New Zealand’s Ministry of Health has admitted it is failing to provide adequate healthcare for trans people.

An internal memo obtained by the media said that demand for trans healthcare is growing, and “limited” public health services are falling behind, The Wireless has reported.

The Ministry of Health said the model of care for gender transition must be reviewed, with improvement of the “patchy” accessibility of healthcare a priority.

“While gender reassignment surgery is topical, it should be looked at in the context of a broader spectrum of transition-related healthcare to transgender people,” the memo read.

“A review of the model of care is required.

“The demand for health services to support people undergoing or considering gender transition is growing significantly, but public health service provision has not kept up with demand.”

Trans health advocate Jem Traylen of Rainbow Wellington said waiting lists for gender-related surgeries can be decades long, and other elements of appropriate care are also lacking, from GP training to funding for counselling.

Traylen called the current system “a few bits and pieces here and there that aren’t talking to each other”.

New Zealand has just one doctor capable of carrying out gender-related genital surgery for trans people, but the District Health Board has said there are no plans for her to perform the procedures.

The Ministry of Health has estimated the 19th person on the waiting list for surgery could expect to have their procedure in 38 years.

Many trans New Zealanders who can afford it are travelling overseas to have transition-related surgeries at their own expense.

Nurse Kieran Monaghan said the waiting time to access even an assessment to begin transition is eight to nine months for people in the Wellington area.

Jumping the queue by accessing assessment privately can cost up to $1000.

Monaghan said the problem is “chronic underfunding”, and worst outside of major cities.

“There are some gains being made in the major centres in terms of the available clinical interventions, but it appears services are less visible or available in the provinces,” he said.

“It seems like there’s a lot of migration towards the bigger cities.”

Advocates are optimistic that the government will allocate funding to help turn around the state of trans healthcare in New Zealand under Prime Minister Jacinda Ardern, who has positioned herself as a supporter of LGBTI rights.

“This government will eventually sort this problem out, we just don’t know when yet,” said Traylen.

“I hope there will be policy announcements later this year and I believe we will get something in next year’s budget.”

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