Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank the Deputy. Our thoughts are with Aisling as she goes through her treatment programme.

On endometriosis, I want to acknowledge the many different groups that have engaged with endometriosis sufferers and the importance of all of that advocacy work. It was a step change to invite women to come into the Department when many of them feel that the Irish health system has so badly let them down. It was difficult for many women to come in and do that but we had to bring that experience right into the heart of the Department, for it to be heard very loud, very proud and right at the centre of policymaking, and to have the HSE there as well. I acknowledge how many different people have already said that.

Of course, the most important point and what is so important in relation to the GPs is that women are the most reliable narrators of their own experience. I need to say it again: women are the most reliable narrators of their own experience, not just on this but on everything. I am absolutely sick and tired of women not being listened to and not being heard. Part of the change with regard to GPs is to operate on a presumptive diagnosis piece and to really listen to women about the complexity of symptoms that can be there that are not necessarily menstrual. There can be constipation, UTI and a whole range of things that are not necessarily presenting as a menstrual issue.

All the Deputies are correct in what they say about the quality of diagnostics and surgery. Many women are getting an inadequate service at present. I recognise that and indeed, they have told me that. For many women, because of the complexity of imaging and diagnostics and the complexity of reading MRIs, we do not have sufficient consistent capacity in this State to that reliably. That is an area that I am trying to develop, both in facilitating international experts coming here to provide additional training and longer-term fellowships and pathways for improvements in diagnostics. I also acknowledge the advances in AI that will facilitate this over time. I have been researching that as well but nevertheless, there is a significant body of work to do. I would say the same regarding surgeries and the complexity of same, including in relation to excision over ablation. I recognise that is a clinical issue but we must move to a model where we are capable of doing very complex surgeries. We do not want women to get to the point where endometriosis is right throughout their bodies. It is important to recognise that it is not simply a gynaecological issue. It can present right through the diaphragm. I have met women who have had endometriosis in their shoulders, eyes, brains, right through their colon and it is a very serious, painful condition. The pain management specialists and supports need to be improved, as does the quality of the surgical capacity. I do not say this to be critical of surgeons but it is just simply not there yet. I know that surgeons have leaned in to wanting to have better collaboration and fellowships with the centres of excellence that exist around the world, although there is not enough of that yet. We are certainly not there yet and we need no congratulations of any kind in relation to this. This is a body of work that has begun and that we will sustain and develop over time. We are trying to seriously improve things but there is a long way to go yet and I fully acknowledge that.

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