Joe O'Reilly (Fine Gael)
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I welcome the students from Denmark in the Visitors Gallery. It is wonderful to have them here. They are from a very beautiful country that is a great friend of Ireland. There are great connections between Ireland and Demark and we have similar industry and agriculture etc.

Garret Ahearn (Fine Gael)
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I also welcome our friends from Denmark. They are very welcome to Ireland even though they keep beating us in soccer and Christian Eriksen scores brilliant goals against us. We wanted to go to that World Cup but the Danish team beat us.

I thank the Minister of State, Deputy Naughton, for taking this important debate. I cannot think of anything more distressing or upsetting, other than a family member passing away, than a mother or a couple finding out they cannot have children. One of the most distressing parts after finding this out is that there are no supports available from the Government which recognise the challenges the couple then faces. I have spoken to a number of people who went through the process of initially finding this out and then on the journey through IVF treatment.Sometimes it is successful, which is brilliant, but sometimes it is not. Even if you are successful after one or two goes, the cost is significant. On average, it takes three goes. These are people who are predominantly in their late 20s, 30s and early 40s. They are working and are facing all of the bills and other costs of living that we are facing at the moment, but they want to have families. We are one of only two countries in the EU - the other is Lithuania - that does not provide any funding whatsoever. It is sometimes so frustrating that it feels like we are waiting for Lithuania to do this before we do so that we can be last. The State was founded on the basis of supporting families and the family network. If there is an example of how the State should be supporting families, it is supporting women and couples to have kids.

The National Infertility Support and Information Group, NISIG, has been operating for 25 years and supporting people going through this process. It has done a wonderful job in giving people information and preparing them for the journey ahead. It has essentially been doing this work itself; no one else is helping. It has made a proposal for the upcoming budget. I will go through some of its recommendations. These are simple recommendations that the Minister for Health committed to while in opposition and that are contained in the programme for Government. We just need to implement them quickly. The group recommends providing State IVF funding in line with the Health (Assisted Human Reproduction) Bill 2022 so that it comes into effect in 2023. That funding would include all other fertility treatments and blood tests undertaken by anyone within the WHO's definition of someone who is experiencing infertility. Importantly, a model should be introduced whereby private clinics can provide State-funded treatment until such time as publicly-funded treatment is provided. People should continue to be allowed to reclaim tax benefits on any privately undertaken fertility treatments in Ireland. The drug prescription medical card must be kept in place for the long term to help alleviate the cost of prescriptions associated with assisted human reproduction, AHR, treatment. Counselling support is also important for part of the fertility treatment journey. If someone who was going through anything else that was emotionally distressing attended a doctor, the doctor would give him or her advice on where to go for counselling. In the case of fertility services, though, it seems that the doctor is meant to provide the counselling. That is not credible. The NISIG is the only charity dealing with this issue. It does incredible work, but it needs to be financially supported next year and beyond.

Infertility is not normally spoken about. We need a campaign similar to the ongoing one on contraception. We need to open up a conversation about this matter. Few women and, in particular, men like to talk about this issue. One in six people or couples suffer from infertility, yet it is not talked about to that extent.

These recommendations need to be implemented as a matter of urgency. For obvious reasons, people only have a certain time in which to have children. Most people only find out that they have infertility issues later than expected, that is, when they are trying to have children. No one goes into a clinic at 21 or 22 years of age to find out whether he or she has infertility issues. That happens in someone's mid-30s. People's time to have a child is limited from then on. The cost element is significant. People have to make decisions about whether to pay their mortgages and bills or whether to try to start a family, and it always comes around to the question of whether it will even work. We need to show that, as a Government, we care about and want to support these people and that we want them to have the opportunity to start a family and make that journey in life. It is a difficult journey, but let us try to make it a little easier for them.

Hildegarde Naughton (Galway West, Fine Gael)
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I thank the Senator for giving me, on behalf of the Minister for Health, the opportunity to inform the House of the progress made to date regarding the provision of fertility-related treatment through the public health system.

As the Senator will be aware, a commitment to introduce a model of care for infertility is in the programme for Government. The model of care was developed by officials in the Department of Health in conjunction with the HSE's national women and infants health programme and approved by the Government. It will ensure that 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 - GPs - and extending into secondary care, that being, regional fertility hubs, and then, where necessary tertiary care, for example, IVF and other advanced 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 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. Utilising funding of approximately €63 million in total, five regional fertility hubs have been established and are operational. The sixth and final hub is due to open before the end of this year. The completion of phase 1 of the roll-out of the model of care will therefore result in fully operational regional fertility hubs in each of the six current 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. Substantial planning, development and policy work has been required in respect of this phase. At this juncture, the design and scope of this aspect of the model of care have not been finalised, as detailed consideration of a range of issues, including service and treatment design, eligibility and access criteria, and associated resource implications needs to be completed. This work will also need to be informed by the final Health (Assisted Human Reproduction) Bill 2022, the progress of that Bill, which has passed Second Stage in the Dáil, and associated regulations that will be developed following the enactment of the legislation. Departmental officials are continuing their engagement with the HSE on the programmes of work required to advance consideration of the issues arising for commencing phase 2.

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 embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.

Garret Ahearn (Fine Gael)
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I thank the Minister of State for her response, but it is frustrating. She stated: "At this juncture, the design and scope of this aspect of the model of care have not been finalised". For what are we waiting? The Minister for Health was incredibly vocal on this issue while in opposition. He made a commitment. People cannot wait too long. Sometimes, this is spoken about as if it is some sort of entitlement, but it is not. It is an equality issue. I ask the Minister of State, who sits at Cabinet, to use her role to ensure that these women and couples are heard and supported.

I do not know whether the Minister of State got to hear it, but at lunchtime yesterday, Newstalk devoted more than half an hour to this issue. It had people on, including a girl called Grace and others, who spoke about their personal journeys. If people just listened to such stories, much of this would be done faster. In her role at Cabinet, I ask the Minister of State to influence the Cabinet to make a decision as quickly as possible.

Hildegarde Naughton (Galway West, Fine Gael)
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I realise the importance of having these services in place. I will raise the Senator's concerns directly with the Minister. While it is not possible to give a definitive timeline for the passage of the AHR Bill through the Houses, this matter is a priority for the Government.

Regarding current supports for those undertaking AHR treatment, a defined list of fertility medicines needed for such treatment is covered under the high-tech arrangement administered by the HSE. I am aware that such schemes can have a material impact on the cost of AHR treatment for individuals who avail of them. In addition, other supports are available to patients who access treatment privately. They may claim tax relief on the costs involved under the tax relief for medical expenses scheme. Nevertheless, the Department is committed to establishing a proper regulatory framework for AHR and then to completing the roll-out of the model of care for infertility.Ultimately, we have two main end goals. First, in respect of the legislation, we aim to ensure that assisted human reproduction practices and related areas of research are conducted in a more consistent and standardised way and with the necessary oversight. Second, through the full implementation of model of care for infertility, our aim is make certain patients receive care at the appropriate level of clinical intervention and that those requiring, and eligible for, advanced treatment are able to access this through the public health system.

I thank Senator Ahearn for raising this really important issue and assure him that I will raise it directly with the Minister.