comes to questions of consent, or the concerns raised by the NHS wording around puberty blockers compared to the MoH — it is good to see that in both consent forms for puberty blockers, here and here discuss both the issues of bone density and fertility absolutely transparently.

Also, as this information is publicly available online, anyone being accepted into the services receives a welcome letter that directs them to the information, while also offering support for families of young people accessing the service.

Comparison Time

So, what does this tell us about the NZ model of child and teen gender health services, compared to the UK model now being urgently overhauled? Well, from all of this publicly available information that anyone at all can access — we’re doing a pretty good job!

The Tavistock GIDS was found not to be able to provide safe care, specifically because it was a single service provider for a population of 60,000,000 people. That placed stress both on the staff of the service and on patients who, having waited a long period of time, would often attend their initial appointments in some distress and this would be exacerbated by the assessment process. All of this is contained in the Interim Cass Report, as well as its further research intentions to collect more information on puberty blockers and hormone treatments from international studies.

The NZ model is not one of a single service provider. In NZ, patients do not have to travel to Auckland from the South Island to receive an assessment — although smaller regions have service-sharing agreements, like the West Coast and Canterbury. The services in NZ are extraordinarily transparent, as the Northern Region’s public availability of all their guidelines, consent forms, and supporting information demonstrates. The Ministry of Health has made it much easier to find information than the NHS.

Summary

It didn’t take a ‘great piece of local investigative journalism’ to find this out. All of the information I have included here, right down to the consent forms for puberty blockers and hormone treatment, was no more than three clicks away from the website Dr. Donovan retrieved the quote regarding puberty blockers.

If you can find a quote to use in comparison to the UK to highlight ‘concerns’ about NZ’s system in an opinion piece, surely it would not have been too onerous to click through and find the information which would resolve those concerns — rendering the Op Ed redundant.

Something is going on here, it’s those reasons I mentioned back at the start. There’s something very wrong with the media environment in the UK, and it’s starting to appear here in NZ.

Hey, I’m a cis guy writing about this stuff. If you want to read great trans authors also talking about these issues — I’m going to link to one at the end of each of this series’ entries.

What The Trans!? is a media collective who cover a wide range of issues relating to lgbt+ rights: https://www.whatthetrans.com/