Seanad debates

Tuesday, 16 November 2021

Nithe i dtosach suíonna - Commencement Matters

Healthcare Policy

2:30 pm

Photo of Lynn BoylanLynn Boylan (Sinn Fein)
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I remind the speakers to keep to their time.

Photo of Garret AhearnGarret Ahearn (Fine Gael)
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I will indeed.

I thank the Minister of State for being here and taking this important question on the support the State needs to give to people going through IVF treatment. I brought it up for a couple of reasons. It is very important and we, as a Government, have made a commitment to the people in this State to support them through IVF treatment, just as other EU countries do. The Bill brought forward is called the assisted human reproduction Bill 2017. We are one month away from 2022. Time is not on people's side when it comes to trying to have baby. So many people I have spoken to are going through treatment or are considering going through treatment and they always talk about two elements as part of that process of trying for a child - the emotional and the financial.

The emotional side of things, especially when people find out, is a real roller coaster from the start because they have to absorb the information. They question why it happened them. Cost does not really come into it at that point. It is more about understanding. In fairness to clinics throughout the country, they offer a free counselling service to people when they find out this information, which is welcome. However, many people are just not in the position to be able to talk about it openly.

When one wants to start going down that route of IVF, one needs to do other things beforehand, such as taking tablets that need to be kept in the fridge. Then there is the obvious issue of privacy. When one has guests over and they are going to the fridge to get something, one does not necessarily want them to see tablets one might be taking for something private. There is a constant whirlwind of emotion for a couple going through IVF.One can then look at the financial side of it which is hugely important. Normally people have a discussion about whether they can afford it, how many times will they do it and whether they are willing to borrow to have a child. I spoke to a person who said they will spend every single euro they had to have a child. That is how much they want it. However, there is a knock-on effect to that. If someone is willing to spend every single penny he or she has to have a child it means if he or she is lucky enough to have that child then he or she is struggling from the start because he or she must repay a massive loan to have a child. When many people have children they discuss whether they are in a position in their lives to be able to afford to have a child. If you are in the situation of going through IVF, your discussion is about whether you can afford to try to have a child, not whether you can afford to have the child afterwards. Thus, from the very start you are in a position of being behind everyone else because you have had to spend so much money to actually be fortunate enough to have a child, and that is if you are lucky.

We as a State need to be able to provide those people with a financial service. Women and couples cannot wait any longer. As I said, time is not on their side. In 2017 the Government made a commitment to support families and couple through IVF. The legislation was supposed to be passed last year. When we talk about legislation we always compare ourselves to other EU countries. There are only two EU countries that have no state support for IVF, and they are Ireland and Lithuania. We only need to look across the Border. In the UK a person can get three treatments of IVF free of charge. It is a failure of us as a Government and as a State that we have citizens of this country who must go abroad to get a service they should be allowed get here. We as a Government support families and children in an awful lot of ways, like maternity and paternity care, but on this we are really letting people down. I am very interested in hearing the Minister of State's response.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising this Commencement matter. I am taking it on behalf of the Minister, Deputy Stephen Donnelly. As the Senator will be aware, publication of the assisted human reproduction legislation is a priority for the Department and the Government and a commitment to enact the legislation is included in the programme for Government, Our Shared Future. The Department continues to engage intensively with the Office of the Attorney General in order to finalise this complex legislation. I was really struck by something which the Senator hit on really well, namely, that this is a very emotional issue we are talking about. Sometimes when one is reading out words or articulating something, perhaps you do not understand, unless you have been there yourself, the real complexities and the emotional strain this puts not only on the lady herself but on the relationship, the household and the wider family community who understand where the couple is at.

Another programme for Government commitment is the introduction of the model of care for infertility, which was developed by officials in the Department in conjunction with the HSE's national women and infants health programme. This model of care will ensure infertility issues affecting both men and women will be addressed through the public health system at the lowest level of clinical intervention necessary as part of the full range of services available in obstetrics and gynaecology.

The model of care comprises three stages, starting in primary care with GPs and extending into secondary care, in the form of regional fertility hubs and then, where necessary, tertiary care such as IVF and other AHR treatments, with patients being referred onwards through structured pathways. Phase 1 of the roll-out of the model of care has involved the establishment, at secondary care level, of regional fertility hubs in maternity networks, in order to facilitate the management of a significant proportion of patients presenting with infertility issues without the need to undergo invasive IVF or other advanced AHR treatments. Funding of €2 million was provided to the HSE to commence phase 1 of the roll-out in 2020 and this was utilised specifically in respect of the development of the first four regional fertility hubs, namely, Cork University Maternity Hospital, the Rotunda Hospital, the National Maternity Hospital and the Coombe Women and Infants University Hospital.Additional funding was made available in budget 2021 to enable the continuation of phase 1 this year, including through the setting up of the final two regional fertility hubs, one located in the Saolta University Health Care Group at University Hospital Galway and one within the University Limerick Hospitals Group at Nenagh General Hospital. Work is well under way on the recruitment, refurbishment and the equipping of these two hubs. Therefore, the completion of phase 1 of the roll-out of the model of care will result in fully operational regional fertility hubs in each of the six hospital groups across the country.

Phase 2 of the roll-out will see the introduction of tertiary infertility services, including IVF in the public health system, but will not commence until such time as infertility services at secondary level have been developed across the country. Required resources have been allocated and the assisted human reproduction, AHR, legislation commenced. Overall, the underlying aim of the policy to provide a model of funding for AHR within the broader AHR regulatory framework is to improve accessibility to AHR treatments while at the same time embedding safe and appropriate clinical practice and ensuring cost effective use of public resources.

I hope that goes some way to answering the Senator's question. It is welcome we have a balance of provision in terms of geography with Nenagh General Hospital and University Hospital Galway included as fertility hubs. We have a more inclusive addressing of this issue.

Photo of Garret AhearnGarret Ahearn (Fine Gael)
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I thank the Minister of State for her response. I agree with her there are other things we can also do, as time is of the essence in addressing this issue. The quicker somebody finds out that they need treatment, the better. When women get a standard medical, they could get a blood test to assess their ovarian reserve, known as an anti-Müllerian hormone, AMH, test. It costs an extra €80 because it has to go to a different facility to be tested. The State should support that. That would mean a woman could find out much earlier in her 20s that she might have a problem and might not be able to have children in her 30s but could in her 20s and, therefore, would not get that devastating news her 30s. That blood test should be offered free of charge by the State in order that women could find out at an earlier stage if there is a problem, which would give them a longer period of time to decide what they want to do as an individual and as a couple.

I welcome that the National Infertility Support and Information Group, NISIG, will meet the Taoiseach's advisers this week. That shows that the Government is starting to move forward on this issue. This is a greatly emotive issue for many people, many of whom are not willing to talk about it openly, whom we need to support, and I hope we can do that as quickly as possible.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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It is not possible to give a definite timeline for the completion of the AHR Bill and its subsequent passage through the Houses of the Oireachtas. However, as the Senator said, it is on the priority list for drafting and publication during the current term. I understand intensive work on the Bill is being undertaken by officials to finalise the legislation before the end of this year.

Regarding the current supports for those undertaking the AHR treatment, a defined list of fertility medicines needed for such treatment is covered under the hi-tech arrangement administered by the HSE. I am aware such schemes can have a material impact on the total cost of such treatments for individuals who avail of them.

The Senator's proposal makes perfect and utter sense and in the long term, such an early intervention would probably be a cost efficient method. That is exactly what I will bring back to the Minister, Deputy Stephen Donnelly, in respect of the issue the Senator raised. While we acknowledge work is being done perhaps other earlier interventions should be included when blood samples are being taken because in the long term they would have a cost benefit. Also, most importantly, it would give control back to the individual.