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DHB gender-affirming healthcare services

Gloria Fraser made this Official Information request to Bay of Plenty District Health Board

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From: Gloria Fraser

Tēnā koutou,

I am writing to request information about the gender-affirming healthcare services provided by the Bay of Plenty District Health Board.

Could you please advise whether the following gender-affirming healthcare services are funded by the Bay of Plenty District Health Board for transgender patients, and whether the services are currently available:

- Hormone therapy
- Mastectomy
- Hysterectomy
- Orchidectomy
- Facial hair removal
- Breast augmentation
- Voice training

Could you please provide information about the process of accessing those services that are available?

- Specifically, is an assessment by a mental health professional required in order to access gender-affirming healthcare services? If so, which services?
- In the case of hormone therapy, can primary health providers prescribe hormones, or does this have to be initially approved by an endocrinologist?
- Is any period of real life experience required to access surgery?

Finally, could you please advise what the process is if transgender patients require one of the above services, but the Bay of Plenty District Health Board does not offer this service? Does the Bay of Plenty District Health Board currently fund patients to travel to other areas to access this healthcare?

If any part of my request is unclear, please don't hesitate to contact me.

If any of the information that I have requested is unavailable or would be difficult to retrieve, but similar information might be readily available, I would be happy to discuss altering or refining my request.

Ngā mihi,
Gloria Fraser

Link to this

From: Diana Marriott
Bay of Plenty District Health Board

I am out of the officeTuesday 22 and Wednesday 23 May.  Please phone James
Fuller 07 579 8411 or 027 839 1791 or email [email address
for any assistance - thanks diana

 

 

 

Notice of Legal Status and Confidential Information: This electronic mail
message and any accompanying attachments may contain information that is
privileged and CONFIDENTIAL. If you are not the intended recipient you are
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Link to this

From: Diana Marriott
Bay of Plenty District Health Board

Thanks for your email request I was not in the office on Tuesday or Wednesday. You will l receive a formal acknowledgement from us - kind regards diana

Diana Marriott
Communications Manager

Bay of Plenty District Health Board
DDI: 07 579 8029
[mobile number]
www.bopdhb.govt.nz

show quoted sections

Link to this

From: Cherie Martin
Bay of Plenty District Health Board

 

On behalf of Debbie Brown, Acting General Counsel

 

 

Gloria,

 

Please find below response to your Official Information Act request dated
22 May 2018:

 

1.       Could you please advise whether the following gender-affirming
healthcare services are funded by the Bay of Plenty District Health Board
for transgender patients, and whether the services are currently
available:

-      Hormone therapy

-      Mastectomy

-      Hysterectomy

-      Orchidectomy

-      Facial hair removal

-      Breast augmentation

-      Voice training

 

There is not set funding in place for these services however the DHB
understands that in the event that a case for gender-affirming healthcare
services is approved as per the high cost treatment pool that the DHB will
have responsibilities to provide adjunct services in support of the
approved services.

 

2.       Could you please provide information about the process of
accessing those services that are available?

 

Access would be via referral to specialist services

 

Specifically, is an assessment by a mental health professional required in
order to access gender-affirming healthcare services? If so, which
services?

 

Yes, an assessment is required by a mental health professional in order to
access all gender affirming healthcare services

 

In the case of hormone therapy, can primary health providers prescribe
hormones, or does this have to be initially approved by an
endocrinologist?

 

Hormone therapy is initially approved by an endocrinologist.

 

Is any period of real life experience required to access surgery?

 

This question is unclear.

 

3.       Finally, could you please advise what the process is if
transgender patients require one of the above services, but the Bay of
Plenty District Health Board does not offer this service? Does the Bay of
Plenty District Health Board currently fund patients to travel to other
areas to access this healthcare?

 

Patients eligible for services located out of district would be funded to
travel according to National Transport and Accommodation (NTA) criteria.

 

 

Regards,

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

 

show quoted sections

Link to this

From: Gloria Fraser

Kia ora Cherie,

Could you please clarify a few points for me:

From your response it seems that the Bay of Plenty DHB only provides services once care is approved via the high cost treatment pool - is this correct? I ask as the Ministry of Health website notes that patients must have been on hormone therapy for 12 months and must provide 3 reports from mental health professionals in order to qualify for funding through the high cost treatment pool. Does this mean that patients in the Bay of Plenty district must self-fund hormone therapy and mental health assessments?

Or, does the response mean that services may be provided on a case by case basis without high cost treatment pool approval? If so, could you please advise which services might be funded?

In regards to the question about real life experience being unclear, please see the Ministry of Health definition of real life experience: https://www.health.govt.nz/our-work/prev...

Ngā mihi,
Gloria Fraser

Link to this

From: Cherie Martin
Bay of Plenty District Health Board

 

Hi Gloria,

 

Receipt of your email is acknowledged and a response will be made as soon
as possible.

 

Kind regards,

 

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

From: Gloria Fraser
[[1]mailto:[FOI #7890 email]]

Sent: Tuesday, 10 July 2018 4:21 a.m.

To: Cherie Martin

Subject: Re: DHB gender-affirming healthcare services

 

Kia ora Cherie,

 

Could you please clarify a few points for me:

 

From your response it seems that the Bay of Plenty DHB only provides
services once care is approved via the high cost treatment pool - is this
correct? I ask as the Ministry of Health website notes that patients must
have been on hormone therapy for 12 months and must provide 3 reports from
mental health professionals in order to qualify for funding through the
high cost treatment pool. Does this mean that patients in the Bay of
Plenty district must self-fund hormone therapy and mental health
assessments?

 

Or, does the response mean that services may be provided on a case by case
basis without high cost treatment pool approval? If so, could you please
advise which services might be funded?

 

In regards to the question about real life experience being unclear,
please see the Ministry of Health definition of real life experience:
[2]https://www.health.govt.nz/our-work/prev...

 

Ngā mihi,

Gloria Fraser

 

 

 

From: Cherie Martin
Sent: Friday, 22 June 2018 1:09 p.m.
To: '[FOI #7890 email]'
Subject: DHB gender-affirming healthcare services

 

 

On behalf of Debbie Brown, Acting General Counsel

 

 

Gloria,

 

Please find below response to your Official Information Act request dated
22 May 2018:

 

1.       Could you please advise whether the following gender-affirming
healthcare services are funded by the Bay of Plenty District Health Board
for transgender patients, and whether the services are currently
available:

-      Hormone therapy

-      Mastectomy

-      Hysterectomy

-      Orchidectomy

-      Facial hair removal

-      Breast augmentation

-      Voice training

 

There is not set funding in place for these services however the DHB
understands that in the event that a case for gender-affirming healthcare
services is approved as per the high cost treatment pool that the DHB will
have responsibilities to provide adjunct services in support of the
approved services.

 

2.       Could you please provide information about the process of
accessing those services that are available?

 

Access would be via referral to specialist services

 

Specifically, is an assessment by a mental health professional required in
order to access gender-affirming healthcare services? If so, which
services?

 

Yes, an assessment is required by a mental health professional in order to
access all gender affirming healthcare services

 

In the case of hormone therapy, can primary health providers prescribe
hormones, or does this have to be initially approved by an
endocrinologist?

 

Hormone therapy is initially approved by an endocrinologist.

 

Is any period of real life experience required to access surgery?

 

This question is unclear.

 

3.       Finally, could you please advise what the process is if
transgender patients require one of the above services, but the Bay of
Plenty District Health Board does not offer this service? Does the Bay of
Plenty District Health Board currently fund patients to travel to other
areas to access this healthcare?

 

Patients eligible for services located out of district would be funded to
travel according to National Transport and Accommodation (NTA) criteria.

 

 

Regards,

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

 

show quoted sections

Link to this

From: Cherie Martin
Bay of Plenty District Health Board

 

On behalf of Debbie Brown, Acting General Counsel

 

 

Gloria,

 

Please find below response to your further Official Information Act
request dated 10 July 2018:

 

From your response it seems that the Bay of Plenty DHB only provides
services once care is approved via the high cost treatment pool - is this
correct? I ask as the Ministry of Health website notes that patients must
have been on hormone therapy for 12 months and must provide 3 reports from
mental health professionals in order to qualify for funding through the
high cost treatment pool. Does this mean that patients in the Bay of
Plenty district must self-fund hormone therapy and mental health
assessments?

 

Relative to other priorities,  if the Endocrine Service has capacity to
meet the referred demand (the patients are prioritised for access to the
endocrine service) then the endocrine service would initiate treatment, or
advise a primary care practitioner of the treatment protocol that is
appropriate. In many DHBs the day to day management of the endocrine needs
of the actively transitioning, or the stable transitioned person,  are
managed by trans-friendly General Practitioners.

 

Mental health assessments would be treated in the same way by the DHB (ie,
if the service has capacity to meet the demand and within normal
prioritisation decisions).

 

 

Regards,

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

From: Cherie Martin
Sent: Tuesday, 10 July 2018 9:41 a.m.
To: '[FOI #7890 email]'
Subject: DHB gender-affirming healthcare services

 

 

Hi Gloria,

 

Receipt of your email is acknowledged and a response will be made as soon
as possible.

 

Kind regards,

 

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

From: Gloria Fraser
[[1]mailto:[FOI #7890 email]]

Sent: Tuesday, 10 July 2018 4:21 a.m.

To: Cherie Martin

Subject: Re: DHB gender-affirming healthcare services

 

Kia ora Cherie,

 

Could you please clarify a few points for me:

 

From your response it seems that the Bay of Plenty DHB only provides
services once care is approved via the high cost treatment pool - is this
correct? I ask as the Ministry of Health website notes that patients must
have been on hormone therapy for 12 months and must provide 3 reports from
mental health professionals in order to qualify for funding through the
high cost treatment pool. Does this mean that patients in the Bay of
Plenty district must self-fund hormone therapy and mental health
assessments?

 

Or, does the response mean that services may be provided on a case by case
basis without high cost treatment pool approval? If so, could you please
advise which services might be funded?

 

In regards to the question about real life experience being unclear,
please see the Ministry of Health definition of real life experience:
[2]https://www.health.govt.nz/our-work/prev...

 

Ngā mihi,

Gloria Fraser

 

 

 

From: Cherie Martin
Sent: Friday, 22 June 2018 1:09 p.m.
To: '[FOI #7890 email]'
Subject: DHB gender-affirming healthcare services

 

 

On behalf of Debbie Brown, Acting General Counsel

 

 

Gloria,

 

Please find below response to your Official Information Act request dated
22 May 2018:

 

1.       Could you please advise whether the following gender-affirming
healthcare services are funded by the Bay of Plenty District Health Board
for transgender patients, and whether the services are currently
available:

-      Hormone therapy

-      Mastectomy

-      Hysterectomy

-      Orchidectomy

-      Facial hair removal

-      Breast augmentation

-      Voice training

 

There is not set funding in place for these services however the DHB
understands that in the event that a case for gender-affirming healthcare
services is approved as per the high cost treatment pool that the DHB will
have responsibilities to provide adjunct services in support of the
approved services.

 

2.       Could you please provide information about the process of
accessing those services that are available?

 

Access would be via referral to specialist services

 

Specifically, is an assessment by a mental health professional required in
order to access gender-affirming healthcare services? If so, which
services?

 

Yes, an assessment is required by a mental health professional in order to
access all gender affirming healthcare services

 

In the case of hormone therapy, can primary health providers prescribe
hormones, or does this have to be initially approved by an
endocrinologist?

 

Hormone therapy is initially approved by an endocrinologist.

 

Is any period of real life experience required to access surgery?

 

This question is unclear.

 

3.       Finally, could you please advise what the process is if
transgender patients require one of the above services, but the Bay of
Plenty District Health Board does not offer this service? Does the Bay of
Plenty District Health Board currently fund patients to travel to other
areas to access this healthcare?

 

Patients eligible for services located out of district would be funded to
travel according to National Transport and Accommodation (NTA) criteria.

 

 

Regards,

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

 

show quoted sections

Link to this

From: Cherie Martin
Bay of Plenty District Health Board


Attachment Bay of Plenty.pdf
60K Download View as HTML

Attachment FW DHB gender affirming healthcare services.html
29K Download


On behalf of Debbie Brown, Quality and Patient Safety Manager

 

 

Gloria,

 

In response to your request dated 18 September 2018 we have updated the
earlier OIA in red below:

 

 

Please find below response to your Official Information Act request dated
22 May 2018:

 

1.       Could you please advise whether the following gender-affirming
healthcare services are funded by the Bay of Plenty District Health Board
for transgender patients, and whether the services are currently
available:

-      Hormone therapy – This is provided and the service is currently
available.

-      Mastectomy – Not provided

-      Hysterectomy – This is provided on medical grounds on a
case-by-case basis and is currently available.

-      Orchidectomy – Not provided

-      Facial hair removal Not provided

-      Breast augmentation Not provided

-      Voice training Not provided

 

There is not set funding in place for these services however the DHB
understands that in the event that a case for gender-affirming healthcare
services is approved as per the high cost treatment pool that the DHB will
have responsibilities to provide adjunct services in support of the
approved services.

 

2.       Could you please provide information about the process of
accessing those services that are available?

 

Access would be via referral to specialist services. The services involved
are sexual health and mental health with a process in place of ensuring
that both specialist services are aware of and involved in managing the
referral.

 

Specifically, is an assessment by a mental health professional required in
order to access gender-affirming healthcare services? If so, which
services?

 

Yes, an assessment is required by a mental health professional in order to
access all gender affirming healthcare services as per International
guidelines (WPATH standards 7^th version).

 

In the case of hormone therapy, can primary health providers prescribe
hormones, or does this have to be initially approved by an
endocrinologist?

 

Hormone therapy is initially approved by  either an endocrinologist or a
sexual health specialist. Approval covers a 2 year term, as per NZ
prescribing restrictions.

 

Is any period of real life experience required to access surgery?

 

This question is unclear. Yes, as per international guidelines (WPATH
standards 7^th version).

 

3.       Finally, could you please advise what the process is if
transgender patients require one of the above services, but the Bay of
Plenty District Health Board does not offer this service? Does the Bay of
Plenty District Health Board currently fund patients to travel to other
areas to access this healthcare?

 

Patients eligible for services located out of district would be funded to
travel according to National Transport and Accommodation (NTA) criteria.
The DHB is not aware of any formal interdhb clinical pathways for these
services.

 

 

Regards,

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

From: Gloria Fraser [mailto:[email address]]
Sent: Tuesday, 18 September 2018 8:41 AM
To: Cherie Martin
Subject: RE: Gender-affirming healthcare services

 

Kia ora Cherie,

 

That’s great, thanks so much! I’ve attached the response from Bay of
Plenty, so you can see what we based our coding on.

 

Here’s the coding scheme for availability of services:

 

Code Description
NA Not available
NR Not available - Patients are referred to another DHB
NDF No dedicated funding - service may be provided on a case by case basis, or
only for patients in particular age groups
A Service is publicly available

And here’s how we coded Bay of Plenty:

 

Hormone Facial Breast Voice
DHB Therapy Mastectomy Hysterectomy Orchidectomy hair augmentation
removal training
Bay of NDF NDF NDF NDF NDF NDF NDF
Plenty

 

Here’s the coding scheme for process of accessing services:

 

Mental health Primary health can Real life Funded
Code professionals’ prescribe experience travel
assessment
Yes, assessment by Yes, primary health Yes, funded
Y mental health providers can Yes, real life travel
professional prescribe experience required available
required
Assessment by Primary health
mental health providers can
professional prescribe some
S required for some medications, others - -
age groups need specialist
approval
 
Assessment by No, primary health No, real life No, funded
N mental health providers cannot experience not  travel not
professional not prescribe required available
required
Not applicable – Not applicable – Not applicable – -
N/A gender-affirming gender-affirming gender-affirming
healthcare not healthcare not healthcare not  
provided provided provided
DHB did not DHB did not
understand meaning provide
Unclear - - of real life response
experience
 

And again how we coded Bay of Plenty:

 

Assessment by mental health Primary health Real life Travel to
DHB professional required can prescribe experience other DHBs
hormones required funded
Bay of Y N Unclear Y
Plenty

 

Please let me know if you think any of this coding needs to be modified.

 

Ngā mihi nui,

Gloria  

 

 

From: Cherie Martin [mailto:[email address]]
Sent: Monday, 17 September 2018 3:53 p.m.
To: Gloria Fraser <[email address]>
Subject: RE: Gender-affirming healthcare services

 

Hi Gloria,

 

If you send me the information I will send it to the correct person to
check over.

Thank you

 

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

From: Gloria Fraser [[1]mailto:[email address]]
Sent: Monday, 17 September 2018 2:49 p.m.
To: Cherie Martin
Subject: Gender-affirming healthcare services

 

Kia ora,

 

I’m a PhD researcher preparing a paper for publication about the
availability of gender-affirming healthcare services across New Zealand’s
DHBs (with a target journal of the New Zealand Medical Journal, if
accepted). The paper is based on a series of OIA requests I’ve made to all
New Zealand DHBs over the past few months (see
[2]https://fyi.org.nz/user/gloria_fraser). The report will include
information about which services are available within each DHB, and the
process for accessing them.

 

Before I submit this report for publication I’d like to check my
interpretation of the OIA responses with each DHB to give an opportunity
to correct any incorrect information, or misinterpretations on my part.
Your email was sent through to be by James Fuller.

 

Would you be a good person to send this through to? If so, I will send you
details about your DHB and would need a response by October 5^th.  If not,
could you please let me know who might be best? If you know of people in
other DHBs who are knowledgeable in this area that would be fantastic too,
as I’m missing contacts in several DHBs

 

Ngā mihi nui,

Gloria

 

PhD and Clinical Psychology Student

School of Psychology | Te Kura Mātai Hinengaro

Victoria University of Wellington | Te Whare Wānanga o te Ūpoko o te Ika a
Māui

Pronouns: she/her

 

 

Notice of Legal Status and Confidential Information: This electronic mail
message and any accompanying attachments may contain information that is
privileged and CONFIDENTIAL. If you are not the intended recipient you are
advised that any use, review, dissemination, distribution or reproduction
of the information is strictly prohibited and may be unlawful. If you have
received this document in error, please notify the sender immediately and
destroy the message.

Notice of Legal Status and Confidential Information: This electronic mail
message and any accompanying attachments may contain information that is
privileged and CONFIDENTIAL. If you are not the intended recipient you are
advised that any use, review, dissemination, distribution or reproduction
of the information is strictly prohibited and may be unlawful. If you have
received this document in error, please notify the sender immediately and
destroy the message.

References

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Link to this

From: Gloria Fraser

Kia ora,

Thank you very much for confirming our interpretation. One follow up question:

- If someone needs a Hysterectomy specifically to affirm their gender, is this considered to be required on "medical grounds"?

Here are the codes we will be including in our paper. If you have any final edits, please let us know within the next week:

Hormone therapy: Available
Mastectomy: Not available
Hysterectomy: No dedicated funding
Orchidectomy: Not available
Facial hair removal: Not available
Breast augmentation: Not available
Voice training: Not available

Assessment by mental health professional required: Yes
Primary health can prescribe hormones: No
Real life experience required: Yes
Travel to other DHBs funded: Yes

Ngā mihi,
Gloria

Link to this

From: Cherie Martin
Bay of Plenty District Health Board

I am out of the office until Friday 5 October 2018.  If your query is
urgent, please contact [email address]

Notice of Legal Status and Confidential Information: This electronic mail
message and any accompanying attachments may contain information that is
privileged and CONFIDENTIAL. If you are not the intended recipient you are
advised that any use, review, dissemination, distribution or reproduction
of the information is strictly prohibited and may be unlawful. If you have
received this document in error, please notify the sender immediately and
destroy the message.

Link to this

From: Cherie Martin
Bay of Plenty District Health Board


Attachment Bay of Plenty.pdf
60K Download View as HTML

Attachment FW DHB gender affirming healthcare services.html
29K Download


Hi Gloria,

 

Hysterectomy plus adnexectomy will be performed under public funding for
medical reasons (dysfunctional bleeding, risk of uterine cancer), not
purely for gender reassignment.

 

 

Cherie Martin

Legal Executive

Governance & Quality / CEO Office

Bay of Plenty District Health Board

Private Bag 12024, Tauranga 3143

Ph: (07) 579 8545

 

 

 

 

show quoted sections

Link to this

From: Gloria Fraser

Thanks Cherie, we will code hysterectomy as "not available" as this is not available specifically for gender-affirming healthcare.

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We don't know whether the most recent response to this request contains information or not – if you are Gloria Fraser please sign in and let everyone know.

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