Ireland is drafting a new plan for trans healthcare. On Tuesday afternoon, outside the Dáil, part of the trans community put the old system on trial, literally.

The protest

At 14:00 on November 10, the grassroots group Transgress the NGS held a demonstration called “Say No To the NGS 2.0” outside Dáil Éireann, GCN reports. It staged a mock trial and execution of three institutions: the National Gender Service (NGS), the Health Service Executive (HSE) and the Department of Health.

Activist Fiadh Tubridy said the aim was to “highlight the anger felt among the trans community.” The group’s verdict on the plan being drafted: it shows the “complete inadequacy of the proposed new model of trans healthcare in Ireland.”

And then the line that gives the protest its name: “We simply will not accept the National Gender Service 2.0.”

What’s being drafted, and why people are angry

The HSE is writing a new Model of Care for gender healthcare. A working group led by Dr Karl Neff, the HSE’s gender healthcare clinical lead, is developing it. GCN reported in July that Neff will step down by the end of 2026, once the draft is done.

The backdrop is a system GCN describes as having “decade-long” waiting lists. Ireland scored zero on trans healthcare in Europe’s Trans Rights Index this year. The HSE ran a survey in August asking trans people what better care would look like.

Transgress the NGS has gathered more than 2,200 signatures, including over 50 community and political organisations, on an open letter to Health Minister Jennifer Carroll MacNeill and senior HSE management. Its main complaints:

  • The new model isn’t committed to international best practice, especially informed consent.
  • Senior HSE clinicians shouldn’t lead the redesign, given what it calls “the complete lack of trust between the NGS and the trans community.”
  • Trans people should be “treated as equal collaborators.”

GCN also reported that the NGS advised GPs to refuse blood tests to trans patients who get hormones privately or through DIY routes.

Two groups walked out

The protest didn’t come out of nowhere. Two organisations quit the working group on September 2 and made their reasons public on October 9.

PATHI, the Professional Association for Trans Health Ireland, wrote that “we cannot in good faith continue to participate.” In its letter, PATHI said:

  • The draft was shared before the evidence and lived-experience reviews were finished.
  • “3 out of the 7 references in the document are related to the Cass Review.”
  • It shows “a fundamental misunderstanding of the meaning of depathologisation.”
  • It “reinforces the pre-existing centralised consultant-led approach,” which limits primary care and risks delays.

Trans Healthcare Action (THA) said “we do not feel that the development of the model has followed its stated values.” In its statement, it said it will keep pushing for informed consent and for trans people to “be able to access care locally, in primary care settings.” It also said it remains open to working together in future.

Others stayed in, and say it’s working

Not everyone left. TENI, LGBT Ireland, Belong To and AsIAm stayed in the working group, according to GCN, saying they would keep pushing “from within this structure.”

TENI executive director Daire Dempsey put it simply: “We need to fix this crisis for everyone on the waiting list.”

And there’s movement. After a meeting with Ministers Carroll MacNeill and Butler, a new draft is reportedly in progress, according to GCN. TENI said: “We had a long conversation with Minister Butler, who agreed on the need for a new draft.” GCN reports that Butler agreed the new draft should be self-affirmative, inclusive and accessible.

GCN says the news was mostly welcomed online, though some people remain sceptical. After years of waiting, that’s fair.

What to watch

  • The new draft. No date has been published. The key question is whether it moves toward informed consent and a bigger role for primary care, which the groups that walked out and Transgress the NGS have called for.
  • Who writes it. Neff is due to step down by the end of the year, so leadership of trans healthcare at the HSE will change soon.
  • Transgender Awareness Week runs November 13 to 19, followed by Trans Day of Remembrance on November 20. Expect the model of care to come up.

Ireland voted for marriage equality in 2015. Trans healthcare has been the glaring gap ever since. Two things happened this week: anger outside the Dáil, and a promise of a rewrite from inside the system. Whether that adds up to a real reset depends on what the next draft says.

Sources: GCN, “Activists stage mock trial…” (Nov 10, 2026); GCN, working group resignations (Oct 12, 2026); GCN, open letter (Oct 2, 2026); GCN, clinical lead to step down (Jul 20, 2026); PATHI resignation letter (Oct 9, 2026); Trans Healthcare Action statement (Oct 9, 2026). Photo: yasmin peyman / Unsplash.