Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I move amendment No. 1:

To delete all words after "Dáil Eireann" and substitute the following:

"recognises that: — endometriosis is one of the most common gynaecological conditions in Ireland and approximately one in ten women may have endometriosis;

— there is a wide range of symptoms associated with this condition and the burden of disease varies from person to person;

— some women may have endometriosis that goes undetected, while for others endometriosis can have a significant impact on their quality of life; and

— endometriosis is a chronic condition for which there is no definitive cure, many women with endometriosis require long-term care and treatment provided within a multidisciplinary care team; notes that: — the Health Service Executive established the National Women and Infants Health Programme (NWIHP) to lead the management, organisation and delivery of gynaecology services in Ireland;

— just over €5 million has been invested in developing endometriosis care and management in Ireland since 2021, and the Programme for Government commits to continue to support specialist endometriosis services;

— new development funding of €543,822 provided in Budget 2024, with full year costs of €2.175 million in 2025 is further expanding and improving these services;

— investment since 2021 has provided for 24.6 whole-time equivalent (WTE) staff;

— services are expanding as recruitment continues for a further 18.6 WTEs with the additional funding provided for this year;

— the recruitment process of these specialised posts will take time to complete;

— Ireland's first National Framework for the Management of Endometriosis, alongside the implementation of structured care pathways is in final development;

— in March 2025, the publication of the National Clinical Practice Guideline: Assessment and Management of Endometriosis, will support the delivery of evidence-based standardised care;

— investment in endometriosis services has provided for the establishment of two supra-regional centres in Tallaght and Cork and five regional hubs, providing specialist services in each maternity network across the country;

— regional endometriosis hubs operate from the Rotunda Hospital Dublin, the Coombe Hospital, the National Maternity Hospital (NMH), University Maternity Hospital Limerick and University Hospital Galway;

— the NWIHP has advised that all regional hub sites are taking referrals and providing treatment pathways for women affected by endometriosis, a specialist endometriosis clinic structure has been formalised in the Coombe Hospital, the Rotunda Hospital, and University Maternity Hospital Limerick;

— women are receiving care through the University Hospital Galway and the NMH regional hubs, while the formal structuring of these defined clinics is in ongoing development;

— endometriosis care is provided through multidisciplinary teams, these include consultant roles in colorectal, urology and radiology, along with women's health physiotherapists, dieticians, psychologists, specialist nurses and healthcare assistants, recruitment for these funded posts is actively ongoing to further expand specialist capacity;

— surgical treatment abroad, under the Treatment abroad scheme, is available when the necessary treatment is not available in Ireland or within the time normally necessary to get this treatment in Ireland;

— women may choose to avail of private treatment abroad; and

— women who opt for treatment abroad will be provided with ongoing care to manage their condition across the public network after they return; and acknowledges that: — psychologists play a key role in endometriosis care by helping patients manage chronic pain, emotional distress and the psychological impact of the condition, a psychologist has been appointed to support the supra-regional service at Cork University Maternity Hospital with further expansion of the service under consideration;

— the diagnostic criteria for endometriosis are determined by clinical experts in the field, the clinical guidelines and the framework emphasise individualised woman centred care rather than rigid staging;

— in line with clinical guidelines, general practitioners are encouraged to initiate treatment for suspected endometriosis, where symptoms persist or if symptoms are severe, timely referral to secondary care for laparoscopy is recommended;

— the NWIHP has advised that on average 72 per cent of women waiting on specialist services were seen within six months of referral;

— women affected by endometriosis may also be waiting on general gynaecology waiting lists, as of 26th June, 2025, 79 per cent of women waiting on gynaecology waiting lists are seen within six months and 97 per cent of women are seen within 12 months; and

— improvements in endometriosis care are an integral part of the overall transformation of women's healthcare included in the Programme for Government, 18 ambulatory gynaecology 'see and treat' clinics are currently operational with more in development as part of the Model of Care for Ambulatory Gynaecology, six specialist menopause clinics are currently operational for women who require complex specialist care, six regional fertility hubs will provide support to the estimated 47 per cent of women with endometriosis who will also experience related fertility issues.".

I greatly appreciate being facilitated, a Cheann Comhairle. It is most unusual for a Member to be allowed to speak a second time in these circumstances.

I move the amendment very reluctantly. I do not wish to criticise the motion, which has been put forward in the best of faith by Sinn Féin, but there are a number of references in it that we cannot allow to stand on the Dáil record. I refer specifically to clinical decisions, which are very important and may be relevant in some, but not all, cases, and absolutely are for the discretion of clinicians in the fields. In addition, there are some contradictory elements around not wanting women to have to travel abroad but also providing funding for women to travel abroad.

Acknowledging Deputy Danny Healy-Rae's point, I do not wish to be at odds or in disagreement with the House on this issue.

See this speech in context