Dear Health New Zealand,

Health New Zealand has commissioned PATHA “to update the national guidelines and referral pathways for gender-affirming healthcare. Clinical director for primary and community care Dr Sarah Clarke said that was expected to be completed by August” (https://www.rnz.co.nz/news/national/5140...).

My OIA request is as follows:

1) What was the process in commissioning PATHA for the above? Please provide criteria, emails, briefs, meeting minutes etc.

2) How has PATHA shown Health New Zealand that they are reputable, evidence-based, and independent of the culture/ideology wars currently raging in the transgender healthcare space?

3) What are the requirements of the work to be completed by PATHA for the above? e.g.:
Systematic review of evidence to date?;
Full and transparent methodology and data used in systematic evidence review, to be freely publicly available?;
The medical, ethical or other standards that the review, guidelines and pathways must adhere to and state comprehensively?

4) What are the deliverables of the work to be completed by PATHA for the above? e.g:
Report to the Minister of Health on the state of ‘gender-affirming care’ in NZ - using data from around the NZ, split by Region and type and age of care?; trends over-time, concerns?
GP-ready publishable guidelines for evidence-based care for gender-questioning persons including non-medicalised pathways?;
Website-ready explanations of best -practice for gender questioning patients?;
What else?

5) What is the cost of this contract with PATHA? Please specify different elements and deliverables and their dates; a copy of the contract and any correspondence about the contract.

6) The Cass Review Final Report gave PATHA's last guidelines the 2nd to lowest score of all guidelines globally (149/600).
What is the quality assurance process for reviewing what PATHA produces now to ensure it is accurate, comprehensive, balanced and evidence-based?

7) What are the current “referral pathways”?

Kind regards,

B Evans

Dear hnzOIA,

Thank you for your response to my OIA, reference: HNZ00047611. I wish to clarify some of your answers therein.

1) In Appendix 1 of your response:
“This request for proposal (RFP) is an invitation to suitably qualified suppliers to submit a proposal for the ‘Gender-Affirming Primary Care – Update to Guidelines for Gender-Affirming Care’, contract opportunity. This is a closed single-step procurement process.”

Please explain the basis for the closed nature of this contract process (which is a departure from the All of Government best practice procurement rules) and provide the usual supporting information/documentation:
a) the rationale document (Rule 14);
b) which organisations were invited to submit a proposal/tender;
c) which organisations submitted a proposal/tender;
d) GETS contract award notice and date of its publication (Rule 48).

2) “The part of your request which asks for emails, briefs, meeting minutes, etc, is refused under sections 9(2)(g)(i) and section 9(2)(b)(ii) of the Act. This is to maintain the effective conduct of public affairs through the free and frank expression of opinions by or between employees of any public service organisation in the course of their duty as the release of this information would be likely to unreasonably prejudice the commercial position of the organisation who supplied it. It is in the public interest that such information continues to be supplied.”

Could you please clarify how the ‘commercial position’ of an organisation (i.e. PATHA) that cites itself as an ‘interdisciplinary professional association’ and whose Incorporated Society Rules state that “Pecuniary gain is not a purpose of the Society” would be unreasonably prejudiced by the release of information of our public servant’s discourse regarding this contract and what constitutes best care for our gender questioning youth/adults and the services to provide this care?
I request you please reconsider your initial refusal and consider how you might at least partially meet my request?

3) In Appendix 1 of your response, the RFP, there are at least three references to being ‘aligned with WPATH SOC v8’. However, WPATH Standards of Care (SOC8) are currently being questioned and are under intense scrutiny1,2,3,4,5.
a. Given that the contract awarded to PATHA to update the NZ guidelines for 'gender affirming care' requires them to use SOC8 as 'best practice', what steps are Te Whatu Ora taking to amend that contract and/or otherwise take into account recent developments that indicate that WPATH SOC8 may NOT be best practice? Please provide emails, letters, memos, briefs, meeting minutes, reports, and legal opinions regarding this matter.

4) You respond that: “…the draft guidelines will be reviewed by clinical stakeholders and undergo a sign out process to ensure that contents are clinically and culturally safe.”
Please provide documentation on this ‘sign out process’ (such as any applicable policy, procedure, memo or advisory documents) including definitions of what is meant by ‘clinical stakeholders’, ‘clinically safe’ and ‘culturally safe’ in this context. Please list the clinical stakeholders (where this might be problematic such as a single individual, please list the organisation/group that that single individual is a representative of).

Sincerely,
B Evans

Footnotes:
1. Cass Review https://cass.independent-review.uk/home/... – re WPATH, pg 28, 130-132
2. https://www.theguardian.com/commentisfre...
3. https://www.bmj.com/company/newsroom/gen...
4. Research into trans medicine has been manipulated. The Economist, 27 June 2024. https://www.economist.com/united-states/...
5. Opinion: The crucial questions about gender care are not political or legal. We need to know whether treatments benefit most children who receive them. 2 July 2024 https://www.washingtonpost.com/opinions/...

Sincerely,

B Evans