Seanad debates
Tuesday, 7 November 2023
Nithe i dtosach suíonna - Commencement Matters
Health Services Provision
1:00 pm
Mary Fitzpatrick (Fianna Fail)
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I thank the Minister of State for coming to the Seanad today. Earlier this year, this House passed a motion calling on the Government to provide free hormonal replacement therapy for women. My Commencement matter asks the Minister for Health to make a statement on the process that will be required to extend the free female contraception scheme to include hormone replacement therapy, HRT. The Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Joe O'Brien, must be commended on the priority they have given to women's health. The Government has given unprecedented support to women's health. The publication of the first women's health action plan in 2022 included the ring-fencing of more than €48 million in funding for women's health. This is really welcome. It includes free contraception, endometriosis clinics, IVF treatment, menopause clinics, and many more actions as well. I acknowledge that at the outset because it is unprecedented. The introduction of free contraception for young women has been incredibly empowering. It gives them the opportunity to manage their healthcare and it removes the barrier of cost which is real for many women.
The experience of menopause is challenging for women. It is a transformative period in a woman's life. It represents a very significant change in the reproductive system but it also brings with it an awful lot of symptoms. These can be everything from hot flashes to weight gain, hair loss, anxiety, depression, sight loss, arthritis and diabetes - the list goes on and on. It is hard enough to imagine living with any one of those symptoms but many women can have many of them. Many of those symptoms are absolutely invisible to everyone except the woman who is experiencing them. It is invisible to their partners, children, work colleagues, bosses and employers. Many women disappear into those symptoms and from society. They disappear from their workplaces and their families. However, for many, HRT is a solution. It is not a panacea but it helps an awful lot of women. It is free to women who have a medical card, which is right and as it should be. However, the cost of €30 to €70 per month for HRT, the cost of a GP visit which can be between €60 and €80 and the cost of having to have to go to a consultant which could be hundreds of euros for one consultation is a real barrier for some women in accessing effective and essential healthcare treatment. HRT can be a preventative treatment. Not only can it help women to deal with their symptoms immediately, but it can also prevent them from finding themselves in a crisis medical condition down the road.
This Commencement matter looks for an update while acknowledging the unprecedented commitment of the Government to women's healthcare. It reminds the Government that its health action plan promised to grow the available women's health support services and expertise in contraception, menopause and gynaecology, and to change the approach to menopause care to increase the public supports available to women before, during and after menopause. The Government has done incredible work already to support women's health; I believe it can do a lot more. I hope the Minister of State when responding will be able to outline what process can be followed by the Government and supported by this House to extend free HRT through the free contraception scheme.
Martin Conway (Fine Gael)
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Before I call the Minister of State, I welcome some very special guests who are here in the Public Gallery today from the Bohermeen active retirement group. They are here with Senator Cassells. I wish them a very interesting and informative day in Leinster House.They are very welcome. I hope they have a wonderful day.
Joe O'Brien (Dublin Fingal, Green Party)
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I thank Senator Fitzpatrick for this opportunity to speak to the House on the important topic of HRT provision for women in menopause. The Department of Health and the Minister, Deputy Donnelly, are committed to improving women's health. Since the establishment of the women's health task force in 2019, they have listened to what women want from the health service and have taken a number of positive steps to improve women's experiences and health outcomes. This includes the free contraception scheme, which is available to women aged between 17 and 30. There was an allocation of €31.5 million for the scheme this year, which covers the cost of consultations and, where appropriate, fittings, checks and removals of contraceptive devices. This is provided by GPs and family planning, student health and primary care centres. It also covers the cost of prescriptions for the wide range of contraceptive options available through the HSE reimbursement list. Budget 2024 provided €1.3 million in new development funding to expand the scheme to include to those aged 31 from next year.
HRT is a very different treatment and cannot be included in the contraception scheme. At present, there are no plans to expand the scheme to include HRT. Furthermore, the scheme is not open to women over the age of 40 who may be deemed clinically suitable for HRT. Any decision by the Government to provide free HRT to some cohorts of women would require separate, albeit analogous, primary legislation to give effect to such a decision.
To assist those women who choose to take HRT, the HSE operates two schemes that offer financial assistance to people in receipt of prescribed HRT medications which are on the reimbursement list. These HRT medications are available to medical card holders subject to the statutory prescription charge. Eligibility for the medical card under the GMS scheme is determined by the HSE in accordance with the Health Act. In certain circumstances, however, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines where he or she faces difficult financial circumstances, such as extra costs arising from illness. Under the drug payment scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines, which include some HRT medication. In budget 2023, VAT was removed from HRT to assist women further with the associated costs.
Menopause can present differently for individual women in the context of symptoms, severity and duration. Not all women experiencing menopause may be clinically eligible for HRT that is prescription based. Women may also choose not to take HRT but to address their symptoms through alternative therapies and-or lifestyle changes. It is important that women and healthcare providers are educated on the use of HRT and other options and that together they explore all of the available options open to them.
I thank Senator Fitzpatrick for raising this issue and providing me with the opportunity to speak today on the important aspect of women's health.
Mary Fitzpatrick (Fianna Fail)
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I thank the Minister of State for the reply from the Government and the Minister for Health. It is welcome and at least outlines what the clear path would be, and the requirement for primary legislation. We will pursue this with the Minister. It is important to note - and I had noted - that HRT is freely available on the medical card, and this is welcome. However, not every woman has a medical card. No woman should have to beg for a medical card to get HRT.
It is not always easy to diagnose that what a woman is going through is menopause. There are many symptoms, and women are sent on wild goose chases trying to identify and diagnose what exactly is wrong with them. It does not work for every woman, but there is a significant barrier for all women who do not have a medical card, namely, cost. It is an issue of equity for all women. I do not think women should be kept at this disadvantage. There would be a significant advantage in removing this barrier of cost. It would be a significant investment in women's health, not only for the individual women but also in the context of the ability of women to participate fully in society, in their families, in their communities and in their workplaces. I will pursue the matter further with the Minister and the Government.
Joe O'Brien (Dublin Fingal, Green Party)
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I thank Senator Fitzpatrick. Considerable progress has been made in menopause care at primary and specialist care level. Six specialist menopause clinics are now open for women who have complex experiences of menopause. A quick reference guide for menopause was launched to support GPs and practice nurses in diagnostics and treatment at primary care level. A national menopause awareness campaign was launched in October 2022. This was a direct response to demand from Irish women for greater knowledge and understanding of menopause, as well as better access to accurate information and supports. The campaign was relaunched earlier this year in March. It was accompanied by a dedicated webpage to provide trusted information on menopause. More recently, the menopause in the workplace policy framework was launched. This framework was developed to guide Civil Service organisations and-or agencies in identifying ways to support employees experiencing menopause. Menopause is just one of the many important areas of focus since the publication of the women's health action plan. The Department of Health and the women's health task force remain committed to continuing to drive progress in women's health to achieve better health outcomes and experiences for all women and girls in Ireland.