Mary Butler (Waterford, Fianna Fail) | Oireachtas source

The Government has rightly decided not to oppose this Private Members' motion. The Minister, Deputy Stephen Donnelly, was in touch with the Senator earlier in that regard. This decision was made in light of the strong support of the Minister for Health and the Government for improving the health experience and outcomes for women and girls in Ireland.

It is fair to say that, as has been acknowledged here, progressing women’s healthcare has been a key priority for the Minister, Deputy Donnelly, the Department and the Government over the last three years. It is included in the programme for Government. The Ministers of State in the Department - now myself and the Minister of State, Deputy Naughton, and formerly myself and the Minister of State, Deputy Rabbitte, and the then Minister of State, Deputy Feighan - often comment that the Minister is surrounded by women in the Department and that we are well able to have our voices heard. I go back to the point on lived experience. However, I accept that it has been widely acknowledged that the area of women’s health has historically been under-researched and underdeveloped in many areas. We have been determined to change this.

The establishment of the women’s health task force in 2019 gave women’s health the attention it required. Significant investment combined with targeted supports, built on the foundations of listening and responding to women in Ireland, has led us to positive change. We were all struck by those Joe Duffy radio programmes over two or three weeks in which women got the opportunity, for the first time, to have their say. They felt they could come on and were very open in speaking about many private things that women did not previously have the opportunity to talk about. Senator Dooley referred to the fact that women were prepared to talk and have their voice heard. In 2021, the task force completed and published the findings of a series of listening exercises, which included a radical listening exercise to help us to understand where women wanted us to begin in tackling health inequalities. What we were told informed the ten key actions found in Ireland’s first women’s health action plan, which was published in March 2022.

Menopause is a key action within this action plan. The plan commits to changing the approach to menopause care in Ireland. It commits to increasing the public supports available to women before, during and after menopause. The women’s health action plan puts a spotlight on menopause. The radical listening exercises enlightened us on how the women of Ireland feel during what is often a most challenging time of life. I would like to share with Members what Irish women told us to help them to understand how important our focus on the issue of menopause is. The women’s health task force heard that menopause was a taboo subject and something not spoken about by anyone, which makes it an extremely isolating experience. It heard that women felt dependent on mothers, sisters and close friends to provide information where it was not available in the mainstream. A number of women reported feeling isolated, unsupported by society and dismissed. They said that their symptoms were not taken seriously. The topic of menopause “felt secretive and closed”, contributing to a “taboo or stigma”. Women reported under-recognition of symptoms of perimenopause and menopause in themselves. Some women said they were at a very low point during menopause.

The taboo and stigma around menopause have only recently been challenged through public discourse and Government action. In October 2022 and March 2023, a national awareness campaign was launched by the Department of Health with the message: “Let's take the mystery out of menopause. Let's talk about it.” The campaign ran across TV, national and local radio, streaming, online, social media and search. The success of this campaign is clear as two thirds of those surveyed told us that it increased their knowledge of the symptoms and impact of menopause. It is important that we continue sharing this message and continue to talk about menopause openly. As well as the awareness campaign, a dedicated webpage on menopause was launched on the gov.iesite as a one-stop shop for information on menopause. This is another step towards educating ourselves about menopause and the impacts it may have on women.

In addition to increasing awareness and education about menopause, new care pathways and services have been developed. There are now six specialist menopause clinics open and operational across the country. These public clinics are for women who have complex experiences of menopause. It is estimated that approximately 25% of women in menopause have these complex needs. The clinical teams within this setting also provide advice and guidance to GPs in the community to support the effective management of menopausal symptoms for women closer to home within primary care. These clinics are located in the National Maternity Hospital, Nenagh, the Rotunda, the Coombe, University Hospital Galway and Cork.

Women have often expressed feeling dismissed by healthcare providers when it comes to their menopause experiences so, in partnership with the Irish College of General Practitioners, ICGP, we have launched a quick reference guide for menopause. It provides practical and evidence-based advice on diagnosis, lifestyle interventions, safe prescribing, alternatives, testosterone therapy and more. This was published in October 2022. Since the publication of this guide, the ICGP has launched a menopause theory course, which is available on the ICGP education platform on demand. This course was launched in March 2023 and is currently available free of charge to all Irish healthcare professionals. The HSE’s national women and infants health programme is engaging the maternity networks regarding the establishment of a professional menopause network. It is envisioned that this network will be comprised of clinical leads in this area, with representation from the ICGP.

In addition to all of this progress, I am delighted to inform the Senators that, earlier today, a framework on menopause in the workplace was launched, as the Senator has referenced. This has been developed in partnership between the Department of Public Expenditure, National Development Plan Delivery and Reform and the women’s health task force.It provides an overarching structure to guide Civil Service organisations in developing menopause policies and identifies ways that they can support employees, such as offering practical workplace adjustments and supports. I was delighted to be part of the Dungarvan and West Waterford Chamber initiative in this regard. Last year, it was the first chamber of commerce to launch menopause supports and initiatives for women. It ended up winning a national award. I was delighted for that organisation because its members were prepared to speak out and speak openly about issues that are not always spoken about. The framework includes a policy template that can be adapted for use across the wider public service. This is a very welcome development. It is fitting that it has been launched today on World Menopause Day.

Menopause is not uniform and can present differently for individual women, both in symptom severity and duration. HRT is recognised as a treatment for many of the associated symptoms of menopause, for example, hot flushes and mood changes. HRT replaces hormones that are at a very low level in the body around the time of perimenopause and menopause. Not all women experiencing menopause may be clinically eligible for HRT, which is prescription based. Women may also choose not to take HRT and to address their symptoms through alternative therapies or lifestyle changes. It is important that women and healthcare providers are educated on the use of HRT and other options and that together they explore all the available options available to them. I understand from the HSE that while HRT is used as a treatment for menopause, it is also used as a treatment for other conditions across multiple clinical areas. These include the replacement of cortisone in Addison’s disease and the replacement of thyroxine in thyroid disease, for example.

On the cost of HRT, to assist those women who choose to take HRT, the HSE currently operates two schemes that offer financial assistance to people in receipt of prescribed HRT medication which are on the reimbursement list. These HRT medications are available to medical card holders, subject to the statutory prescription charge. My understanding is approximately 43,000 women are able to avail of HRT under the general medical services, GMS, scheme. Eligibility for a medical card is determined by the HSE in accordance with the Health Act. However, in certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces financial circumstances, such as extra costs arising from illness. Second, under the drugs payment scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines, which includes some HRT medications. Approximately 27,000 women receive support in this way. As mentioned, in budget 2023, VAT was removed from HRT to assist women further with the costs associated with HRT.

Menopause is just one area we focused on since the publication of the women’s health action plan. That plan commits to improving health outcomes and experiences for all women across the life course. A number of other significant developments have taken place. I will outline some of those. For example, we launched the free contraception scheme for 17- to 30-year-olds, which is being expanded to 31-year-olds in 2024. The opening of additional see-and-treat ambulatory gynaecology clinics brings the national total to 14 clinics. We have also opened six regional fertility hubs. There has been development of six regional endometriosis hubs and two supraregional specialist centres for complex endometriosis care. We have further developed on the sexual assault treatment unit across the country. We are tackling period poverty for the first time through the removal of VAT on period products and various initiatives with local authorities and NGOs.

The first time I heard period poverty being discussed was when my colleague, Senator Clifford-Lee, raised it. A significant number of issues related to women and women's healthcare are always discussed in this House. There is an opportunity, which is great. Somebody mentioned the word "menopause" was used in the House more than ever before in the lifetime of this Seanad. It is great there are opportunities to discuss such important health issues for 51% of the population. I thank each and every one of those Senators. I was also struck by the fact that while most of the speakers were female, it was great to hear the voices of men as well.

Implementation of the services I listed represents significant development and advancement for women's health nationwide. I know there is a lot more to do. My colleague, the Minister, Deputy Stephen Donnelly, is committed, along with the women’s health task force, to continue to drive progress in women’s health. This includes looking at all of the ways that we can achieve better health outcomes and experiences for women and girls in Ireland. I spoke to the Minister today regarding the motion, which I fully support. My understanding is that as we only had the budget last Tuesday, the recent budget allocation did not include the provision of this roll-out. The Department estimates it would cost between €8 million and €10 million. It is not an exact amount, but in the overall frame of things it is not a huge amount of money either, with all of us working together and pressing the Minister. The service plan for 2024 for the HSE obviously has to be worked out.

As I said, we are only a week out from the budget, but in the context of a budget of €22.5 billion, free HRT is value for money and would make a significant difference to an awful lot of people. I was struck by what Senator Dolan said about single mums and deprivation. You would hate to think that any person does not receive HRT because they could not afford it. Many people can afford it and can avail of it. Some 60% of the population have medical cards and doctor-only cards, which can help greatly, and we also have the drugs payment scheme. As a woman, I would hate to think that anybody who needed to avail of HRT would not be in a position to do so. I give a commitment that I will again speak to the Minister about it. It was great to hear all the voices on the same page today and women speaking for women.