Marie Sherlock (Dublin Central, Labour)
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15. To ask the Minister for Health the number of women who have applied for and who have travelled abroad under the endometriosis surgery abroad interim scheme; and if she will make a statement on the matter. [17509/26]

Marie Sherlock (Dublin Central, Labour)
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My question is regarding the endometriosis surgery abroad interim scheme. We all want women to be treated in Ireland, and I know there is progress being made towards that. However, we can all agree we are some distance away from being able to see that in Ireland, both in terms of diagnosis and care. My question concerns the number of people who have applied under the new scheme and the number who have been treated, which is probably a small number. Since the new scheme was published I have had quite a number of people approach me because they are confused.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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We met women with endometriosis at the beginning of September 2025 and this scheme was put in place six weeks later. It was put in place for a specific reason, which was that we wanted to make access to surgeries as easy as possible. There are already two schemes, which are the cross-border directive and the treatment abroad scheme. In many ways those required women to pay upfront when what we wanted to do was pay the upfront cost for them. I understand we set up a dedicated two-year scheme to keep it in line with EU rules and that was launched on 18 October 2025. I need to be cautious with regard to patient confidentiality in my response but I can say that a dedicated email address was established. I think we have received approximately 80 communications with that email address. They do not necessarily relate to that scheme but to the operation of other schemes as well. It has provided a single point of contact, which has been useful because the information was too fragmented before. We have had 20 completed applications since it opened on 18 October and approximately ten women have travelled abroad for surgery under that initiative. That is not the total number of women whom we have supported to travel. We have also supported women to travel under the cross-border directive and the treatment abroad scheme because they have been at different stages of their care and have taken different approaches. This has opened up a scheme for people who want an upfront cost paid.

However, the focus on it through centralising it in this way has enabled a better conversation with the other schemes as well. There have been a number of different questions on it, which is natural with any new scheme, many of which we are smoothing out. This includes referrals by consultants and different issues. I met officials from the national women and infants health programme, NWIHP, and today I have the good fortune of getting to meet up to 100 endometriosis patients in the Department with clinicians.

Marie Sherlock (Dublin Central, Labour)
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The meeting last September was hugely important, and very welcome, but there was a large degree of alarm weeks later when the scheme was published that the names repeatedly mentioned at that meeting of the surgeons operating on women in Romania and Greece were not on the list. I have a very real concern that there is a lot of confusion about the most appropriate persons to treat complex endometriosis and that there is a large degree of deterrence, and women are not going to apply to the scheme or maybe they have engaged with the Department to ask questions about surgeons who are not on the list, and, ultimately, will be excluded from the new scheme. The reality is that we do not have numbers because they have not been properly coded in terms of who has been travelling abroad up to now and where they have been going under the treatment abroad scheme. That has been a real problem.

The second key issue I have a concern with is that the surgeons on the list are very much gynaecologically-focused but endometriosis is a whole-of-body inflammatory condition. My concern is that the list is very narrow, while being very long.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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When a new scheme is established, it must be done in a legally robust way. It is necessary to identify a reason these clinicians and not those clinicians are included. For example, the European Endometriosis League, EEL, and the British Society for Gynaecological Endoscopy, BSGE, criteria were picked. All of those clinics that were on those very defined lists automatically came onto the scheme. The clinics that the Deputy is referring to in Athens and Romania were not among those accredited by the EEL or BSGE. We said this clearly at the time. We asked NWIHP to engage further to see had they and could they meet the clinical standards to enable them to be within the scheme in a legally robust way. NWIHP has engaged with Athens and Bucharest. That process is not complete. I expect there will be some positivity and some negativity in relation to that. A relationship has also been developed with Bordeaux, which is, of course, much closer. There is a dedicated centre there and we are going to include that on the improved list. It is a live and iterative list that we are trying to develop all the time but it has to meet the clinical guidelines as well for our clinicians to refer people on to that scheme, which was one of the barriers in the past.

David Maxwell (Cavan-Monaghan, Fine Gael)
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I thank the Minister.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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We have to keep it clinically safe as well and within the rules for the future.

Marie Sherlock (Dublin Central, Labour)
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I appreciate that. Hopefully, we will agree that there has been an issue in this country in that the clinicians operating here have not fully understood endometriosis, so there have been barriers to referring on. There is a challenge in this regard. NWIHP has to have the confidence to be able to put centres on a list. The reality, though, is that women have had to find centres using their own wit over the past number of years to get the appropriate care. If any lesson is to be learned from this experience, it is that we need to listen to them in terms of where they have got the appropriate care. These are the women who have gone before and are currently seeking assistance now. It is not good enough just to say that we will solely listen to the clinicians in this country, because there has been an issue that they have not been providing the services that women have needed here. There is a circle to square. It is not acceptable that the centres that have been used are excluded, and I hope they will be added.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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If I were to come back and give the Deputy the specific reasons there might be a concern about one clinic, she might take a different view. Perhaps we might have that conversation privately, because I suspect she does not have the complete information that I have, which is not a fair balance. We might perhaps speak about that separately.

She is correct that in the past there was a reluctance to refer patients abroad because clinicians did not know where they were referring them to. That is a cultural issue as much as anything else but we have overcome that now. I would not, though, classify all clinicians in that space.

Marie Sherlock (Dublin Central, Labour)
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I did not-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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But the Deputy did. Let me just be careful. We have clinicians who have been taking their own time to go and see others through surgeries so that they might learn more. We have developed different education pathways and fellowships over the past number of months, particularly with clinicians who really wanted to do better in Ireland and access the opportunity to do better in Ireland. I want to support those clinicians who are taking those steps. On Friday, the Royal College of Physicians is hosting its first conference on endometriosis with the Institute of Obstetricians and Gynaecologists. This is because of the weight we have placed on its importance. It is about clinicians at the highest level in the institute and the college responding and putting their focus onto this issue. I have seen them step up, and I would love to see that acknowledged.

David Maxwell (Cavan-Monaghan, Fine Gael)
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With the permission of the House, we will go back to Question No. 12. Is that agreed? Agreed. This will be final question of this session