> ## Content Index
> Fetch the complete content index at: https://aontachtmedia.ie/llms.txt
> Use this file to discover other available public pages before exploring further.

# Nelle Oeffler On NGS Focus Group Collapse
- URL: https://aontachtmedia.ie/nelle-oeffler-on-ngs-focus-group-collapse/
- Published: 2026-10-29T12:07:58.000Z
- Updated: 2026-10-29T13:24:50.000Z
- Description: Nelle Oeffler from 'The Leftist Cooks' sat down with an Aontacht reporter to talk about the collapse of the National Gender Service focus groups, transphobia and colonialism.
- Author: Lenses Browne
- Tags: Critical Analysis

Nelle Oeffler from '[The Leftist Cooks](https://www.instagram.com/neillyfromtheleftistcooks/?hl=en&ref=aontachtmedia.ie)' sat down with an Aontacht reporter to talk about the collapse of the National Gender Service focus groups, transphobia and colonialism. Listen to it on Spotify or read the transcript below! 

I'm here with Neilly from the Leftist Cooks, and today we're going to discuss the recent focus group that collapsed regarding the redesign of the National Gender Service, the NGS. Neilly, how are you getting on today? 

> I'm good, thank you. Yeah, I'm mostly going by Nelle these days. It's, you know, typical trans business. It's just, I think I'm finally settled at this point \[laughs\] now for the foreseeable. But yeah, no, things are good apart from the state of trans healthcare in Ireland. 

Yes… So look, we have a readership that maybe not— might not be super familiar with the difficulties regarding trans healthcare. Could you give us an overview of the players involved in this story and how it got to this point? 

> Sure, okay, well, the most important piece of background for people who are totally unfamiliar is that there are systems in place in other countries that is an ‘informed consent model’. And what that means is you go to your— like in Iceland, for example, you go to either your GP or to a gender specialist, you tell them, I'm trans, and they say, “oh, okay, and do you have any other concerns?” “Like, have you got mental health issues, or do you have any questions? Do you have any concerns about something like starting hormone replacement therapy might mean?” And you answer a few other questions, and then that takes about 15 minutes. Within 45 minutes, you've got a prescription in your hand because they've given all the information that you need to consent to the trans healthcare that you'll be receiving. And for the most part, most trans people are looking for pretty tame interventions like that hormone replacement therapy, and then they can progress down the line with other forms of treatment like top surgery, bottom surgery, and things like facial feminization surgery, you know, voice box scrapes and things like that. But like the usual first port of call is actually very, very doable, very, very quickly, entirely through GPs.

> And that's shown in places like Iceland and Germany. And that's called the informed consent model. That is not the model that we have in Ireland. In Ireland, we have an ‘unnamed system of care’. It's not a specific formulated system. We have what the HSE call a ‘multidisciplinary team’ operating out of a single prefab on the grounds of St. Columcille’s in Loughlinstown. And at the moment, there's over 1,000 people on the waiting list to get access to this single prefab. The waiting list is estimated anywhere between 10 and 18 years for a highly vulnerable group.

> This group is seeking care that can be given within 15 minutes. What we have instead is the National Gender Service, the NGS as it stands, and it is operated by a multidisciplinary team of endocrinologists. I think there's 2 of those… but also Freudian psychiatrists

I didn’t know they still have Freudian psychiatrists. 

> Well, it's actually, from my perspective, speaking personally, the issues with trans healthcare in Ireland, are part of a bigger issue with how mental health in Ireland works generally. Now, we don't need to necessarily couple together trans healthcare with mental healthcare, but the HSE does… in part because they have a dearth of mental healthcare professionals with qualifications that in many other countries would be considered totally irrelevant. Under the current system, and part of the reason why the waiting list is so long, once you've waited your 18 years to get to Loughlinstown, you'll sit in that room for a 3-hour assessment. with, a psychiatrist of dubious qualification, as has been exposed by the [Journal](https://www.thejournal.ie/investigates-national-gender-service-6690859-Apr2025/?ref=aontachtmedia.ie) and, [Transgress The NGS](https://www.instagram.com/reels/DRxbq8cjKLs/?ref=aontachtmedia.ie) with leaked audio. As has been exposed, you'll be asked questions about your habits, your sexual habits, your habits in terms of pornography, “the kind of pornography you like”, “how you like to get yourself off”, \*whether you like to take it in the ass”, like “the degree to which you like to have anal sex”.

> If you're trying to access bottom surgery, you will be asked lots of generalised questions without being given an idea of how you're supposed to answer about whether or not “you would prefer to just continue to take it in the ass”. You'll be asked a lot of questions if you're transmasculine, if you're trying to transition to being a man, you will be asked a lot of questions about your “reproductive capacity”. In a way that is pretty archaic. They're very concerned about preserving wombs and ovaries and things. And you'll be asked a lot of personal traumatising questions. 

> A lot of people have come out of that experience after frequent meetings pretty screwed up by it. And a lot more people are quite anxious about having to go through that process. Additionally, that 3-hour excruciating interview presents a pretty significant and obscure off-ramp for your care. If you don't answer those questions correctly, you may be denied care, and you may not know why you've been denied care. Again, for a very vulnerable group who, you know, have high instances of suicide as a result of not receiving care, you can be denied care, as has been documented by the journal and others, for not being employed, for being overweight, for not already being out living as a trans person without any hormonal or surgery intervention for upwards of 18 years.

> You can be denied care because you've spoken ill of the NGS. This is a gruesome system for trans people as it currently stands.

Can you expand on people being denied care because they have spoken ill of the NGS?

> It is an unfalsifiable claim. I will recognise. But trans people, in speaking to each other, some people who I will not name have claimed that they have been denied care, in part because they spoke out about the NGS. 

I suppose either way, the fact that it's unfalsifiable and it's kind of Kafka's healthcare system, where you have no idea whether you gain access, don't gain access, why, why you don't, or even like what game you would have to play with them in order to kind of navigate this paternalistic system. I suppose it kind of gets to the heart that it is unfalsifiable. 

> For sure. And people, I think, will guess under such a system, people will guess, and people will guess inaccurately, and people will, speculate, and, misinformation will spread within the trans community about like, here's exactly what you're supposed to say. But of course, what we're not talking about here is a mental health care professional engaging with someone where their vulnerability and honesty and their ability to look after themselves is (not) rewarded. This is a system that rewards, just giving the right answers.

Yep. Okay, so all this is then the context for the focus group that was conducted, to, I suppose, revamp the NGS after some level of controversy?

> Yeah, I think this controversy and all of these controversies put together has put the fire under the HSE and the government to do something about trans healthcare. I think that the particularly huge, [Trans And Intersex Pride ](https://www.instagram.com/transpridedublin/?hl=en&ref=aontachtmedia.ie)march that marched on the Dáil, 2 years ago was probably a healthy wake-up call as well. And fair play to us as a community, and fair play to everyone who came out to support us, because I think it really has made— it's made people think that they should do something. The trouble is that the way that the public sector and the HSE and the government tend to do things is a lot of box-ticking, window-dressing, committees and talk, and then ultimately the new thing that emerges is actually the new boss, same as the old boss, you know.

![](https://aontachtmedia.ie/content/images/2026/10/data-src-image-914e98df-20a1-4419-999c-9ed29df8e8bb.jpeg)

**Reproduced with permission from River Gilles Cooke.*

Yeah. So for the focus group itself, can you take us through the process of how that gets started? How did you get involved? And maybe what groups were involved?

> Sure. Okay, well, so there, there is a working group of trans advocacy groups. PATHI (Professional Association for Trans Health Ireland), the Trans Healthcare Alliance (THA), TENI, BelongTo, and others have been involved with the College of Surgeons and the HSE separately for quite some time in trying to develop a new system. At least that's what they were told. You will see from PATHI and THA - exiting that working group- precisely why and some of the ways that they were misled in terms of how much the trans advocacy groups would actually get to impact the healthcare model that would emerge from that. Separately, a systematic review was commissioned by the HSE that has not yet been published. What's important to take note of here is the timing of all of these things. The HSE, the Royal College of Surgeons, and the government are making changes to the NGS, promising to abolish it in fact, and completely rethink how trans healthcare works. But they have a working group working over here siloed away in category A of ‘liaising with the trans community’. Then they have a ‘systematic review’ over here (in category B) . It hasn't been published yet. There's no way to have it influence the new model of care.

> And then way late in the process, we get brought in with initially a survey, which is a survey which I don't know how many people that was served to, but it was a great number of you know, trans people, just random trans people on the ground filled in this survey for the HSE. I want to say, I think you should look up when that survey came out because I actually don't remember. I want to say it's like July, August.

> And as part of that survey, you could say if you'd like to be, you know, this was conducted by Red C, and if you'd like to be part of the focus group that we're gonna— focus groups that we're going to have in-person conversations, you should this box and put in your name here, whatever, right? And so of course loads of us did that. I did that.

> Even later in the process, so we're talking September, these focus groups actually happened. I don't know how many there were. I believe there were actually several. I know that there was at least one that was for trans youth and parents, and I was part of one that was for like, just, just general trans people, adult trans people. And there were 6 people in my focus group. It was a pretty good mix of like non-binary, transfeminine, transmasculine, people who were like immigrants, people who lived in Ireland their whole lives, so on and so forth, right? So pretty good mix, mix of ages. And yeah, but it was really late in the process. And in this focus group, we were seeing drafted material for the new model of care. These screenshots from a different focus group to the one I was in, but they're the same screenshots, were since leaked to Reddit. 

![](https://aontachtmedia.ie/content/images/2026/10/data-src-image-050ca73b-4cfc-40b0-8aad-4637ab5714f0.png)

So there are separate centers producing knowledge?

> I didn't have the foresight to screenshot them myself. I just took notes like an ageing millennial. But yeah, Yeah, and we can get into what, like, what the problems are, you know, what the problems are from a trans perspective. But basically, the thing that's of note here at this point in the conversation is that there are three separate centres producing knowledge here. (1.) There's the working group of trans advocacy groups and the HSE and College of Surgeons, (2.) there's the systematic review, and then (3.) there's the focus groups. All of them are happening separately to one another. And there's already drafted material available to see. So they're all— so the people behind the NGS are just behind closed doors, like, producing draft material anyway. And they're going like, “oh, but we did talk to trans people.” “We talked to them, but we didn't factor in anything that they said.”

> Essentially, whether they were advocacy groups or focus groups or, like, the science on trans healthcare. We didn't factor any of that in. We just came up with new ways of revamping the NGS on our own in order to keep our jobs, you know. (That is how the reform process proceeded) . 

See, this is, this is like a structure of consultation we see quite often, whether it's like with data centres coming in or, whether it's, with homelessness services in the inner city, where you have small focus groups that don't necessarily have input, and it tends to be more of a model of like doing community relations through the focus group rather than actually giving kind of a more meaningful say. Would you kind of agree with that characterization?

> I would definitely characterise it that way, simply because of the order in which the process took place.

> I think they probably hoped that the draft that they had would pull the wool over our eyes a little bit. And that the process of sort of seeking tacit approval in a focus group would have gone better, right? But I think that what they were aiming for was to have something that really felt very new and shiny… and then have the focus groups kind of go like, “yeah, I mean, it's not ideal, but, you know, that's what we get. Okay”, “yeah, we can work with that”, you know. And you can actually see, I mean, the working group, whatever version, whatever version of the draft the working group are working with, like TENI and BelongTo are still involved. So there is some degree of going like, oh, well, we can work with this, though, we can improve from here. That hasn't worked for most trans people in Ireland. But you can see how, yeah, with something like, well, like, like, yeah, addiction treatment or homelessness, Like they might say, well, we did ask. I know it's only— it's at such a point in the process that you are either approving it or not, but you were involved, rather than you were actually involved in drafting it, or that the drafting took place as a result of the issues that were outlined by the affected group.

Okay, at what point in the process did it become clear that actually this couldn't continue, that there was really nothing going to come out of this kind of redraft process?

> Slide 3 \[chuckles\] . By Slide 3, it was clear this was, actually in some ways worse, as a model, and in, in many ways just the same.

> In our focus group, there was a very vocal member of the group and, she just said, can I stop you there? This is all bollocks. and it was refreshing. I can actually tell you I was the most diplomatic of the group. I was— I didn't— I wasn't exactly saying like, oh, maybe we can work with this, but I was saying, okay, like that one of— one of the things they were proposing was 3 hubs rather than 1\. Loughlinstown would still be the main hub, and it would still be the only hub for trans youth, unfortunately. but they're also proposing a hub in Cork and a hub in Galway. And I mean, I can't deny that that's an improvement, you know, and I kind of wanted to give them a little bit of leeway in terms of like— but I mean, there's not much, there wasn't really much I could say that would, particularly, you know, that there wasn't much to be diplomatic with. 

I would maybe like to move on to kind of wider cultural issues with regards to transphobia. But before we kind of move on, is there anything kind of left to say on this kind of specific, focus group angle?

> The issues with the new model are that it actually has too many steps. It's got like 14 steps, and each of them presents an off-ramp for care. It codifies what had been an obscure process before, where like you can be denied care. Now you can be denied care at any of these steps for any of the same reasons. It also continues to involve, you know mental healthcare practitioners of dubious qualification, probably largely the same people that manned the NGS. 

> And, that's the reason, like, we're not, we're not making a fuss out of nothing. The problem is we can see how this will end up, producing a longer waiting list and actually denying care for more people. While— and it's just not an ‘informed consent model’, and there's no reason why Ireland needs to. Ireland won't do a good job of inventing its own system, clearly. 

> We just need to use something like informed consent and WPATH (World Professional Association for Transgender Health). So it's just important to note why we're taking issue with this revamped version and why we're describing it as just window dressing, you know.

The core of the current model, which is kind of paternalism, which is me as the expert, even if my expertise is quite dubious, and I have a, a degree in Sigmund Freud and, you know, things that are really— should be relegated to last century, that, that I have say over what you were able to do with your body and you do not.

And at the moment, this is, you know, a very, very opaque kind of system. But this would make it maybe less opaque, but then maybe more clear about all the different ways that one can be denied healthcare. So I mean, you basically have 14 gates you need to get through before you can, before you can actually access healthcare.

> Yeah, they've made it more transparent and more cumbersome. While continuing to give GPs the excuse to not do some very simple basic training, which PATHI (Professional Association for Trans Health Ireland) is willing to do with them. 

> On just, “are you trans?” “Are you aware of the risks?” “Here's your prescription for hormones”. Like, they're giving GPs the power to continue to say, I have no idea what to do about this, this is magic weird bonkers healthcare from Narnia. That is epistemic vandalism. It is fundamentally a misrepresentation of how trans healthcare works. And it is maddening that they just take as given that GPs can't do all of this. That's what will clear the waiting list, is GPs doing all of this. And if you say to a GP, and if a GP says, “I can't treat this person because they're trans”, then you say to them, “then that is bigotry. That's discrimination. And you're— that's you discriminating against your patients”. So that's what you need to be retrained on, buddy, or else you don't get to be a GP in Ireland anymore

Yes. Look, the HSE is kind of crumbling at various different bits at the moment. However, if you are a cis woman and you're going through menopause, it is actually quite possible to get your hands on HRT. 

They don't have these 14 steps you know, and so I think it's very hard to really point the finger at anything other than blatant transphobia as regards the discrimination over who gets healthcare and who doesn't. 

I think at best, in the most charitable view, incompetence. At worst, in the least charitable view, virulent transphobia. From my perspective, it's going to be a little bit of column A, a little bit of column B. I think that the Irish state, the Irish government and the HSE kind of want to have it both ways in terms of, -you know imagining themselves as a very progressive forward-thinking, you know, the forefront of European liberalism kind of place, while also regarding trans healthcare as bonkers healthcare from Narnia and ultimately inscrutable and unknowable. And that these people are simultaneously, you know, “poor me, world's smallest violin, super valid, queer, let's go, you know, Smirnoff float”, and, completely mentally ill and have no idea what they need or what they want, and they need, they need a shrink to tell them, you know.

> If you're just trying to access the thing that is testosterone, you can get that. I mean, if you've had, if you've had, like part of your prostate removed, you can get that. If you've had testicular cancer, you can get that. If you're ageing, if you say you need it, like, you can get that as a man. And if you need oestrogen for menopause or other reasons as a cis woman, you can absolutely get that. So it's a case of treating trans people, I think, simultaneously like a strange, unknowable curio, which is more in keeping with the British political establishment… That's why we end up with a window dressing solution, because they're trying to maintain the facade that they're, you know, the leading edge of European liberalism. 

So you've touched on maybe the cultural point, which I was maybe hoping to discuss with you a little bit before we kind of wrap this up. When I was doing up my notes for this interview, the first notes I wrote were “Transphobia… England?”. and so maybe I'd like to pull this out, as we are seeing, because there was a trans kind of mutual aid group in Berlin that was raided, I think it was yesterday. 

> yes \[mournful inflection\] 

We're seeing, more and more kind of anti-trans, open, discriminatory legislation coming out of the States, and that people are losing their driver's licences. and that's quite serious, quite scary. and then we're seeing a whole load of, I suppose, kind of cultural TERFism coming out of, England. and as you know, we have our particular colonial relationship, with, with there as well. So I wonder if you could maybe kind of draw out that link for us a little bit?

> You know, TERFism as a cultural movement is really baffling and fascinating, you know. I know that feminists like [Sophie Lewis](https://miscellanynews.org/2024/11/14/features/sophie-lewis-discusses-terfs-in-philosophy-lecture/?ref=aontachtmedia.ie), explicitly draw a line between trans-exclusionary radical feminism and British colonialism. It's not even so much that the social construction of man and woman and the ‘order of things’, like the woman in the home and the man in the workplace, was necessary for empire, although it was, but further than that, because English, British colonialism is a very taxonomical affair, right? It's categorising racial hierarchies, it's categorising the world into the bits that belong to us and the bits that are uncivilised. And I think that British feminism has this through line of kind of pro-empire civilising feminism. And obviously the history of Irish liberalism is so tied up with cozying up to Empire and kind of trying to have it both ways, you know. So what's happening in the UK is very complicated from a social reproduction perspective. Like, it's very complicated. Why is TERFism such a successful movement? Like, it does have to do with Britain's own version of Make America Great Again, you know, Britain's version of returning to order and taxonomical clarity, having been all mixed up with those, those, you know, laissez-faire European liberals. 

> “But now we've done Brexit now, and we're very ordered, and we're going to open up the gas fields, and everything's very structured. And look, this is a very grown-up, practical Labour government, and everything is grown-up and practical, and we're going to have a very…” and it's a very British stiff upper lip kind of a kind of conservatism that, that can, that can frequently masquerade as being progressive when it comes to things like the Labour government and, and, you know, popular TERFism. So that's kind of that, because that's the British part of it, you know. I think Ireland doesn't know quite where it sits in terms of the true social regression that's happened in the United States and in Britain, where we don't necessarily have a codified history of liberalism or conservatism. We never quite succeeded in Connolly's vision. We never quite succeeded in some kind of Brehon law, feminist imaginary. We've always just kind of gotten by basically like syphoning money from Empire… at least we have in terms of the last 100 years. And so we're not quite sure what to do, I think, in terms of TERFism. 

> And that's why there's a kind of having it both ways that emerges where we want to window dress in terms of— and we do this with immigration as well, like somebody like Jim O'Callaghan want to window dress in terms of social reforms, but also like dog whistle that we are punishing, the weak and the perverse, you know, and the strange. We are punishing the other a little bit. Like only by accident, the way that liberals do. And I think that's where trans people sit in the rapidly evolving Irish imaginary. 

I really appreciate the time that you've given for this interview, and it's really fabulous. Can I get your take on one final story that's actually on the Aontacht Newsroom floor at the moment, which relates to trans issues? Kaspar Stratta was [one of the three activists](https://aontachtmedia.ie/kaspar-stratta-1/) that stormed Shannon Airport, I think a little bit over a year ago now. Now this relates to the trans issue, because actually the state has nowhere to put him if he's convicted. He can't go to a man's prison, he can't go to a women's prison, as in both cases he faces quite serious abuse. It looks like the governor of the jail is just, looking to, if he is convicted, just to just keep him in solitary confinement for the entirety of his stay, which is quite inhumane.

> Jesus… Well he's a hero and he shouldn't be in prison. You know, so that's the first thing is like, this is, this is unjust, right? Shannon Airport is being illegally used by the United States government. And, you know, I've been to plenty of protests at Shannon Airport. And, you know, I wish we went further more often, but because of the way that these protests are curtailed, like, it's really business as usual in Shannon. And it's really, it's a real dark mark on our participation in this genocide and ongoing genocides and the war crimes. So, you know, Kaspar is a hero and shouldn't be in prison. But I think that if you're speaking to the larger social issue of like, what's the deal with trans people in prison? The problem is trans people do present social problems, right? We have crises that throw themselves up because the world is made of structures that are patriarchal. That's what happens there. And, you know, I mean, TERFs are, are daft in their response to that, which is to say that the particular crises that trans people throw up in terms of patriarchy are silly and childish and bad and will bring about the end of Western civilization. 

> But any complaints that we have about patriarchy as feminists, of course, are reasonable and should be published in The Guardian, right? So if we're going to be consistent about this, then we need to start imagining and being vocal about a trans politics which is anti-carceral, a trans politics which imagines that anyone, not just trans people, should be able to walk into a pharmacy and get hormones over the counter. As Sophie Lewis puts it, “bread, roses, and hormones”.

> A trans politics should imagine that anyone can change their name to whatever the fuck they want, that anyone can cut off their parents for whatever reason they want, and that all of the social crises that trans people throw up are not made better by genociding trans people out of existence or making them go into hiding again, which isn't going to happen. They are made better by facing the issue in patriarchy and tackling it at its roots. So this is a carceral— this is an issue around carceral punishment. This is not an issue around there being a trans man in Ireland who did activism!