Dr. Brendan O'Shea:

Presumably because Deputy O'Connell has a strong professional health care background she knows all the buttons to press on our side. It is unique. One is nearly tempted to go back to the phrase used by that other parliamentarian - "grotesque, unbelievable, bizarre and unprecedented". There is no other situation in health care where we are not allowed to make a referral. When one considers the average patient - whoever that is - such as a 32-year-old, fit, healthy, adult woman, arguably the risk and level of complexity is quite low. However, we all know in practice that, given the complexity, unusual situations are quite common. The Deputy has outlined them all and has answered the question. It adds enormously to the uncertainty in these circumstances. These are the cases that keep us awake at night. They are the cases we feel vulnerable about. They are the cases where criminalisation looms large in the consultation for the practitioner. It is ironic that in 2017 the Irish State is only now finally rolling out electronic referrals to a whole range of services in the public system. We are not able to make a paper referral for this particular service. We are in a very difficult situation in primary care as matters stand on the eighth amendment.