Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

What is important for us is actually making progress on endometriosis and there is some progress taking place. The first major difference we have, and this does not account for the many years of underinvestment in and under-recognition of women's health, is that we have a dedicated women and infants health programme. That has made some difference to how maternity services are conceived. We have more work to do there. It has made some difference with regard to how menopause services are conceived and we have more work to do there. It has made some difference with regard to endometriosis and we have more work to do there.

We know, of course, that endometriosis is one of the most common gynaecological conditions. How this was under-recognised for so long is beyond me, when there are so many women presenting with such consistent symptoms. We know and recognise it and while our amendment does not go through the physicality of that in the same way the Sinn Féin motion does, I totally understand that. There is a huge range of very difficult symptoms and there is also asymptomatic endometriosis. There is a different spectrum of experience, and with the divergence, it is important that we listen to all of those experiences. It is also important that we respond to that complete spectrum of experience, some aspects of which can be responded to at GP level, while others need specialist intervention services. I have to try to make sure all of that is there.

Since 2021, we have invested over €5 million to expand specialist endometriosis services to provide treatment for women with moderate and complex endometriosis. There is an additional €2 million this year to continue to do that. So far, that investment has allowed us to recruit 24.6 whole-time equivalent staff, or 24 people and one part-time person. We have the funding. Specialist services are expanding further with the HSE recruitment process to recruit another 18.6 people, or 18 people and a part-time person, with the funding provided this year. We are more than halfway through that recruitment programme and there is no question about that. That is for some of the specialist services.

For most endometriosis cases, particularly at the less severe end - and I appreciate many of the people here are perhaps at the more severe end - most of the care can be provided by GP care. That requires GPs who understand endometriosis and listen to women who are presenting with these symptoms. It also requires having this dialogue in public. That is why it is so welcome that Deputies are telling this story as broadly as possible, as many women have been doing for many years.

The moderate and severe cases of endometriosis, however, may require - they do require it, in my view but it is a clinician's decision - referral to the specialist model of care. At the moment, as Deputies are aware, there are two services, one in Dublin and a more recent one in Cork. I visited the Cork service where I spoke with the nurses and doctors and some of the patients. I understand the care pathways and where that has yet to go. There are also five regional endometriosis hubs that many people will be aware of. For those who are not aware of them, they are in the Rotunda, the Coombe, the National Maternity Hospital in Limerick, in Galway and in Lee Road clinic. They are all operating and taking referrals. Women are receiving care through Galway and the National Maternity Hospital.

There is more work to do on the structuring of those clinics.

We now have clinical guidelines in relation to this. GPs are encouraged to initiate treatment for suspected endometriosis. They can and are encouraged to refer suspected cases through those different pathways. That all sounds very clinically-led, and it is, but it is about the visibility of this condition in GP services and GP surgeries, so that they know there are pathways where more complex cases can be progressed.

I understand more than 1,100 new patients were seen in 2024 and that, on average, 72% of those women were seen within six months, between August and December. More than 300 specialist surgeries were provided between August and December last year and another 200 in the first three months of this year. I know more needs to be done on that. However, it is important for me to put those facts on the record of the House.

Women with endometriosis may be on other gynaecology waiting lists. That is also important. There was an increase of 108% in general gynaecology referrals over the past number of years. I hope in part that this is some recognition of women presenting with their conditions and being listened to about their conditions and being referred onwards. There has been significant investment since 2021. It has enabled twice as many women to be referred to our gynaecology services with more than 80% of women waiting less than six months. As a woman, I would say that is still not enough. I have been Minister for a number of months and I have visited Cork and met with women who are really suffering from this condition. A lot more work needs to be done.

We have see-and-treat gynaecology clinics that you can walk into and be treated immediately. Those are having a real impact. I hear from women that they are making an impact on waiting lists and on women's lives. They are being seen and treated at the same time. There is work on related issues.

Let me address the national framework. For the first time in Ireland, we have this defined clinical pathway for women with endometriosis at the highest level expressed in the national framework for endometriosis. We are not finished with it yet. There is a body of work to be done to agree with GPs how they will fit in and how they will be part of that. That is not yet complete. There is more work to be done. Discussions are ongoing between the HSE and the Irish Medical Organisation, which represents GPs. I would love to be in a position to update the House on that in the next while.

There are important diagnostic criteria for endometriosis that are determined by clinical specialists but I do not have time to get into them. I want to address the particular question around motions and how they are dealt with. I appreciate the members of Sinn Féin will disagree with me as is their right. In any event, we take the opportunity to set out the different things that have been done. I do not reject any of the points articulated by the women here. We take a slightly different policy direction in one respect, which is that instead of one centre of excellence, we have decided to do it more regionally-----

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