David Cullinane (Waterford, Sinn Fein) | Oireachtas source

There is time and there are plenty of opportunities for the Opposition to hold the Minister and the Government to account, but there are also times when we must thank the Minister and acknowledge the work that has been done. The shining of a light on women's health, the establishment of the task force and the putting in place of this plan and strategy will really benefit women. I refer to measures being undertaken already, because action plans are not always implemented when they are published. The measures to be undertaken here will require ongoing interventions and some of these actions will be implemented over time. Already, however, we have seen investment in several areas and that is welcome. I commend the Minister on his work in this area, and all those in the Women's Caucus and the task force who looked at all these measures.

The Minister would accept, I think, that we were all left a legacy from previous Governments. This was not a good society for far too many years when it came to women's healthcare. There have been far too many tragedies and crises, far too many things happened that should never have occurred and far too many women were let down. This aspect must be acknowledged as well. The Minister will also acknowledge there is still more we can do and that we can always build on the strategy he launched several weeks ago and which is the subject of this debate. Therefore, I welcome this opportunity to speak on issues in women's healthcare.

I start with the topic of women and the menopause because it is an area on which I published proposals several weeks ago. Between November 2021 and January 2022, I conducted a survey to hear directly from women about their experience with menopause and their access to supports and healthcare services. More than 1,000 women gave their perspectives and shared their personal experiences of supports, treatments and the general impact on their health in this context. We heard from women from right across the island, north and south. The survey results showed that 98% of respondents believed, at that stage, that the Government was not doing enough to support women experiencing menopausal symptoms. I am sure the task force found similar views were expressed when it was doing its research and work, because this was something we were not talking about and it was a taboo subject.

We were not doing enough in this area and there were not enough supports. Even in the context of awareness in the medical fraternity, much work remains to be done. I can understand completely where women were coming from in respect of issues in the workplace, access to proper supports and primary care and the absence of specialised clinics and staff. The fact that we have started to move in the right direction in this area now is testimony to that. We must, however, admit and acknowledge that up to that point we were failing women going through the menopause and not doing enough to support them. Some 88% of respondents also felt there was still a stigma in Irish society about discussing this issue.

Because of this, many women are not comfortable discussing their concerns with their doctors. Some 85% of survey respondents do not believe healthcare professionals in Ireland are equipped to give advice on those issues. Many doctors themselves will admit they are not equipped because they have never had the opportunity to learn.

There are a number of things we can do in this area to build on the work that the Minister has done. We need more clinics. We need more of the support hubs, which have been established. There are a number of very good hubs that are up and running already. We could do with many more of them throughout the State. We need to expand out and learn from the clinics and the hubs that are in place and look over time at how we can expand them throughout the State.

We also need to look at hormone replacement therapies, HRT, and, first, at the supply issue. It is my understanding there is a shortage. In some areas there is a crisis. Will the Minister focus on that to ensure the HSE is alert to that and it is responding to make sure we have proper supplies of treatments, medications, gels etc.? We also need to look at all the other wraparound supports women need. I would add supports in the workplace to that. That is important. One of the issues that came back strongly to me was the absence in most HR policies of any reference to the menopause, such as to symptoms, awareness, training for staff and training for managers. There is a general lack of support. It is not, for example, part of any sick pay entitlements in most organisations or under most employers. We have not put a focus on this, and I think that we should.

I want to deal with the issue of endometriosis, which I know the Minister has discussed several times and something on which he wants to see movement. A number of women have spoken to me about living with endometriosis which went undiagnosed as a result of the same problems: a lack of awareness and training among clinicians, being bounced across waiting lists for years, and only being diagnosed when they were lucky to get the right specialist.

Sometimes an unfair burden is put on GPs, and I know there is a really heavy workload. The Minister and I have spoken about the need to reform GP contracts and to make the contracts more fit for purpose for a modern GP practice. General practice has changed for the better, in my view, but GPs are doing an awful lot more and there is always training required. When it comes to women's healthcare, however, and to those two areas I have referenced, there seems to be a dearth in knowledge and understanding among some GPs and some healthcare professionals. It is important the HSE puts a focus on that and the Irish College of General Practitioners, which I understand would have a role to play in this, would provide the training to make sure women have proper supports and, most especially, when they go to see their GP, who is very often the first point of contact, the GP understands the issues, the needs and what supports are in place in order that the GP can make the referrals and ensure women are on the right treatments, which is very often not the case.

I genuinely commend the Minister on the work he has done and the spotlight he has brought to this issue. He has not just shone a spotlight on it but has taken real, concrete actions. I have no doubt much more will have to be done in the time ahead.

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