Dear Health New Zealand,

I am seeking information on gender affirming chest reconstruction (‘top surgery’) in order to provide our transgender community with clarity and to make advocacy for transgender healthcare better informed.

This request is made up of 4 sections. Please prioritise them in order from 1-4 and send each section when it is completed.

Section 1:

Which regions under Te Whatu Ora currently provide gender affirming Chest Reconstruction?

Section 2:
I request any and all information, including but not limited to, memoranda, reports and communications relating to resource allocation and capacity for chest reconstruction for gender affirming care (‘top surgery’) in the Auckland region, including but not limited to:

- Total capacity for top surgeries for the foreseeable future;
- Whether or not the region is accepting new referrals;
- Number of people on the waitlist in the region;
- Number of referrals received each year or in a specified period of time;
- Expected estimated longest wait time for surgery;
- Average wait time for surgery;
- Summary of how patients are triaged and prioritised for these services.

Section 3:
I request the following information relating to chest reconstruction for gender affirming care (‘top surgery’) for the Auckland Region.

- If in the event patients are being declined service, when did this begin?
- If in the event patients are being declined service, what is the reasoning for this? Please provide memoranda, reports or communications relevant to the decision making process. Is there a relevant Te Whatu Ora policy about this?
- What consultation, if any, has been done with interested stakeholders or members of the public who may be affected by patients being declined for top surgery? Please include any internal correspondences, including but not limited to internal memoranda, documents and emails.
- If in the event patients are being declined service, how many referrals have been declined since patients began being declined?
- Have or are patients whose referrals have been originally accepted, been discharged without surgery? If so:
a. How many patients have been discharged before consultation compared to patients discharged after consultation?
b. How many more patients are expected to be discharged without surgery?
c. Why was this action taken? Please include any internal correspondences, including but not limited to internal memoranda, documents and emails.
- When does the region expect to reopen to new patients?
- If the region plans to accept new patients in the future, what plans will be in place to ensure equitable, consistent, and long-lasting service provision? Please include the following where applicable, including whether this will be different from what was previously in place, and if so how:
a. Intended requirements for top surgery referral
b. Intended requirements for undergoing top surgery
c. How patients will be prioritised. E.G. if someone had been referred immediately after the waitlist closed and therefore had been declined, will that person have greater priority over people who have not previously sought referral?

Section 4:
I request any and all information, including but not limited to, memoranda, reports and communications, relating to policies and processes for chest reconstruction for gender affirming care (“top surgery”) in the Auckland region including but not limited to:

- Whether prospective patients seeking referral for top surgery are required to be on testosterone hormone therapy for a minimum period of time, and if so what that minimum period is;
- Whether there is a BMI requirement for referrals and/or surgeries and if so, what that BMI requirement is;
- Any other requirements for a person to be referred to a top surgery waitlist, such as ‘Real Life Experience’;
- Any other requirements for a person to undergo top surgery;
- Any policies regarding top surgery specifically;
- Any policies regarding gender affirming surgeries which affects top surgery;
- Any policies regarding transgender healthcare as a whole, especially policies which attempt to address disparities associated with the trans community.

Yours faithfully,

Mr. A.H.

Dear Health New Zealand,

I am writing to you because this request is very overdue (over 3 months have passed), and I have not received notice of an extension to the 20 working day time limit. Please advise when you expect to respond to my request.

Yours sincerely,

Mr. A.H.

Dear hnzOIA,

Thank you very much for your response.

In the interest of time and resources, I am willing to exclude communications and other information (not counting memoranda and reports - I would still like these to be included) from my request.

I have a number of clarifying questions about the response you have provided:

1. It is stated that patients began being declined for this service in November 2024. The response to 'whether or not the region is accepting new referrals' was yes. Does this mean that some patients but not all are currently being declined, or has the period where patients were declined already passed and all new patients are not being declined and are instead being accepted, or something else?

2. Can you please provide the contents of the tools used as examples of how districts may prioritise patients (National Prioritization Tool, Clinical Prioritisation Assessment Criteria, Readiness Assessment, anything else that may be used to gauge 'greatest clinical need' and 'will benefit the most')?

3. You have declined part of my request under s 18(e) OIA because consultation has not been undertaken. However, the statement declining that part of my request was also made under parts of my request which did not relate to consultation. Could you please confirm whether these questions will still be answered? I have quoted the relevant section of my request below:
"- If in the event patients are being declined service, how many referrals have been declined
since patients began being declined?
- Have or are patients whose referrals have been originally accepted, been discharged
without surgery? If so:
a. How many patients have been discharged before consultation compared to
patients discharged after consultation?
b. How many more patients are expected to be discharged without surgery?
c. Why was this action taken? Please include any internal correspondences,
including but not limited to internal memoranda, documents and emails.
- When does the region expect to reopen to new patients?"

4. The Health NZ website linked in the response relates to the genital surgery service. I requested "Any policies regarding top surgery specifically; Any policies regarding gender affirming
surgeries which affects top surgery; Any policies regarding transgender healthcare as a
whole, especially policies which attempt to address disparities associated with the trans
community". It does not appear to me that policies regarding the genital surgery service has much relevance to my questions regarding top surgery. If it is relevant, could you explain how it affects top surgery specifically?

I have the following new, follow-up questions:

1. The stated limit for top surgeries in the Auckland region is 20 per year. How many surgeries are actually done? Please provide the stated limit and the number of surgeries done each year in the Auckland region for the last 5 years if possible.

2. Which regions in New Zealand are currently offering top surgery?

Thank you very much for your time and responses.

Yours sincerely,

Mr. A.H.

Dear hnzOIA,

Just sending this message so that the status of the request updates correctly.

Yours sincerely,

Mr. A.H.