At the time of writing, more than 200 people were waiting on an active list for genital reconstruction surgeries.277 Numbers of referrals have been increasing sharply in recent years, yet this figure it is likely to still underestimate demand.278 The 2019 Wellbeing Budget allocated funding to undertake an estimated additional 12 – 14 genital reconstruction surgeries per year, on top of the current four every two years.279 This announcement was welcomed by transgender communities as a first step in the right direction. It is significant as delaying necessary treatment is not a neutral option and can lead to self-harm or suicide.280 Transgender prisoners The Department of Corrections is funded to provide primary healthcare to the same standard as a person would receive in the community.281 Despite this, the transgender prisoners who met with the Commission raised healthcare as a major human rights issue. They spoke of a lack of access to doctors and wait times between four to eight weeks to be seen for a general health issue. There was no oversight or monitoring of their hormone therapy by health professionals,282 and one person discussed a disruption in medication for about two months when admitted to the facility. Hormone therapy is a medically necessary intervention for many trans individuals, and withdrawal of hormone treatment can be associated with harmful side effects on physical and mental health.283 The Commission met with prisoners three weeks after the Department of Corrections implemented a new policy on the management of transgender prisoners.284 This policy was rolled out to improve the care, management, and safety of trans people in prison, whether they are in a facility which aligns with their gender identity or not. Any individual deprived of liberty must have access to health services which are culturally appropriate and acceptable. 285 The Transgender Prisoner policy was due to be reviewed within four months of implementation. 29 trans prisoners took part in this process, and a number of the review’s findings match the testimonies the Commission heard while visiting trans prisoners.286 This included facial hair removal as one of the most pressing and distressing issues impacting trans prisoners; as well as Corrections officers deliberately addressing prisoners by their incorrect birth names, including those who had legally changed their names. 14% of prisoners in the review felt an ad hoc approach was taken with their healthcare, with changes made to their hormone treatment regime. Only 53% of staff nationally had completed the training four months after the policy had been implemented. The review recommended making amendments to the policy, updating the staff training package, and following up on matters raised by prisoners who require additional health support. At the end of December 2019, there were 219 people on the active list. A. Wyatt, personal communication to T. Polkinghorne, May 29 2020. 278 Data from Counting Ourselves showed the unmet need for genital reconstruction surgery was 39% in trans women and nonbinary people assigned male at birth, and 21% in trans men and non-binary people assigned female at birth. See Jaimie Veale and others Counting Ourselves: The health and wellbeing of trans and non-binary people in Aotearoa New Zealand (Transgender Health Research Lab, University of Waikato, Hamilton, 2019) at 25. 279 Letter from Dr Andrew Simpson (Chief Medical Officer, Ministry of Health) to Louisa Wall MP (Health Select Committee Chairperson) regarding the Petition of Diane Sparkes – surgery for transgender youth: follow up questions (31 May 2019). 280 Jeannie Oliphant and others Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand (Transgender Health Research Lab, University of Waikato, Hamilton, 2018) at 26. 281 Department of Corrections Annual report 1 July 2017 – 30 June 2018 (Wellington, 2018) at 57. 282 The World Professional Association for Transgender Health recommends hormone-prescribing physicians “provide ongoing medical monitoring, including regular physical and laboratory examination to monitor hormone effectiveness and side effects.” See The World Professional Association for Transgender Health Standards of Care (7th ed, WPATH, 2012) at 42. 283 Ibid at 67. 284 Department of Corrections “I.10 Management of transgender prisoners” (2018) <https://www.corrections.govt.nz>. 285 Dainius Pūras, Report to the Human Rights Council of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health UN Doc A/HRC/38/36 (10 April 2018) at [38]. 286 Department of Corrections “Transgender Policy Practice Review” (unpublished report, 2019). 277 45