HNZ00091504 Response.pdf

21 August 2025

Mr. A.H.
[FYI request #30288 email]

Tēnā koe Mr. A.H.
Your request for official information, reference: HNZ00091504
Thank you for your email on 23 June 2025, asking Health New Zealand | Te Whatu Ora for further
information on gender affirming chest reconstruction (‘top surgery’) under the Official Information
Act 1982 (the OIA). Your request is set out in Appendix One.
We have provided responses below as outlined in the sections of your request.
Response
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?

The Region is accepting a limited number of gender affirming top surgeries each year, currently 20
per year. These are accepted sporadically throughout the year to avoid a sudden influx at a
particular timepoint. Therefore, the answer to your question is that not all referrals are declined, but
at any given timepoint when the referrals are reviewed, some wil  be declined and some wil  be
accepted.

Waitlists for reconstructive surgeries, including top (chest reconstruction/breast removal) surgeries
are under continual review. Patients who do not meet the service’s referral acceptance criteria, do
not respond to communication or who do not provide the GP completed information within required
timeframes when requested wil  not be considered and wil  be removed from the wait list as part of
the review process, with patients and their GPs or referrers being advised of these outcomes
individually.

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 'wil  benefit the most')?

Al  patients must have a readiness for surgery assessment prior to referral but this is a baseline
requirement, not a tool for gauging who wil  benefit the most from surgery.

The National Prioritisation Tool for plastic surgery and the Clinical Prioritisation Assessment
Criteria are used to prioritize the patient once placed onto the waiting list for surgery.

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 wil  stil  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?

In the period beginning 1 January 2025 to 13 August 2025 there have been 15 patients accepted
for top surgery at Counties Manukau and 29 patients declined.

- Have or are patients whose referrals have been originally accepted, been discharged
without surgery?

No, all patients previously accepted for surgery are having their surgery performed (unless they no
longer meet baseline criteria, e.g. BMI and smoking status).

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.

As explained, no patients have been removed after referral acceptance. There are no memoranda,
documents or emails. As such your request related to the parts above is refused under section
18(e).
- When does the region expect to reopen to new patients?

The waitlist is not currently closed and therefore cannot “reopen”. It is restricted to a specified
number of surgeries a year. As such your request is refused under section 18(e) as the information
does not exist.

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?

Specific references to top surgery are referenced in relation to the broader topic of health services
for trans gender people. You can find this reference under the heading Gender affirming surgery
along with other relevant information linked here: Transgender surgery and therapy

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.

The number of transgender top surgeries performed by Counties Manukau was reviewed in
September 2024 due to a noted increase in referrals. At that time, the number performed over the
past few years was as fol ows:

Counties Manukau - Top Surgeries

Year
Total
2012
2
2013
1
2014
1
2015
1
2016
2
2017
4
2018
10
2019
22
2020
20
2021
21
2022
18
2023
19
2024 - [Jan to Sep]
13

It was noted, at the time of the review, the department had performed 13 surgeries so far that year
with a further 14 individuals on the waiting list for surgery that year.

In addition, another 22 individuals had already accepted for First Specialist Appointment (FSA) and
a further 12 referrals sent for consideration. This was a significant increase from the previous five
years, when the number had been around 20 each year. No previous limit had been required as
numbers had been stable for five years.

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

Counties Manukau district is the provider of gender affirming top surgery and surgical services for
the Te Tai Tokerau / Northern Region.

The Bay of Plenty district provides gender affirming Chest Reconstruction for the Te Manawa Taki /
Midland region.

Southern district provides gender affirming Chest Reconstruction for the Te Waipounamu / South
Island region.

How to get in touch

If you have any questions, you can contact us at [email address]
If you are not happy with this response, you have the right to make a complaint to the
Ombudsman. Information about how to do this is available at www.ombudsman.parliament.nz or
by phoning 0800 802 602.
Nāku iti noa, nā

Danielle Coe
Manager (OIAs) Government Services

Appendix One: Full request

In the interest of time and resources, I am wil ing to exclude communications and other information
(not counting memoranda and reports - I would stil  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 'wil  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 wil  stil  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?
TeWhatuOra.govt.nz
Health NZ, PO Box 793,
Wel ington 6140, New Zealand