Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I very much welcome this motion to allow for amendments outside the scope of the original health insurance Bill. The amendments brought forward by the Minister will, if passed, provide the statutory basis for free HRT, as we have been told.

It is true to say that for too long women's healthcare has been sidelined but, thankfully, that is changing. There are still numerous examples of paternalism in our health service, especially in reproductive health, but the shroud of shame that reinforced that culture is certainly beginning to lift. The Minister should be commended on the particular interest he has in the area of women's health and the progress that has been made to date. Although there are many more important actions that still need to be taken, which I will return to later, it is important to acknowledge the initiative he has taken here. Notwithstanding this, the introduction of free HRT from January will have a significantly positive impact on many women's lives. That is very much to be welcomed.

For too many, the cost of HRT has been prohibitive. Most women who avail of HRT take it for two to five years and face prescription costs of between €30 and €70 per month, if they do not have a medical card. This new scheme should save those women up to €840 a year. That is very much welcome, but HRT comes in many forms and prescribing vastly varies based on hormonal profiles. That is why it is important that key stakeholders are engaged in the planning of this roll-out. Women and their representative groups must be also consulted to ensure the scheme is effective and tailored to their needs. Maybe that is happening already but it is very important. I am not aware of there being that consultation. Another matter that must be addressed is the shortage of HRT. I appreciate that this is a global issue and that the Minister has taken legislative steps to address medicine shortages. However, greater engagement with the relevant stakeholders is required to bridge this gap, in particular, with the Irish Pharmacy Union.

I will take this opportunity to speak more broadly on the women's health action plan and its implementation to date. An updated action plan for 2024-25 was published in April but it was not accompanied by a new implementation plan. Publishing a plan is well and good but delivery is obviously the key thing. I acknowledge that significant progress has been made on free contraceptives, menopause care and IVF, but I am very concerned about perinatal mental health. The new women's health action plan makes no mention of the long-promised mother and baby unit in St. Vincent's hospital. This was promised in the 2022-23 action plan. Some of us have noticed that it seems to have been dropped. What has happened to that? It is very badly needed. This new unit was supposed to have been delivered by 2023 but in a recent parliamentary question reply from the HSE, I was told that St. Vincent's does not have the space for it. This means that mothers who require admission to a psychiatric unit in the postnatal period will continue to be separated from their babies. That is unacceptable, as I am sure the Minister will agree. Given all the well-documented adverse effects associated with this practice, there should be no question of that happening. It is now seven years since this facility was first recommended in the model of care for specialist perinatal mental health services. Why has it taken this long to realise that St. Vincent's cannot facilitate it? What are the alternative arrangements?

Of course, one unit was not a very ambitious target to begin with, yet it is still being missed.

There are more than 20 of these units in Britain, for example, yet we do not seem to be able to provide even one for the entire country. The Minister needs to provide a new timeline for delivery of this vital perinatal mental health facility.

I also add my voice to the National Women's Council's call for a more targeted approach to women's health. The action plan needs a clearer focus on how the inequalities experienced by marginalised women can be addressed. This must include the social determinants of health. In some cases, we are talking about basic social determinants such as poverty, educational disadvantage, housing inequality and low incomes. They need to be addressed because they are a huge factor in terms of women, and indeed men in other cases, in being able to access care. We are also conscious of the commercial determinants of health, which, very often, work against well-being and good health status. The issue of the social determinants of health was dealt with extensively in the 2017 Sláintecare report, but it has not received the kind of attention that it deserves. While removing cost barriers is an important part of the solution, tackling the social determinants of health requires a cross-departmental and cross-government response, which was why the implementation office for Sláintecare was supposed to be in the Taoiseach's office, because most Ministers have a role to play in terms of tackling the social determinants of health.

I am also very concerned about the lack of progress on the legislative recommendations in the O'Shea review of termination services. The health committee published its report on this last December. Almost a year later, it is still only being considered by the Cabinet committee on health. Clearly there is no appetite to act on the health committee's recommendations to give effect to the O'Shea report without delay. The delay certainly has been very undue. At this stage in the Dáil term, with an election looming, it is hard to see that there will be any chance of these issues being addressed in advance of the election, and that is very regrettable. These ongoing deficits in women's healthcare will need to be the priority for the next Minister for Health. We certainly need to keep them on the agenda.

Insofar as this proposal goes in respect of HRT and making it available free of charge, it is a good initiative. There is a slight concern among some people who would say there is already quite a high prescribing rate for HRT. We need to make sure the Bill does not increase that rate. There are ways other than HRT through which women deal with menopause. That is absolutely fine. There is a lot of different thinking on that. It is important that it does not influence the approach the medical profession and women themselves take to menopause. It is a very welcome development, however.

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