Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael) | Oireachtas source

I genuinely want to try to respond to everything I can. I will preface my remarks by saying that I do not know the answer to everything, but I will try to get better answers as I get further into the brief and things come more naturally to me. I will honestly try to give the best answers I possibly can. I will also try to give very honest answers because I do not think there is anybody in this room who does not want to see the health service improve over time. There is no disagreement on that. There is really no difference between us in wanting to see it improve. The only difference is that I am responsible for paying for it, so I have to be honest about how we can do that and by how much we can increase the budget.

Many of the issues that were raised involve a price tag. While I want to say "Yes" to everything, it is just not realistic or possible for me to do so. I want to be honest about my approach, which is that I want to extend everything as much as possible. However, I also want to try to get the best value for what we are doing. For example, many Senators referred to screening in general and to extending the age limits in respect of, for example, with BreastCheck. We looked at this in the development of the programme for Government in the context of wanting to broaden the age thresholds. We quickly realised we are not clinical experts and it is probably better, as we review these schemes - which is stated in the programme for Government - to take the advice of clinical experts on the best way of doing that. Do we, for example, simply extend BreastCheck in terms of ages? What would be the best ages? How would we capture that in the best way? What are we doing in respect of lung cancer? What is the position when it comes to bowel screening? How are the different cancers picked up at different stages?

I am not a clinician, so there is a process to be engaged with in that context. All those things cost additional money but, in many ways, they have saved us enormous hardship, most importantly, in terms of patient care, and saved us money in terms of treatment. We have to make sure that as we make choices – they are definitely choices – we get the best return for our extended investment in the healthcare system. I will be very honest about all of those things over time.

Many different points were raised, and I want to try to respond to them appropriately. I will deal with HRT first because many Senators raised that. There are two primary issues with HRT. The first is the shortages involved. Specifically, we are talking about HRT patches, in particular, Estradot, which is in short supply. That comes in four different versions or doses. There is a certain amount we can do, and then there is the reality as well. The issue is not access to this drug, as it is with other drugs, for example, where it has not been licensed or anything of that nature. The issue is demand, the growing demand across Europe and the manufacturer’s ability to produce it quickly enough to meet demand, not just here but across the Continent. I am getting updates about the availability of the different patches. The 37.5 mg, the 50 mg and the 100 mg patches should all be resupplied by 7 March. Regarding the authorisation holder, we cannot get an estimated date of return for the 75 mg patch. Senators can see how case by case it is. That is a difficulty. I do not wish to be dishonest in any way. Strictly speaking, the Government cannot override that shortage of supply. We can do everything we can to try, but, ultimately, we are suffering in the same way as the rest of Europe is in respect of the availability of certain medications and how that changes over time. I will always try to get updates and provide information. This is where the expertise of pharmacists is very important. They have - not in every case but in some - been able to find alternatives that have long since been licensed medications to try to support some, not all, women while shortages obtain. I just want to be honest about what is possible.

The second piece, correctly, relates to the cost of HRT. It is important to distinguish something. The former Minister, Stephen Donnelly, secured €20 million funding to cover the cost of the HRT products. That did not include - Senator Tully inquired about this - a GP scheme, nor did it include funding to cover pharmacists' dispensing fees. Those are different. The State has not done that before. I refer to these incremental initial steps. I think the former Minister wanted to pay for the medication as a contribution to reduce the cost. I spoke with a woman yesterday who is getting HRT, as we all do in our different areas, and who paid about €60 for two products. On her receipt, it just says €60 – or whatever the cost – and it names the medications, the number of pills and the dosage, whatever that happens to be.What it does not say is the cost of the medication or the dispensing fee charged by the pharmacist for each medication. For example, in a scenario where the cost is €60, perhaps the medication costs €10 for one product and €30 for another with a €10 dispensing fee for each product. This scheme has been available for implementation since 1 January to cover the cost of medication, not the dispensing fee. It is the first time this has happened but there was a reluctance to implement it.

I met the IPU on 11 February and have been engaging with it since then. There is a huge opportunity here and I would love to speak with the Senator further on this. Pharmacies are a bit like credit unions in that they are in every town in Ireland. Pharmacies could have a much greater and expanded role in healthcare in terms of diagnostics, prescriptions and common conditions. I am really excited about the opportunity for pharmacy and I met the IPU about this. There is a huge body of work to do to support pharmacists a little more than we have been - there is no question about that - to go further in our ambition on what pharmacy can do, as well as to resolve this. In fairness, this is the first time the question of a dispensing fee has come up.

It is not within my budget. I do not have a budget to cover a dispensing fee but I am genuinely trying to find a space in the middle that enables the implementation of this scheme as early as possible, which certainly will cover the cost for medication and then we will see what else is possible. I want to be transparent. The cost of the medication has always been available to be free since 1 January. I hope that answers the fair questions people have asked. It was never to cover all the cost; only the cost of medication. I have gone back to check this a few times but I appreciate how these things sometimes may get lost in translation.

Senator Flynn highlighted women in prison and some of the more intersectional issues. She is quite right and I will address this in terms of some of the issues of more marginalised communities. Women in the Dóchas Centre prison suffer in particular with addiction and mental health issues. I was on the penal reform committee of these Houses before I became a Minister and this is a serious issue. I have asked my officials to try to engage with Dóchas to find ways that I, as Minister for Health, can lean in and do better for women in the prison, particularly in recognising the impact very short sentences have and in respect of the inability to support and treat people over time. Women coming in and out of Dóchas - which they typically do based on the sentences they get - means it is very hard to get any further in terms of providing supports. Two years ago, I was in the new women's prison in Limerick- and we hear all sorts about Limerick Prison. What struck me was the dentist chair there. It really spoke to me about the violence many women had experienced before they ever got to Limerick's prison for women prison and how important dentistry was as an immediate support tool to women coming in. There is probably a no more marginalised group than Traveller women in prison. If you look at the statistics - and I have raised it again and again - Travellers are much more likely to be imprisoned, both the Traveller community in general but particularly Traveller women. It is important to recognise some of the sharp realities of life there.

Several Senators correctly raised eating disorders. I met Deputy Butterly, who was here last week and spoke so eloquently on the radio about her daughter - I think her name is Jennifer, forgive me if I am wrong. I also spoke at the Bodywhys conference, which was an international conference with speakers from London and the Netherlands who provided evidence-based research on early intervention initiatives. They have been doing very interesting research. I recognise, however, there is a need for more supports. I wish to highlight and recognise the Minister of State, Deputy Butler, is doing a lot work on both adult and children in this regard. It is important to recognise that. The new children's hospital - which I visited last week - will have 20 dedicated CAMHS beds, with eight of those beds dedicated to eating disorders. This will be an important step. There will also be 14 of the anticipated 16 multidisciplinary eating disorder teams in place around the country in 2025. We have another two to do there.

Regarding the pelvic floor issue raised by Senator O'Loughlin, I visited St. Michael's Hospital this morning, which has a dedicated unit that opened in December 2024. I am told it is working well in meeting some more of the need.

There is a balance around the issue of IVF and AHR. An amending Bill is needed to tidy up some of the necessary work but it is also important to get the authority established and do this all in one go within this calendar year. I should have said at the outset, however, that I really appreciate everyone's engagement and ideas because I have learned so much from all the Senators here today. There is a body of work to do that will extend eligibility a little more. Once the authority is established, it will enable same sex couples to begin accessing services. It is important when we consider where we go best on furthering eligibility, that we look to the scientific evidence of where we are likely to get the best outcomes first, rather than looking to our constituents or our hearts in the first instance.

Some Senators raised the issue of carers. It is really important to highlight carers. Senator Tully and I were co-chairs of the Oireachtas family carers group and during that period, the disregards for carer's allowance were extended considerably three times, for both the savings disregard and the incomes disregard. We must take this further. We all want to get to a point where there is no means test for that but we also need to look at priority. As the Senators are aware, in my own constituency and others, we deal with carers who are all doing very different things. Some are providing 24-7 care, while some are doing other things. Some carers are caring for one person and others are caring for two. There are very different measures of need in this and while the body of work is really for the Minister for Social Protection, I recognise people have very different experiences.

Cavan termination of pregnancy services will open on 31 March. Regarding pregnancy loss, we did a fair bit on this in the past Oireachtas in extending and making available statutory entitlement to leave and after 24 weeks, people are entitled to a full maternity leave. It is not much but it is some support to recognise the pregnancy. Many female Members of this House and the Dáil spoke on that. I am glad to hear the continuation of that being highlighted. It is such an important issue for - as the Senator said - one in four women. There are many in this room who share that experience and it is important to highlight that loss.

Senator Higgins raised the more international piece and she is quite right to do so. I had one line in my speech on this. Yesterday, I met Marcos Neto, UN assistant secretary-general. I have been meeting him over a long period as we are trying to get the United Nations Development Programme office for sustainable finance to be based in Dublin. We have been working on this for a long time with the former Minister, Eamon Ryan, in the past Government. I am sure the Minister for Finance, Deputy Donohoe, the Tánaiste and Minister for Foreign Affairs, Simon Harris, and the Minister of State, Deputy Richmond, will be supportive of it. Mr. Neto has said Ireland is one of very few countries around the world expanding its overseas development aid budget, in contrast with many European countries. We should all remember that. While we should of course be doing that, this is in contrast to many others who are making significant cuts.

As one of those countries, I am speaking next week to the United Nations Commission on the Status of Women. It has never been a more important time to highlight women in the United Nations, especially with all the changes currently happening in diversity, equality and inclusion all over the world. I want the Senators to know what I am doing on their behalf. I have a bilateral meeting with Sierra Leone. Botswana, Malawi and Ireland are trying, as a trio, to rejuvenate this whole process and to rejuvenate the Beijing Declaration and Platform for Action on genuine equality between men and women. I have a side event, called the "Socio-economic consequences of early Pregnancy in Latin America and the Caribbean; A Call for Policy Action", where I will speak with colleagues from Panama, Costa Rica and the Dominican Republic. We have another really important side event, called "Women in Gaza: Rising for Freedom and Dignity", organised by the League of Arab States together with UN Women. I thank the Senator for highlighting the war crimes happening in Gaza and Ukraine in respect of sexual violence and the targeting of medical facilities. I have a meeting with Karama, a network of civil society and activist groups from the Middle East, and with Concern and have a number of other events. To highlight to colleagues what is happening on an international basis, we are increasing our overseas development aid budget and we are engaged on a multilateral basis to try to lift the experience for women around the world and not just in Ireland, although, of course, our focus starts here. Have I forgotten anything?