Ms Richelle Flanagan:

Following up on the pregnancy issue, a paper was published in 2014 that showed in 1,000 women a significant increase in the risk of spontaneous abortion and premature delivery and a later age of menarche associated with coeliac disease. There is quite a significant impact in terms of fertility and pregnancy. There are probably many women who could be saved going through the fertility process if a GP did a simple blood test in terms of an early screening process. There are definitely savings to be made in terms of IVF, both for people who have to do it privately or via the public sector.

I am a dietician and previous president of the Irish Nutrition & Dietetic Institute, INDI. To put dietetic services into context, the average ratio is one dietician to 54,000 people. In terms of the Tallaght region, which is probably one of our most underprivileged areas, with a population of 674,000 people, there is only one dietician to 140,000 people. When one thinks of the prevalence of coeliac disease as a percentage, there is no way that these people are being seen. It is a real issue. In the north-east areas, it is 1:54,000; in the north city, it is 1:76,000; in the HSE North, it is 1:78,000; and in the mid-west, it is 1:74,000.

Following on from Dr. Doorley's point, and some of the points that have been raised around access to nutrition related services, there is an issue. When it comes to coeliac disease, people are just not being seen.