Paul Murphy (Dublin South West, RISE) | Oireachtas source

I wish to share time with Deputy Barry.

I welcome the Bill and the establishment of the authority as a late and small step towards tackling the reality of Ireland as being in the Wild West when it comes to fertility care. The problem is that the Bill does not do anything in terms of the public provision of fertility care, in particular IVF, and, therefore, does not really address the key issue that Ireland is, according to a report launched by a Fine Gael MEP no less, Ms Frances Fitzgerald, the fourth worst in all of Europe in terms of the provision of fertility care and the only country in the European Union which does not provide any public funding for the provision of IVF.

This is not a new issue. This is not a new procedure. IVF was included in the list of universal healthcare entitlements to be introduced under Sláintecare. According to the 2017 Sláintecare report, a universal health system means one that is "accessible to all on the basis of need, free at the point of delivery (or at the lowest possible cost)." Therefore, this should clearly apply to IVF as a universal healthcare entitlement. Nothing has been done to progress this despite Sláintecare nominally being a policy that everybody across politics supposedly agrees to.

Since 2016, when the Tánaiste and Minister for Enterprise, Trade and Employment, Deputy Varadkar, first promised public funding for IVF, we have heard repeated promises from successive health Ministers to publicly-fund IVF but nothing has happened over the past five years and no timeframe for public funding of IVF has yet been provided by the Department of Health. What does that mean for people? The impact is immense on many people. One is not talking about a small group of people here. One-in-six couples experiences fertility issues. On a yearly basis, it looks like 11,000 IVF cycles are carried out, which would probably translate to approximately 5,000 or 6,000 couples on a yearly basis. That is those who can afford it in the context of the current unaffordable and astronomically-high prices for that fertility treatment.

For many people, this is something personal. It is in their relationship. They are struggling to have a child and they do not necessarily want to speak out publicly about it. They do not want to speak to reporters about it or whatever, and also, for some, there can be a certain residual stigma. It is a situation where people should not have to speak out but, unfortunately, in this situation where the Government ignores this issue and refuses to provide the funding as part of the provision of a proper publicly-funded national health service, people have had no choice but to speak out about their experiences to make this real. A number of people, for example, spoke to the noteworthy investigation at the end of last year. I commend them on speaking out about their personal experience to make this real and to explain what having a cost of tens of thousands of euro, the debt, the stress on their relationship, etc., means for them.

I want to add my experience and the experience of my partner to that list of experiences. We have been going through IVF for more than a year. Even putting the money aside, it is a significant stress on people. Above all, it is a significant stress on my partner. She is the one who has to get all the hormone injections. She is the one who has to go through the disappointment when it does not work at the end of a cycle and then there is a discussion about whether to go again and continue with the cycle of raised expectations and lowered expectations.

There is disruption in terms of work, due to the time that has to be taken to go to the clinic again and again and the disruption to life on a daily basis. Throughout different parts of the cycle, my partner has to be stuck with a syringe by me twice a day. It is a huge burden on her, in particular, but on couples as a whole, in general.

Then we come to the issue of money. It is hard enough for people to have to go through that in order to be able to give themselves the best chance of having a child, but then there is the associated cost. I have heard many people talk about the level of costs and, to be honest, they have not looked into it enough because they are talking about the average costs being €4,000, €5,000 or €6,000. That is the average cost on the price list to have IVF, but what people do not realise is that they have to do a whole bunch of other stuff that is also on the price list in order for the IVF to work. Already, we are talking about significantly more money. We have already spent probably €12,000 and we could end up spending more money and it may or may not work at the end of it. We must remember that for many people who want to have kids, they simply cannot afford to do it. Therefore, by not having public provision of IVF, the Government is saying to them there is unequal access to them having the best chance they can of having a child. It is morally wrong that it is determined by how much wealth someone has. Other people get into significant amounts of debt, which adds extra stress to their lives and relationships. It is simply not acceptable to continue with the current situation. What we need is free public provision of fertility healthcare as part of a national health service, up to and including IVF.

When the Government has spoken about it, it has talked about having public provision through the public system rather than being outsourced to private clinics. However, for example, the clinical director of Merrion Fertility Clinic, Professor Mary Wingfield, said there is no infrastructure or trained staff to provide the complex treatment of IVF or intracytoplasmic sperm injection, ICSI, in our public facilities. In her opinion, "it would most likely need to be outsourced to private clinics." That continues with the problem. I accept we will have a regulatory authority, but the problem of having for-profit medicine, especially in such an area where people are encouraged to pay for all sorts of stuff that is not medically proven to add anything, is an horrendous situation. By the public simply paying for this outsourcing, there are significant extra costs from the point of view of ordinary people because of the impact of profit. If we take the current under-resourced health system and say it is going to provide IVF, we are going to run into trouble because then we will have two-tier access, which is bad in all sorts of medical circumstances where time is of the essence, which is the case here. We will have a situation where, in theory, people could sign up for IVF, but they will be on a list for two or three years or for however long. As people who are going through it know, the chances of having a child successfully at a certain point, just drop precipitously in a year or two, makes a very big difference. Again, unless we provide for it properly and employ the proper staff and bring the knowledge in-house into the public system, then we are going to perpetuate a two-tier system.

This is linked to the question of the separation of church and State. It is not an accident that Ireland is the only country in the EU without public provision, considering the church dominance of our hospitals. The Catholic church remains completely opposed to IVF, yet the Government continues to want to effectively hand over ownership of the new national maternity hospital to the church. There needs to be separation of church and State and the building of a properly funded national health service, free from any church influence whatsoever. We must ensure that sufficient resources are put in so that everyone can have equal access. We are all born differently. That can create problems for certain couples, which means it is more difficult for them to have children than others, but with the benefits of modern medicine, we can go a significant way to helping people overcome those difficulties. We add an extra burden when we say people must have a lot of money or be able and willing to go into debt in order to do it. That is wrong. The Government can and should address it but, unfortunately, it looks like significant campaigning will be necessary to put pressure on the Government to do so.

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