Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I very much welcome today's Private Members' Bill and the opportunity to discuss the very important topic of assisted human reproduction. I will begin by recognising the work of the two Senators sponsoring today's Bill, Senators Fiona O'Loughlin and Catherine Ardagh. Both Senators have worked tirelessly in advocating for these new services in women's healthcare, for new investment, and for urgent progress to be made in the provision of fertility treatments and services, including advanced treatments such as IVF. I have just been passed a sticky note with "Urgent IVF" on it. It is happening at formal and informal levels.

I add my voice to the commending of Senator Ardagh on sharing her own journey. It is interesting to hear language such "stigma" today. There should be absolutely no stigma around fertility, no more than there should be around any disease in healthcare. Nonetheless, when Senator Ardagh started to share her journey, it was not something that was commonly spoken about. One of the roles we must all play as Members of the Oireachtas is to normalise topics and issues that should be normal, such as menopause, endometriosis and many other issues. I commend Senator Ardagh on sharing her journey because these things are not easy to do. I acknowledge the broad political support there has been and continues to be across the House for the investment in and roll-out of new, modern healthcare services for women. When I was appointed in 2020, I made it clear that we needed a revolution in women's healthcare. We were not interested in things getting a little better year after year. Our ambition has been and still is to move faster than ever before, make up for decades of underinvestment and provide new services and financial supports in many important areas, including menopause, gynaecology, endometriosis, contraception, maternity services, breast-feeding, perinatal supports for both physical and mental health, eating disorders and, of course, the subject of today's Bill, which is fertility.

To that end, we have invested in women's healthcare at a completely new level over the past three years. In 2021, I allocated €17 million for new developments, followed by an additional €31 million last year and a further €50 million this year. Taking those allocations over the past three years into account as well as the full-year costs, by next year, before we add any new development funding, there will be a new €150 million in base funding for women's healthcare services that was not there three years ago. Great credit is due to Senators for their political support, to the many people in civil society for their ongoing advocacy and support and to the officials in my Department, the HSE and our clinical partners around the country. As a result of their efforts, we are seeing that money turned into what matters, which is the provision of new services for women around the country. We have more obstetricians, gynaecologists, midwives, nurses and health and social care professionals in post. We have new breast-feeding clinics, a new national network of same-day gynaecology clinics, perinatal teams, new training and supports for GPs, new specialist endometriosis and menopause services, which is really important, and, of course, we have a new national network of six regional fertility clinics.

These clinics are beginning this year to introduce fertility services for intending parents, both men and women. As their number is scaled up over the years, we will build towards our ultimate goal, which is to provide advanced assisted human reproduction treatment, including IVF, on the basis of fully public provision. We all know people who long to become parents and who are faced with the difficult reality of fertility issues. Providing financial support to assist couples to avail of assisted human reproduction treatment will make a real difference. It is a complex issue that requires careful consideration. Critically, we must ensure decisions are evidence-based and have due regard to patient safety, good governance and appropriate regulation. We must also ensure the provisions in the Government's Health (Assisted Human Reproduction) Bill 2022 meet international precedents and that good practice is considered.

My Department and the HSE have looked to other jurisdictions to establish what is working best. It is important to note that in Ireland, potential demand has not been definitively quantified and is likely to increase as the services becomes more widely available and less expensive for those looking to avail of them. We may need to adopt a phased approach, ensuring resources are directed to the greatest benefit of those seeking treatment. The plan for providing advanced AHR treatment will involve using private providers while building up the public capacity. Work is well under way on finalising the drafting of the Health (Assisted Human Reproduction) Bill 2022, which I hope to have passed through all Stages during the summer term.

I acknowledge the huge amount of work undertaken by the two Senators in putting together today's Private Members' Bill. As Senator Ardagh said, they initially met with officials in my Department in 2020 and have been working closely with the drafters to ensure they put forward technically robust and well-drafted legislation. The Bill, in essence, seeks to establish a body, the assisted human reproduction treatment advisory committee, to "advise on criteria for eligibility for financial assistance with assisted human reproduction treatment". I fully support the broad intent behind the Bill, including that there be secure, recurrent funding within the HSE for AHR treatments this year and into the future.

I am happy to inform the House that I instructed my officials last year to begin to gather exactly the sort of expert input the Senators have rightly called for in their Bill. A significant body of work was undertaken to develop eligibility criteria. I have personally met with HSE clinicians, private providers, patient advocacy groups and Deputies and Senators to discuss the issues. There are open lines of communications between the advocacy groups, clinicians, private providers and my Department as we seek to do two things, namely, finalise technical aspects of the Government legislation and draw up eligibility criteria. The expert work rightly called for in today's Bill is well progressed. Where we have got to, which is a seven-month timed amendment, makes a lot of sense. The Bill is important and, if agreed by the Seanad, will act as a backstop to ensure that exactly the work that is being called for is done.

The Health (Assisted Human Reproduction) Bill 2022 would have gone through all Stages and been passed last year if not for the changes requested. I was asked to pause it in order to bring in what are extremely complex and important surrogacy amendments on Committee Stage. As such, I am slightly taken aback to hear criticism from Sinn Féin of the timelines. That party, along with others, asked me to stop progressing the Bill in order that the surrogacy amendments could be added. I agreed to do that. It is disappointing to have the same people who asked for the timelines to be delayed now criticising those delays.

I was also disappointed by the contribution of Senator Seery Kearney, including her clear criticisms of officials in my Department and those drafting the legislation. The Government Bill would have passed last year, as I said, if not for the requested changes. The Senator noted we are still working on parts of it, which we are. We are doing so because the people who would have been engaged in finishing it moved to doing the complex work involved in the surrogacy amendments, for which the Senator has powerfully campaigned for a long time. I put it to Senators that if the House asks me to pause legislation and redirect the resources of my Department to amending legislation that is incredibly complex and that normally would take several years to work its way through the system, and if the officials in my Department, with my oversight and with a strong push from both Houses of the Oireachtas, seek to have that done in a shorter time, then I do not think we should be criticising them. It is very unfair on the officials to do so and it is a bit rich.

The amendments are being finalised. The Attorney General's office is looking at them with a view to signing them off. I will then bring the Bill back to the Cabinet for final agreement, after which I will put it, including the amendments that incorporate the substantial new work on surrogacy, to the health committee. The latter will decide when it wants to take Committee Stage. I expect it will be an intensive debate. My hope, for the reasons on which we are all in agreement, is that the committee will take Committee Stage quickly and the Bill will then go forward for Report and Final Stages in the Dáil and Seanad. I hope we will get it through in this term. It needs to be in place from September.

IVF services will be provided initially by private providers. It was proposed to me that rather than using private providers, we should have public-only service delivery. However, it would take many years to scale that up. I made the call that we will do both in parallel. We will begin immediately to scale up public provision because that is ultimately the way we want to go.In the meantime, we cannot ask intending parents to wait three years, five years, seven years or whatever it would take to build up these services, so I have allocated a very substantial amount of money to help with subsidising care from this September.

I acknowledge that many colleagues are saying there are intending parents all around Ireland waiting to know if they will they qualify and, if they do, how much of a subsidy there is going to be. I want to say two things on that. First, I acknowledge there are a lot of people waiting and we are therefore moving that on as quickly as we can. Second, as soon as I have a draft on that, I will be discussing that with colleagues in the Seanad and the Dáil to make sure we get it right. Inevitably, some people will be very happy and, inevitably, some will fall outside of the criteria and may not be so happy, but we are going to have to make some calls around qualifying criteria, as they do in every country.

I would like to talk briefly about the model of care more broadly because there is a lot more happening as well as IVF. It was put together with my Department and the national women and infants programme. There are three stages, starting in primary care with GPs, and a lot of additional support has been put in place for GPs. Second, we have secondary care in these new regional fertility hubs and then, where necessary, tertiary care, IVF, intracytoplasmic sperm injection, or ICSI, and other advanced treatments. Phase 1 has involved the establishment of these regional fertility hubs, and these are there to manage a significant proportion of patients. We talk quite rightly in the House about IVF but, in fact, the majority of patients will not need IVF and they will need these secondary treatments, and that is what the national network of regional clinics is for. The completion of phase 1 is envisaged later this year, so there has been a lot of progress from a standing start last year. We will have six fully operational regional fertility hubs around the country.

Phase 2 is the introduction of the tertiary fertility services, including IVF, through the public health service. In this regard, funding was allocated in the budget to support access to advanced assisted human reproduction, AHR, including, crucially, to allow the commencement of phase 2 of the model of care. This investment will facilitate the first steps to be taken towards the provision of the publicly funded service. In particular, it will allow the historic development of the first national advanced AHR centre, including IVF and ICSI, through a wholly public clinic, and I am happy to say that is scheduled to be open next year, in 2024. Subject to the provision of additional funding in the future, it is envisaged that additional advanced AHR centres will be developed and become operational on a phased basis around the country. The allocation for this year is being utilised to support the regional fertility hubs to expand their scope of service by introducing, for example, the provision of intrauterine insemination, IUI, which for certain cohorts of patients can be very effective, less complex and less intrusive than some other types of AHR treatment.

It should be noted that the majority of the other jurisdictions which publicly fund do so on a partial rather than a full basis and that it is the norm internationally that such specific criteria as we discussed would be met. It is important to say there is already very significant funding for IVF in the country, and it might be more than we realise. First, as was pointed out, there are some very small patient cohorts for whom it is already provided. Second, there is a tax rebate for people who avail of services, which is modest but it is there. The one area where there is a very significant spend is on medicines. Fertility medicines typically cost thousands of euro and patients only have to pay €80, or €160 if the medicines are accessed over two months. Therefore, in fact, patients going through IVF already receive a State subsidy of thousands of euro per cycle and it is something we need to acknowledge. In fact, when we checked the amount for 2021 just for the fertility drugs covered by the State, believe it or not, €40 million had already been paid by the State for these drugs. Obviously, we are going to go significantly further than that, but it does tend to get ignored that, in fact, there is a multi-thousand euro contribution already being provided by the State.

I want to do a few things. First, I thank the two Senators for today's Bill but also, in particular and as important, for the ongoing support, advocacy and pressure at times for advancing fertility treatments and for advancing women's health services. I extend the same thanks and acknowledgement to the entire House because there is a lot of common ground across the House and across politics in terms of investing in women's health services, in fertility, which obviously is for men and women, in surrogacy and in a lot of different areas. Through the lifetime of this Government, we are on track to have fundamentally changed, upgraded, reformed and modernised fertility services and women's health services broadly throughout the country. I thank Senators for their ongoing work, support, advocacy and disagreement, where that is warranted, and no doubt sometimes it certainly is warranted.

My commitment to the House is that we are absolutely focused on bringing in IVF treatment this September. I met with the group just two weeks ago and the first and last thing I said to them was “September”. It is September. We will have the proposals in shortly on the draft eligibility criteria and we remain absolutely committed to making sure the State support for IVF and for the treatments, as well as for the medicines, which is already in place, kicks off from this September.