Mark Daly (Fianna Fail)
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I welcome the Minister of State, Deputy O'Donnell, to the House.

Margaret Murphy O'Mahony (Fianna Fail)
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I sincerely thank the Cathaoirleach for selecting this Commencement matter today. I also thank the Minister of State, Deputy O'Donnell, for coming to the House to take the debate. I rise today to highlight the urgent and ongoing challenges faced by people in Ireland living with inflammatory bowel disease, particularly Crohn's disease and ulcerative colitis. I call for action to address gaps in awareness, services and financial supports. Last week marked world IBD day, a day to raise awareness and give a voice to those living with these conditions. For many this is not something they think about once a year but their reality every single day.

I will begin with real story. A member of my office, Jason Dyland, began experiencing severe abdominal pain and weight loss two years ago. Like many people he initially hoped it would pass but it did not. What followed was a long and difficult journey, multiple GP visits, multiple scans and tests and multiple hospital admissions. Despite this, many results came back inconclusive and at times he felt dismissed. Many thought he was faking illness when in reality he was faking being well. Eventually he was diagnosed with Crohn's disease. His experience is not unique and reflects a wider problem in how we diagnose and support people with IBD.

Inflammatory bowel disease affects at least 40,000 people in Ireland. It is a chronic lifelong condition that is often invisible but deeply debilitating. Symptoms include severe abdominal pain, fatigue and urgent frequent use of the bathroom. On their worst days people may need to use the bathroom more than ten times. It is often described as living with food poisoning every day. Diagnosis can take far too long. Many patients experience delays and a significant number end up in emergency departments before receiving answers. This points to clear gaps in early detection and awareness.

Beyond the physical symptoms the emotional toll is significant. This is not an easy condition to talk about; there is stigma, embarrassment and isolation. Many people struggle with anxiety and depression yet access to mental health supports remains limited. There are also everyday challenges that many of us rarely consider. Leaving the house, going to work or travelling can require careful planning around something as basic as access to a toilet. Most patients believe our public spaces do not adequately meet these needs. This impacts people's independence and their quality of life. The healthcare gaps are equally concerning. Patients report difficulty in accessing specialist supports such as dieticians and appropriate follow-up care. Confidence in primary care is mixed and people often spend significant time navigating the system without feeling fully supported.

One of the most pressing issues is the financial burden. Despite being serious lifelong conditions, Crohn's disease and ulcerative colitis are not covered under the long-term illness scheme. As a result, many patients face substantial out-of-pocket costs for education and care, often running into thousands of euro each year. A significant number experience financial hardship and some are forced to delay treatment due to cost. This is deeply concerning and very unfair.

IBD also affects people during key stages of life, particularly young adulthood. It has a real impact on education, employment and career progression. Many are forced to reduce hours, change roles or pass on opportunities because of fatigue and unpredictable symptoms. Today I ask for more than an acknowledgement; I ask for action. We need to see earlier and more efficient diagnosis pathways, greater awareness and understanding of IBD, improved access to specialist and mental health supports, better public infrastructure, particularly access to toilets and, critically, a review of financial supports, including consideration of including IBD in the long-term illness scheme.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Senator Murphy O’Mahony for raising this important issue. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill.

Inflammatory bowel disease, IBD, is the name used for a group of disorders that cause inflammation of the intestine. It is a term used for conditions known as ulcerative colitis, Crohn's disease, and indeterminate colitis. I hope Jason is doing well. Is he still a member of the Senator's staff?

Margaret Murphy O'Mahony (Fianna Fail)
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He is.

Kieran O'Donnell (Limerick City, Fine Gael)
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I wish him well.

Margaret Murphy O'Mahony (Fianna Fail)
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I thank the Minister of State.

Kieran O'Donnell (Limerick City, Fine Gael)
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Approximately 50,000 people in Ireland suffer from IBD. The national clinical programme for gastroenterology and hepatology was established in October 2019 as a joint collaboration between the HSE and the Royal College of Physicians of Ireland, RCPI. Gastroenterology and hepatology multidisciplinary teams, MDTs, provide expertise in the diagnosis, treatment and prevention of conditions of the digestive tract, liver and pancreas, including inflammatory bowel disease. The HSE advised that as of May 2026, all level 4 hospitals, in addition to Connolly Hospital and Mercy University Hospital, which is level 3, have gastroenterology MDTs.

In relation to supports for patients, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card under the General Medical Services, GMS, scheme. In accordance with the provisions of the Health Act 1970, as amended, eligibility for a medical card is determined by the HSE. In certain circumstances, 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. The HSE affords applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.

The issue of granting medical card eligibility based on having a particular disability or illness was previously examined in 2014 by the HSE expert panel on medical need and medical card eligibility. The group concluded that it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the expert group's advice, a person's means remains the main qualifier for a medical card. Under the drugs payment scheme, DPS, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means-tested and is available to anyone ordinarily resident in Ireland.

Access to affordable healthcare services has improved over the last few years. These improvements include reductions in the DPS threshold, expansion of access to free GP care, and the abolition of all public inpatient hospital charges for children and adults. These measures continue to create a health and social care service that offers affordable access to quality healthcare. Finally, individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is available at the standard tax rate of 20%.

I note the other points the Senator raised in respect of the long-term illness card in terms of public transport and access to public facilities in respect of public toilets and bathrooms and so forth. Obviously, the Government keeps these aspects under active consideration.

Margaret Murphy O'Mahony (Fianna Fail)
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I thank the Minister of State. I suppose we can agree that a lot has been done but there is more to do regarding this issue. I will finish by paying tribute to Jason who works along with me in my office. By telling his story, he has opened the doors for many others to feel not alone.

People living with IBD are managing a condition that is unpredictable, exhausting and often invisible to others. They deserve a system that recognises that reality and responds to it. Jason’s story and the experience of thousands of people across Ireland should not be defined by delays, gaps or barriers. It should be defined by timely care, dignity and proper support.

Kieran O'Donnell (Limerick City, Fine Gael)
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I again thank Senator Murphy O'Mahony for raising the issue of the ongoing struggles faced by people living in Ireland with inflammatory bowel disease.I am taking this Commencement matter on behalf of the Minister for Health and will convey this to her on the Senator's behalf. The other matter she raised would be relevant to other Departments and Ministers. There are measures in place to reduce the cost burden of coping with long-term illness. The Government remains committed to improving healthcare services, providing for each citizen of Ireland.

Inflammatory bowel disease has been highlighted as an area of utmost importance through the work of the national clinical programme for gastroenterology and hepatology, shown throughout the development of the IBD working group, which is comprised of consultants, nurses, allied healthcare professionals, including dietitians and psychologists, and a patient representative. The key output from the working group has been the development of an IBD modernised care pathway. This care pathway will service patients, both adults and children, presenting with consistent gastrointestinal symptoms lasting more than six weeks, abdominal pain, indigestion, changes in bowel habit, internal bleeding, nausea, loss of appetite and loss of weight, and patients with a known diagnosis of family bowel disease. The Government remains committed to improving access to care for acute and chronic diseases such as inflammatory bowel disease through Sláintecare healthcare reforms.