That is so wrong of the Deputy.
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I thank the Deputies for the work they are doing with and on behalf of women. It is wonderful to see so many different parties and so many different voices, male and female, articulate the female health experience. Every single person knows that it has been overlooked. Every single person knows that experience of telling a story and not being listened to or believed. I completely respect those experiences and I have no interest whatsoever in engaging in politics around something as important and serious as this. What I am interested in is service delivery and the quickest possible way of ameliorating, fixing and making good the sheer lack of service delivery for women's health that has gone on for so long. There have been important advancements in the last five years. There is an important programme in place now, which is a different way of listening to and respecting women. I cannot make up for previous experience but what I can say is that, as the first female Minister for Health for a long time, I have a very strong commitment to delivering services that are going to make a difference in people's lives. We can deal with the technicalities and politics of an amendment and how that works. Deputies are welcome to make whatever charge they wish against me. I am not here for that. I am here to take steps forward on service delivery, to give some description of what has happened, and to discuss what needs to happen next and how we might deliver that. I have no interest in politics with regard to this. I am only interested in service delivery. I will, of course, answer the women, whom I thank for coming tonight, on the technical pieces - the motion, the amendment and how they work. However, I am interested, as the first female Minister for Health in a long time, and who, by the way, has also had friends, family and constituents describe to me the pain in their lives and in their bodies that they have lived with for so long as a consequence of endometriosis and, in particular, undiagnosed endometriosis and what that does for their mental health as well. I share all of the stories the women have told. It is so important that they are told on the floor of the Dáil. They are, with every respect to them and they will know this, stories I have also heard already, albeit perhaps from different women but nevertheless on precisely the same experience. I never deliver the speech that is prepared. It is welcome to have it but Deputies know that, as a matter of courtesy, I do not deliver what is prepared.
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As I said, I am not here to politicise anything. I do not critique the Deputy-----
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Would the Deputy like-----
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I will address the women in the House.
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What is important for us is actually making progress on endometriosis and there is some progress taking place. The first major difference we have, and this does not account for the many years of underinvestment in and under-recognition of women's health, is that we have a dedicated women and infants health programme. That has made some difference to how maternity services are conceived. We have more work to do there. It has made some difference with regard to how menopause services are conceived and we have more work to do there. It has made some difference with regard to endometriosis and we have more work to do there. We know, of course, that endometriosis is one of the most common gynaecological conditions. How this was under-recognised for so long is beyond me, when there are so many women presenting with such consistent symptoms. We know and recognise it and while our amendment does not go through the physicality of that in the same way the Sinn Féin motion does, I totally understand that. There is a huge range of very difficult symptoms and there is also asymptomatic endometriosis. There is a different spectrum of experience, and with the divergence, it is important that we listen to all of those experiences. It is also important that we respond to that complete spectrum of experience, some aspects of which can be responded to at GP level, while others need specialist intervention services. I have to try to make sure all of that is there. Since 2021, we have invested over €5 million to expand specialist endometriosis services to provide treatment for women with moderate and complex endometriosis. There is an additional €2 million this year to continue to do that. So far, that investment has allowed us to recruit 24.6 whole-time equivalent staff, or 24 people and one part-time person. We have the funding. Specialist services are expanding further with the HSE recruitment process to recruit another 18.6 people, or 18 people and a part-time person, with the funding provided this year. We are more than halfway through that recruitment programme and there is no question about that. That is for some of the specialist services. For most endometriosis cases, particularly at the less severe end - and I appreciate many of the people here are perhaps at the more severe end - most of the care can be provided by GP care. That requires GPs who understand endometriosis and listen to women who are presenting with these symptoms. It also requires having this dialogue in public. That is why it is so welcome that Deputies are telling this story as broadly as possible, as many women have been doing for many years. The moderate and severe cases of endometriosis, however, may require - they do require it, in my view but it is a clinician's decision - referral to the specialist model of care. At the moment, as Deputies are aware, there are two services, one in Dublin and a more recent one in Cork. I visited the Cork service where I spoke with the nurses and doctors and some of the patients. I understand the care pathways and where that has yet to go. There are also five regional endometriosis hubs that many people will be aware of. For those who are not aware of them, they are in the Rotunda, the Coombe, the National Maternity Hospital, in Limerick, in Galway and in Lee Road clinic. They are all operating and taking referrals. Women are receiving care through Galway and the National Maternity Hospital. There is more work to do on the structuring of those clinics. We now have clinical guidelines in relation to this. GPs are encouraged to initiate treatment for suspected endometriosis. They can and are encouraged to refer suspected cases through those different pathways. That all sounds very clinically-led, and it is, but it is about the visibility of this condition in GP services and GP surgeries, so that they know there are pathways where more complex cases can be progressed. I understand more than 1,100 new patients were seen in 2024 and that, on average, 72% of those women were seen within six months, between August and December. More than 300 specialist surgeries were provided between August and December last year and another 200 in the first three months of this year. I know more needs to be done on that. However, it is important for me to put those facts on the record of the House. Women with endometriosis may be on other gynaecology waiting lists. That is also important. There was an increase of 108% in general gynaecology referrals over the past number of years. I hope in part that this is some recognition of women presenting with their conditions and being listened to about their conditions and being referred onwards. There has been significant investment since 2021. It has enabled twice as many women to be referred to our gynaecology services with more than 80% of women waiting less than six months. As a woman, I would say that is still not enough. I have been Minister for a number of months and I have visited Cork and met with women who are really suffering from this condition. A lot more work needs to be done. We have see-and-treat gynaecology clinics that you can walk into and be treated immediately. Those are having a real impact. I hear from women that they are making an impact on waiting lists and on women's lives. They are being seen and treated at the same time. There is work on related issues. Let me address the national framework. For the first time in Ireland, we have this defined clinical pathway for women with endometriosis at the highest level expressed in the national framework for endometriosis. We are not finished with it yet. There is a body of work to be done to agree with GPs how they will fit in and how they will be part of that. That is not yet complete. There is more work to be done. Discussions are ongoing between the HSE and the Irish Medical Organisation, which represents GPs. I would love to be in a position to update the House on that in the next while. There are important diagnostic criteria for endometriosis that are determined by clinical specialists but I do not have time to get into them. I want to address the particular question around motions and how they are dealt with. I appreciate the members of Sinn Féin will disagree with me as is their right. In any event, we take the opportunity to set out the different things that have been done. I do not reject any of the points articulated by the women here. We take a slightly different policy direction in one respect, which is that instead of one centre of excellence, we have decided to do it more regionally-----
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-----to reduce the amount of travel and make sure there is an opportunity to get more regional care. In the countermotion we try to set out what has happened, what has yet to happen and to recognise that there are different choices. The point was raised about private treatment and choices. Women are entitled to choose. I want them to be treated within the public system.
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I want women to be treated within the public system. I want to make sure that women have every option to be treated in the public system.
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However, where a woman has gone abroad, she must be supported when she comes back to Ireland. We have set that out in the countermotion.
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That is an outrageous statement to make in the House. That is a term used in domestic abuse situations.
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It is by a woman.
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I am trying to deal with this issue. Forgive me.
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Am I entitled to speak for one minute, a Cheann Comhairle?
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I move amendment No. 1: To delete all words after "Dáil Eireann" and substitute the following: "recognises that: — endometriosis is one of the most common gynaecological conditions in Ireland and approximately one in ten women may have endometriosis; — there is a wide range of symptoms associated with this condition and the burden of disease varies from person to person; — some women may have endometriosis that goes undetected, while for others endometriosis can have a significant impact on their quality of life; and — endometriosis is a chronic condition for which there is no definitive cure, many women with endometriosis require long-term care and treatment provided within a multidisciplinary care team; notes that: — the Health Service Executive established the National Women and Infants Health Programme (NWIHP) to lead the management, organisation and delivery of gynaecology services in Ireland; — just over €5 million has been invested in developing endometriosis care and management in Ireland since 2021, and the Programme for Government commits to continue to support specialist endometriosis services; — new development funding of €543,822 provided in Budget 2024, with full year costs of €2.175 million in 2025 is further expanding and improving these services; — investment since 2021 has provided for 24.6 whole-time equivalent (WTE) staff; — services are expanding as recruitment continues for a further 18.6 WTEs with the additional funding provided for this year; — the recruitment process of these specialised posts will take time to complete; — Ireland's first National Framework for the Management of Endometriosis, alongside the implementation of structured care pathways is in final development; — in March 2025, the publication of the National Clinical Practice Guideline: Assessment and Management of Endometriosis, will support the delivery of evidence-based standardised care; — investment in endometriosis services has provided for the establishment of two supra-regional centres in Tallaght and Cork and five regional hubs, providing specialist services in each maternity network across the country; — regional endometriosis hubs operate from the Rotunda Hospital Dublin, the Coombe Hospital, the National Maternity Hospital (NMH), University Maternity Hospital Limerick and University Hospital Galway; — the NWIHP has advised that all regional hub sites are taking referrals and providing treatment pathways for women affected by endometriosis, a specialist endometriosis clinic structure has been formalised in the Coombe Hospital, the Rotunda Hospital, and University Maternity Hospital Limerick; — women are receiving care through the University Hospital Galway and the NMH regional hubs, while the formal structuring of these defined clinics is in ongoing development; — endometriosis care is provided through multidisciplinary teams, these include consultant roles in colorectal, urology and radiology, along with women's health physiotherapists, dieticians, psychologists, specialist nurses and healthcare assistants, recruitment for these funded posts is actively ongoing to further expand specialist capacity; — surgical treatment abroad, under the Treatment abroad scheme, is available when the necessary treatment is not available in Ireland or within the time normally necessary to get this treatment in Ireland; — women may choose to avail of private treatment abroad; and — women who opt for treatment abroad will be provided with ongoing care to manage their condition across the public network after they return; and acknowledges that: — psychologists play a key role in endometriosis care by helping patients manage chronic pain, emotional distress and the psychological impact of the condition, a psychologist has been appointed to support the supra-regional service at Cork University Maternity Hospital with further expansion of the service under consideration; — the diagnostic criteria for endometriosis are determined by clinical experts in the field, the clinical guidelines and the framework emphasise individualised woman centred care rather than rigid staging; — in line with clinical guidelines, general practitioners are encouraged to initiate treatment for suspected endometriosis, where symptoms persist or if symptoms are severe, timely referral to secondary care for laparoscopy is recommended; — the NWIHP has advised that on average 72 per cent of women waiting on specialist services were seen within six months of referral; — women affected by endometriosis may also be waiting on general gynaecology waiting lists, as of 26th June, 2025, 79 per cent of women waiting on gynaecology waiting lists are seen within six months and 97 per cent of women are seen within 12 months; and — improvements in endometriosis care are an integral part of the overall transformation of women's healthcare included in the Programme for Government, 18 ambulatory gynaecology 'see and treat' clinics are currently operational with more in development as part of the Model of Care for Ambulatory Gynaecology, six specialist menopause clinics are currently operational for women who require complex specialist care, six regional fertility hubs will provide support to the estimated 47 per cent of women with endometriosis who will also experience related fertility issues.". I greatly appreciate being facilitated, a Cheann Comhairle. It is most unusual for a Member to be allowed to speak a second time in these circumstances. I move the amendment very reluctantly. I do not wish to criticise the motion, which has been put forward in the best of faith by Sinn Féin, but there are a number of references in it that we cannot allow to stand on the Dáil record. I refer specifically to clinical decisions, which are very important and may be relevant in some, but not all, cases, and absolutely are for the discretion of clinicians in the fields. In addition, there are some contradictory elements around not wanting women to have to travel abroad but also providing funding for women to travel abroad. Acknowledging Deputy Danny Healy-Rae's point, I do not wish to be at odds or in disagreement with the House on this issue.
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However, I cannot allow clinical decisions to be on the record of the Dáil.
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I do not wish to speak across the Minister of State, Deputy Troy, whose voice is just as important as anybody else's in the House. I appreciate the Ceann Comhairle's discretion.
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I did not say that.
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