Erin McGreehan (Fianna Fail)
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I welcome the Minister of State, Deputy Rabbitte, to the House. Before I address my Commencement matter directly, I welcome the announcement from the HSE this morning that women will be able to have their partners present at anomaly scans. I have been one of those women who has received the worst news from one of those scans. It is coming up to the fourth anniversary and there is not a day when I do not think about that little person. It is great that women going through similar experiences, and who will get similar news today and in the future, will not be alone.

I submitted this Commencement matter issue mainly from frustration and impatience. From personal experience over many years, I have wondered if women are being listened to in the Irish healthcare system. In all the history of our public health system, we have not seen waiting lists like this before for gynaecology services. The latest figures from the National Treatment Purchase Fund, NTPF, show that there were 4,446 patients on inpatient day case waiting lists for gynaecology procedures at the end of October, and around 1,200 of the patients waiting nationally have been waiting for longer than a year. This number has increased by 200 in 2020, and by more than half in the last five years. The number of people waiting for more than a year to see a consultant almost doubled in 2020 and has increased by more than 1,000 in five years. These waiting lists are causing Irish women, young and old, to be exhausted.

I wish to highlight a specific illness called endometriosis. The lack of care, diagnosis and treatment for this illness is atrocious. Women can wait for up to nine years for a diagnosis, and that is if they persevere and do not give up and think that what they are experiencing is just normal. It is not normal to be in pain at any time of the month and endometriosis does not just cause difficulty during menstruation, it can cause difficulties and pain all month long. I suffer with this illness. I am standing here in absolute agony, as it happens, but many women around the country are in the same position as me and go through their daily lives in pain which is usually untreated.There is not enough awareness and there is not enough training. I have heard horror stories from women who have been told that they have imagined this and to take painkillers or go for a run. That advice is all very well and good if one is fit to go for a run and not crippled in pain. Such advice is very insulting to say the least and something drastic must be done. Women are being ignored, women's chronic pain is being ignored, and illnesses are not being diagnosed so, therefore, are not treated.

I am very aware of the HSE's national women and infants health programme that seeks to help the majority of patients with endometriosis and other gynaecological problems by improving their access to gynaecological services. However, from the previous figures that I have stated, serious efforts must be made to meet the demand for gynaecological services. We cannot help diagnose patients if there is an outstanding demand for gynaecological services. I look forward to hearing the details and actions, hopefully, from the Minister of State about the Department of Health's plan to increase capacity, reduce waiting times for women awaiting gynaecological appointments, update us on phase 1 of the model of care and a timeline for the opening of new clinics.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising this matter. I am replying on behalf of the Minister for Health so the answer I will articulate is directly from his Department.

The demand for gynaecological services consistently outstrips supply, with increased waiting lists being experienced across all service delivery areas. I am advised that in an effort to improve access and ensure a more sustainable gynaecology service, the HSE's national women and infants health programme has developed an ambulatory gynaecology model of care. It is envisaged that the implementation of the model of care will help to reduce the waiting times mentioned by the Senator for women awaiting general gynaecology, including patients with endometriosis. The new model of care involves the establishment of one-stop see and treat ambulatory gynaecology clinics. These clinics will help to ensure that gynaecology patients receive safe and appropriate treatment, reduce the need for multiple appointments, ensure a more effective use of public funds and improve clinical outcomes.

I understand that approximately 70% of general gynaecology referrals are suitable for management in this new setting. Moreover, redirecting appropriate cohorts of women for care in an ambulatory setting will bring direct downstream benefits by freeing up scarce resources in acute hospitals, such as gynaecology theatres that could then be used for more complex procedures. In addition, given the need for health services to continue to provide safe and appropriate care in the context of the ongoing pandemic, ambulatory gynaecology provides a real opportunity to move services into a community setting, thus avoiding the need to bring patients to a hospital where Covid-19 might be prevalent. It is welcome that we are starting to treat women in their communities and not looking on these issues, which have been raised this morning, as something special that necessitate a visit to hospital because we should deliver services in a community setting.

I am advised that the roll-out of phase 1 of the new model of care commenced this summer with the establishment of the first three clinics under the governance of the Rotunda Hospital, Dublin, Cork University Maternity Hospital and University Hospital Galway. In addition, a more limited clinic is being developed in University Hospital Waterford. I am informed that the ambulatory gynaecology clinics in Cork and Galway are already providing services. It is anticipated that the Rotunda clinic will be operational in the new year once the necessary refurbishment works have been completed.

The implementation of this model of care directly reflects the Government's commitment to promoting and improving women's health, as highlighted in the programme for Government. Under budget 2021, funding of €12 million has been provided for maternity and gynaecology services. I am advised that a proportion of the funding will be used to develop up to five additional ambulatory gynaecology clinics next year. I am sure that the Senator will seek these services to be provided in her area with the assistance of Our Lady of Lourdes Hospital in Drogheda. Subject to funding availability, and in accordance with the model of care, it is envisaged that up to a total of 19 ambulatory gynaecology clinics will be rolled out across the country on a phased basis in the coming years. As this House will appreciate, the development of these key services will help to alleviate the significant pressure and extensive waiting lists for this key women's health specialty.

I welcome the news today that partners of women can now attend 20-week scans. That is something that all Members of this House, both male and female, have articulated since we returned here last September. They pleaded for compassion to be shown at the special times of one's life whether it be for good or not so good news but such support had to be recognised.

Erin McGreehan (Fianna Fail)
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It is great news. As the Minister of State has said, €12 million has been set aside in the budget for gynaecological services. She has also highlighted the good news about the provision of three new clinics and that 19 more clinics will be rolled out. However, I insist that we do not take the foot off the pedal.

Anne Rabbitte (Galway East, Fianna Fail)
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I am going to read out the concluding statement of the Minister for Health. I would like to emphasise that developing the gynaecology clinics is integral to improving access to services and reducing waiting lists for the specialty. I can confirm that the roll-out of the new model of care is under way with a number of the clinics already up and running.

Finally, on behalf of the Minister, I wish to emphasise that developing and improving gynaecological services is just one aspect of this Government's broader commitment to promoting women's health. This includes supporting the work of the women's health task force, including the development of a women's health action plan to tackle a wide range of issues that impact on women's health outcomes in Ireland, including gynaecological health. The task force priority will be supported by the budget allocation of 2021 and an allocation of a dedicated €5 million to the women's health fund. This funding is in addition to the €12 million provided in the budget for maternity and gynaecological services development in 2021. I am sure that the Senators are glad that I read out the Minister's concluding statement.

Mark Daly (Fianna Fail)
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I thank the Minister of State. I thank Senator McGreehan for raising the issue and bringing her own personal experience to the floor. I hope that all of that will bring impact and change for other women who are in a similar situation.