Fiona O'Loughlin (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank my colleague, Senator Ardagh, for introducing this matter and we intend to work together on a Bill to address the present failings.

I wish everybody a very happy St. Brigid's Day. It is very fitting that today is her day because she was the saint of fertility. In her time she helped women who could not conceive and that is almost 1,500 years ago.

The World Health Organization is very clear that infertility is a disease and should be treated as such with absolute support. We all know people who have gone through the grief and heartbreak of trying but being unable to start their own family. In Ireland, people who cannot conceive naturally get very little or no support within the public health system. Those in need of IVF and other fertility programmes find themselves having to pay between €6,000 and €10,000 per cycle. At the moment, fertility drugs are only covered by the drugs payment scheme or a medical card and private patients can claim tax relief but that is it, and it is just for fertility drugs. The State absolutely needs to help with costs and medically in order that there is a continuity of care.

As my colleague has said, in 2017 the then Government approved a Bill that laid out regulations and a need for the establishment of a regulatory body. Then, in 2019, more details on a model of care were given but nothing has happened since. I acknowledge that the Minister for Health confirmed additional funding, supports and the opening of fertility hubs in budget 2021. We need a functional and fair State sponsored system that supports infertility and to be able to determine criteria and eligibility. I hope that he can achieve what his predecessor did not.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank Senators Ardagh and O'Loughlin for raising this matter and giving us the opportunity to discuss it this morning. I agree entirely with the comments of both Senators. We have an ambitious plan to progress this. It is moving. It is a very important commitment in the programme for Government. It is critical that couples who seek help for fertility, including IVF, are supported. We want to see them supported in the public health system. We want to move away from a situation in which for many people, it is not something that is affordable because of the huge costs. We want everybody to have the same chances regardless of income and that really is the goal in this regard.

As the Senators are aware, the programme for Government commitment introduces the model for care that was developed by my Department and the HSE. The model ensures that infertility issues will be addressed through the public system at the lowest level of clinical intervention necessary, which is an important principle. As Senator Ardagh has said, the model is comprised of three stages starting with primary care with a GP, extending it to secondary care through the setting up of regional fertility hubs and then, where necessary, tertiary care, IVF and other advanced human reproduction or assisted human reproduction treatments as well. Structured referral pathways will be put in place and patients referred onwards for further investigation or treatment as required and, of course, as clinically appropriate. I am glad to say that the roll-out of the model has commenced and involves the establishment at the secondary care level of regional fertility hubs in maternity networks. The hubs will facilitate the management of a significant proportion of patients presenting with infertility issues without the need to undergo invasive IVF or other advanced assisted human reproduction, AHR, treatments. They will accept direct referrals from GPs and will provide patients with more direct and faster access to teams who specialise in infertility, which is really important.The focus last year was on commencing the development of the first four of these regional fertility hubs. As Senator O’Loughlin has said, we now have additional funding to set up the final two hubs this year to continue with this roll-out. The final phase of the model of care roll-out will see the introduction of the tertiary infertility services, including IVF. I think this addresses a lot of what the Senators are saying today. Critically, this will be in the public health system, which is just so important. This phase will commence when the infertility services at second level have been developed across the country. This is what we are working hard on, that is, a clearer picture of the specific level of demand for tertiary treatment and the required resources allocated, as has been raised by both Senators.

The AHR legislation is commenced and the regulatory authority for AHR is operational so those are the steps we have put in place. There are a lot of steps to do this but we have got to really push it very hard. Drafting of the legislation is ongoing by officials in my Department, who are working closely with the Office of the Attorney General. The publication of the AHR Bill is a priority for this Government and its enactment is included in the programme for Government. It is really important that we do this.

It should be noted that while AHR treatment is not currently funded by the Irish public health service there is support available, as Senator O’Loughlin has said, for patients who access such treatment privately, for instance, tax reliefs on the costs but that cannot be the model. The model must be access through the public system and affordability cannot be one of the factors. Given the cost associated with certain fertility medicines there can be a material impact on the total cost of AHR treatment for those individuals who are eligible for, and avail of, the medical card or drugs payment scheme through their use of medicines covered under the high-tech scheme, which is administered by the HSE. Overall, the implementation of the model of care will help to ensure the provision of safe, effective and accessible fertility services at all levels of the public health system as part of a full range of services in obstetrics and gynaecology.

Fiona O'Loughlin (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am really pleased that this is a priority for the Government and have no doubt that many others are as well. I agree with the Minister 100%, this is about equality and equity of access to the support which some need to start their own families. Money should not dictate whether people have access to this treatment or not, as it currently does. We all know many who have remortgaged homes or indeed put off buying their own homes because they need to pay costs related to IVF. The Minister rightly said the service should be safe, accessible and effective. I have one question for the Minister. I appreciate that he has given us the chronological order but does he have a timeline for the third phase and the State helping support IVF? This is done, for example, in Scotland where three cycles are paid for by the State once a person has met the relevant criteria.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I again thank Senators Ardagh and O'Loughlin for raising the issue and allowing us to debate it. I should state that the drafting of the AHR Bill and the roll-out of the model of care really are a priority for the Government, for me and obviously a priority for the Senators who have advocated long and very well on this issue, which I thank them for. The drafting and roll-out have been subject to delays due to Covid. Obviously dealing with Covid has pulled the HSE and the Department every which way. It has impacted on the normal work streams and this has been one of them. However, I reiterate to the House that I am committed, as is the Government, to the roll-out of this model of care for infertility in line with the available resources. The end goal is to achieve full implementation of the model of care; that is what really matters and what we must focus on. That means patients always receiving care at the appropriate level of clinical intervention and those who require and are eligible for advanced treatment being able to get it through the public health system, which is so important. I hope this has been of assistance today.