Leadership Change and Draft Model Completion in Ireland’s Gender-Healthcare Service

The Health Service Executive (HSE) announced that Karl Neff, a consultant endocrinologist appointed as the new clinical lead for gender healthcare in 2024, will step down later this year. Neff’s departure is scheduled after he finalises a draft “person-centred” model of care, which the HSE says will support an integrated gender-health service across Ireland. The agency will open a recruitment process for his replacement.

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Debate over the future model intensifies. Minister of State for Mental Health Mary Butler praised Iceland’s informed-consent approach, noting that interventions are delivered after appropriate assessment and at age-appropriate stages. Support groups and several politicians argue that Ireland should adopt a similar model, allowing patients to choose their treatment pathway. Conversely, Irish doctors at the National Gender Service cite the UK’s 2024 Cass report, which recommends comprehensive mental-health assessments and tighter restrictions on puberty blockers and hormones. The Cass review described the evidence for prescribing puberty blockers to children as “remarkably weak” and referenced 233 Irish referrals to the Tavistock Clinic between 2012 and 2022.

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A HSE spokesman confirmed Neff’s planned exit, stating, “Dr Neff had planned to leave upon completion of the draft model of care and [he] will be doing this.” The Department of Health added that Minister for Health Jennifer Carroll MacNeill and Butler are actively working to secure government commitment for the new model by year-end. Butler also forwarded a business case requesting HSE financing for an advanced nurse practitioner to support Dr Tomás Ahern’s gender clinic in Drogheda, which currently operates both public and private services.

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Medical professionals at the National Gender Service have voiced opposition to an uninhibited informed-consent framework, urging adherence to the Cass recommendations. They argue that comprehensive mental-health assessments are essential to safeguard young patients and that unrestricted access to puberty blockers lacks robust evidence.

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• “It was clear from what we learned that in the majority of cases, most people benefited from counselling, psychological supports and in particular the support of social work,” — Mary Butler, Minister of State for Mental Health

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• “It was also clear from their model of care that all interventions were provided after appropriate assessment and at age-appropriate life stages.” — Mary Butler

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• “Dr Neff had planned to leave upon completion of the draft model of care and [he] will be doing this,” — HSE spokesman

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• “I would ask the HSE consider this business case to ensure continuity of care for existing patients and to expand the capacity of Dr [Ahern]’s clinic to those waiting long periods for care,” — Mary Butler

The Irish Times