Lisa Chambers (Fianna Fail)
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I am sharing time with Senator McGreehan. I wish a happy International Women's Day to everyone, not least to all the women in Ireland who suffer with endometriosis, which is what this Commencement matter concerns. The Minister of State will be aware this chronic condition affects one in ten Irish women and girls. It is incurable. Some of the main symptoms include chronic pain and fatigue, heavy bleeding, and infertility or mental health issues, to name but a few. There are still no clear clinical guidelines for GPs and no clear care pathway through our health service. On average, it takes women seven years to get a diagnosis, with many saying it can take them in excess of ten years. That is important because the longer the disease is left unchecked to wreak havoc internally, the more damage it does. It is so important, like in many aspects of healthcare, that there is early intervention.

Because GPs are not properly educated and trained to spot the symptoms and because of the absence of clinical guidelines for GPs, this condition often goes undiagnosed or misdiagnosed, with many women reporting having been prescribed antidepressant medication and having been told it was all in their heads, it was all part of being a woman and they needed to buckle up and deal with the pain because it is just their lot. That this story is reported by so many women shows it is prevalent throughout our health service, with many women reporting of the trauma of being gaslit by their GP and of being told what they are feeling is not really happening and it is all in their heads.

We need urgent action on this.With every week and month that go by, another woman or young girl is suffering and in pain, bedridden and missing weeks of school. These women are unable to have a good quality of life and are missing out on work and education opportunities. The damage being done to a significant cohort of the population is immense. One in ten women have this condition. I ask the Minister of State to please take back to the Minister for Health, Deputy Donnelly, the need for urgent action, clear clinical guidelines, a care pathway for treatment and education among GPs to spot the symptoms early on.

Erin McGreehan (Fianna Fail)
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As a sufferer of endometriosis, I know it is a tremendous disease. It takes over one's body and mind. One deals with pain several times each month. It is incredible. I am one of the lucky ones because I know what is wrong with me. There are thousands of women who do not know what the problem is. They are told by their doctors that it is a normal pain. It is not normal. As Senator Chambers stated, they are told to buck up and get on with it and that this is part of being a woman. Pain is not part of being a woman. That said, we have seen time and again that pain is synonymous with being a woman in this country and we have seen the bruises and suffering associated with that.

The current waiting lists for gynaecological outpatients' appointments are incredible. More than 30,000 women are awaiting treatment and a doctor's appointment. That is absolutely horrendous. Given that one in ten women has endometriosis, how many of those women awaiting an outpatient's appointment have endometriosis but are not getting treatment? We need quick action on getting those ambulatory clinical services open sooner rather than later because this is about quality of life for young women and girls who are suffering but do not know what is wrong with them. They are told it is all in their heads. I ask the Minister of State to please bring that back to the Minister, Deputy Donnelly, because action needs to be taken.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senators for bringing this issue to the floor of the Seanad and giving me an opportunity to address it. My speech is on behalf of the Minister, Deputy Donnelly, but both he and I are acutely aware that the Senators have long been advocates on this issue. I wish to begin by emphasising that the Government is committed to promoting and improving women's health outcomes. That commitment is spelled out very clearly in the programme for Government and has been underpinned by a provision of €12 million in budget 2021 for new developments in maternity and gynaecology services.

As Senator Chambers stated with regard to the current treatment of endometriosis, a general practitioner referral to a gynaecologist is the standard pathway of care for the management of this condition. This is similar to the pathway in place for the management of other gynaecological conditions. I am advised that all obstetricians and gynaecologists are trained in the diagnosis and treatment of endometriosis.

The HSE national women and infants health programme has advised that the best way to help the majority of patients with endometriosis is to improve access to gynaecology services generally. I think all present would agree on that. The programme has developed a plan to increase capacity and reduce waiting times for women for gynaecology appointments. The plan aims to reorient general gynaecology services to an ambulatory or see-and-treat model, rather than the traditional outpatients referral model. The new model of care involves the establishment of one-stop 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, ultimately, improve clinical outcomes. The roll-out of phase 1 of the new model of care commenced last year and I am delighted to confirm that the ambulatory gynaecology clinics in Cork and Galway are now providing services, while it is anticipated that the clinics in the Rotunda Hospital and Waterford will be operational this year. It is important to state that although I have mentioned four hospitals, that is not nearly enough by any manner or means. With the new funding provided in budget 2021, the roll-out of the model of care will be accelerated and additional ambulatory gynaecology clinics will be established this year.

Last year, the women's health task force identified several priority areas for action. In that context, the need to improve services for women with endometriosis was recognised and included as part of a priority work stream to improve gynaecological health for women and girls.The endometriosis work stream identified a number of potential actions in this area, including enhanced services and supports, and the potential establishment of a centre of excellence for endometriosis surgery.

Budget 2021 has also provided a dedicated €5 million health fund to progress a programme of actions arising from the work of the health task force. The Department of Health has engaged with the HSE to identify proposals which could be implemented in 2021 and funded through the women's health fund. A number of proposals are being finalised with stakeholders and it is anticipated that announcements will be made in the coming weeks on the actions which will be supported by the fund. The developments I have outlined underscore this Government's commitment to improving services for endometriosis and gynaecology more broadly.

However, as Senator Chambers says, one in ten is the figure, there are 30,000 on a waiting list, two hospitals are providing the service and two more are due to come on stream in 2021. That is clearly not good enough. It is about education and providing support to our GPs as well. We must get rid of the idea that it is in one's head. There is an issue with that. We need to be able to call that out and give people their lives back.

Lisa Chambers (Fianna Fail)
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I know the Minister, Deputy Stephen Donnelly, is aware of this and I have spoken to him about it on a number of occasions. The female members of Fianna Fáil will be meeting the women's task force in the coming days to discuss this and other women's health issues. Can we imagine any other area of healthcare where one in ten men would be this impacted and where there would be no care pathway, no proper referral system and no education? I cannot imagine that. There have to be wrap-around services, including mental health services, pain management and education for young girls so they can identify what is not a normal pain and when to seek help.

Erin McGreehan (Fianna Fail)
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I want the Minister of State to bring the issue of the €2.5 million in funding for the critical care unit in the Rotunda Hospital back to the Minister. It is the world's oldest maternity hospital and that is all that is needed for it to move forward to the next stage and to get its standard of care up to a modern level. Some 3,000 people are on the waiting list for care in the Rotunda Hospital and I would ask the Minister of State to move on funding for the critical care unit.

Anne Rabbitte (Galway East, Fianna Fail)
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I will bring everything the Senators have said back to the Minister. The women's task force is meeting later on this week and I will be 100% supportive of it. For far too long, young ladies did not really know what they were presenting with. They all thought this was normal but it is far from normal. No man in the country would accept this. It is mainly ladies who are present in the Chamber for this conversation on International Women's Day and there is no way a man would put up with what the Senators have described this morning. We all know what bad period pain is like and one would hope it would go away with two Panadols but it should not continue without a diagnosis being sought and it should not reoccur every month along with other pains. This pain is debilitating and we have to stop that happening.

We have to give women back their lives, and the only way we can do so is by having a proper ambulatory service throughout the country. It should not just be available in four hospitals or in certain geographic areas. We have to look at everybody. We must also provide education for our GPs so that when these young people go back and talk to their mams, there will no longer be any talk from GPs about this all being in their heads. We need to stop that approach.