HSE Gender Healthcare Lead Karl Neff to Depart Amid Care Model Overhaul

London, United Kingdom Jul 18, 2026 ALN: The Health Service Executive (HSE) is poised to embark on a significant recruitment process for a new clinical lead for gender healthcare, as the current lead, Karl Neff, prepares to depart later this year. Neff, who has held the position for a brief two years, will leave following the completion of a draft model of care that aims to fundamentally reshape Ireland's gender services. This transition is not just a change in personnel but marks a pivotal moment in the evolution of gender healthcare in Ireland, amidst growing discussions about best practices and patient rights.

This shift comes at a critical juncture, with heightened scrutiny surrounding the model of care that Ireland's gender services will adopt. The conversation around gender healthcare has gained momentum in recent years, reflecting broader societal changes and increased visibility of transgender issues. Minister of State at the Department of Health, Mary Butler, has publicly expressed her support for Iceland's gender-affirming healthcare model in recent correspondence with the HSE's chief executive. The Icelandic model, known for its informed-consent approach, emphasizes the importance of patient autonomy in the treatment process, which contrasts with more traditional models that may require extensive evaluations before treatment can begin.

Many transgender support groups and political figures advocate for this informed-consent model, which would empower patients to make choices regarding their treatment options without excessive barriers. The informed-consent model is seen as a way to respect individual autonomy and streamline access to necessary healthcare services. However, the debate is not without contention. Some medical professionals, including those at the National Gender Service, have recommended that Ireland consider the UK’s Cass report, which emphasizes the need for comprehensive mental health assessments for young people and suggests restricting access to puberty blockers and hormones until thorough evaluations are conducted.

The Cass report, released in 2024, brought to light significant concerns about the lack of robust evidence supporting the prescription of puberty blockers to children. It specifically referenced the Tavistock Clinic, where 233 Irish children were referred between 2012 and 2022, raising questions about the long-term implications of such treatments. The report's findings have sparked a heated debate within the medical community, advocating for a cautious approach to prescribing these treatments to minors. This cautious stance is rooted in a desire to ensure that young individuals receive thorough assessments that consider their mental health and overall well-being before embarking on medical interventions.

Karl Neff, a consultant endocrinologist, was appointed to lead the HSE's gender healthcare initiative in 2024. His tenure has been marked by efforts to address the complexities surrounding gender healthcare in Ireland. A spokesperson for the HSE confirmed his impending departure, stating that he would complete the draft model of care by the end of 2026. The spokesperson noted, “Dr. Neff had planned to leave upon completion of the draft model of care and will be doing this.” This statement underscores the importance of Neff's contributions during his time in the role and highlights the need for continuity as the HSE seeks to implement the new model of care.

The goal of this new model is to establish a person-centered approach that will support the development of an integrated gender healthcare service tailored to the needs of individuals in Ireland. This approach aims to ensure that services are not only accessible but also responsive to the unique needs of each patient, reflecting a growing recognition of the importance of individualized care in healthcare systems worldwide. The transition to a more integrated and person-centered model is seen as essential for improving the quality of care provided to transgender individuals, who have historically faced significant barriers in accessing appropriate healthcare services.

In correspondence dated back to January, released under Freedom of Information (FOI) law, Minister Butler communicated with then HSE chief executive Bernard Gloster regarding pressing gender health issues. She mentioned her discussions with Neff about the new model of care, highlighting the collaborative efforts being made to address the complexities of gender healthcare in Ireland. Butler's engagement with Neff underscores the government's commitment to reforming gender healthcare services and ensuring that they meet the needs of the community.

Butler expressed gratitude for the opportunity to visit Iceland, where she reviewed its gender healthcare service alongside Colm Henry, the HSE’s chief clinical officer. This visit provided valuable insights into the operational aspects of Iceland's model, which operates on an informed-consent basis. In her letter to Gloster, Butler praised the Icelandic model, stating, “It was clear from what we learned that in the majority of cases, most people benefited from counselling, psychological supports, and in particular the support of social work.” This emphasis on supportive services reflects a growing understanding of the importance of mental health in the overall well-being of individuals seeking gender-affirming care.

Butler also emphasized that all interventions in Iceland were provided after appropriate assessments and at age-appropriate life stages, further reinforcing the need for a thoughtful and careful approach to gender healthcare. The lessons learned from Iceland may play a crucial role in shaping Ireland's new model of care, as policymakers seek to balance patient autonomy with the necessity of comprehensive evaluations.

In addition to her advocacy for the new model, Butler has sought financial support for a HSE gender clinic in Drogheda, run by Dr. Tomás Ahern, a consultant endocrinologist. Ahern also operates a private service through Gender Plus, which offers gender-affirming specialists. The establishment of such clinics is vital for expanding access to gender-affirming care, particularly in areas where services may be limited.

Butler noted the need for specialist support for Ahern's clinic and attached a business case for the HSE to finance a registered advanced nurse practitioner to assist in the clinic. She stated, “I would ask the HSE to consider this business case to ensure continuity of care for existing patients and to expand the capacity of Dr. [Ahern]’s clinic to those waiting long periods for care.” This request highlights the urgent need for increased resources and support for gender healthcare services in Ireland, where demand continues to grow.

A spokesperson for the Department of Health confirmed that Minister for Health Jennifer Carroll MacNeill and Butler are actively working on a government program commitment to deliver a new model of care for gender healthcare by the end of the year. This commitment reflects the government's recognition of the importance of addressing gender healthcare needs and the urgency of implementing reforms that align with contemporary best practices. As the recruitment process for a new clinical lead begins, the future of gender healthcare in Ireland remains at the forefront of public discourse, with many stakeholders closely monitoring the developments that will shape the landscape of services available to transgender individuals in the coming years.