Maria McCormack (Sinn Fein)
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I welcome the Minister and thank her for coming here to take this matter regarding the important issue of endometriosis. It has been almost a year now since the publication of the national endometriosis framework. I acknowledge that publishing the framework was an important step forward. I really appreciate the constructive engagement I have had with the Minister on endometriosis care over the last year.

Today is about taking stock. Patients want to know what has actually changed since the framework was published. As we know, endometriosis affects one in ten women in Ireland. If we had proper data, it would probably show that one in six or one in seven is affected. It is not just a painful period. It is a chronic inflammatory whole-body disease that can affect the bowel, bladder, diaphragm and other vital organs, including the lungs. It impacts every aspect of a woman's life, including her education, employment, fertility, relationships and mental health. For many years, women living with endometriosis have told us the same story. They wait years for a diagnosis. They are often told their pain is normal. They struggle to get access to specialist care. In many cases, they are forced to travel abroad for treatment because we simply do not have the proper treatment here.

When we met earlier this year, the Minister outlined a number of important commitments. I would appreciate an update on these today. With regard to education and training, the Minister advised that additional training would be provided for GPs and consultants to improve awareness, diagnosis and referral pathways. Will the Minister provide an update on the progress that has been achieved? Has this training commenced?How many healthcare professionals have participated?

We discussed the importance of improving specialist imaging. Too many patients continue to tell us they have had MRIs or ultrasounds reported as normal here only for extensive endometriosis to be discovered during surgery. The Minister committed to improving specialist training for radiographers in identifying endometriosis on imaging. Will the Minister outline what progress has been made in implementing this commitment and how the Department intends to measure whether diagnostic accuracy is improving?

We also discussed the endometriosis interim surgery abroad scheme. While I welcome the establishment of the scheme, patients continue to raise concerns regarding access. Gatekeeping from consultants has been commonly described to me, whereby consultants refuse to refer people abroad. A question I am constantly asked is about the exploration of adding additional countries to the scheme, in particular Romania and Greece. Is there an update on these countries being considered, particularly given the significant number of Irish women who travel to seek treatment there?

I also welcome the fact that endometriosis now has its own HSE clinical code. This is an important step in understanding the true scale of the disease. Will the Minister provide an update on how this data is being collected and how it will be used to improve future planning and service provision? While progress has been made, patients need to see the progress reflected in their own experiences. They need shorter waiting times, earlier diagnostics, access to specialist imaging, multidisciplinary teams, on which I hope the Minister will elaborate more, and timely treatment. The framework gave hope to thousands of women living with endometriosis in Ireland. I hope that today the Minister will outline how these commitments are being translated into tangible improvements in services. Ultimately, this is how the success will be managed for the women out there.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Senator and I am glad to have the opportunity to discuss our ongoing work in improving endometriosis services for patients. So much has happened, as she is aware, since October but so much more is needed. As I look around the Seanad today I see so many women here of so many different ages and experiences. I am well aware that women here may have endometriosis or may have family members who have endometriosis but it has not been a conversation that has been had as loudly as we are all trying to amplify, to drive awareness about endometriosis. It is a significant health issue affecting as many as one in seven women, as the Senator has said.

As the Senator is aware, in October I launched the national framework for the management of endometriosis. It sets out for the first time a defined clinical care pathway for women and girls with endometriosis. It reflects better many of the voices of patient advocates and aims to transform how endometriosis is recognised and treated across the country. We made as many changes as we could and as were appropriate after our first patient voice forum in September, on which we followed up in March 2026. We have had quite good engagement with many more patients than we ever would have before. Although it is not perfect, it is so much more than has ever been the case before. We have an endometriosis priority action advisory group that meets regularly to support the ongoing development and implementation of priority actions.

The HSE at my request has allocated additional funding to increase services and I have mandated an action plan to raise awareness and improve services for women in the longer term. In quarter 4 of 2025, I allocated funding for the provision of 100 extra surgeries to be done in that quarter and I am pleased that 142 were done in that period. This required considerable effort but it had to be done. These surgeries were carried out over those three months.

Our work on recruitment has resulted in the successful recruitment of an additional colorectal surgeon in Cork University Maternity Hospital and in Tallaght. This is so important because they need to work alongside other surgeons to be able to do work on the bowel. These are complex cases requiring more than one surgeon.

As the Senator is aware, I prioritised the recruitment of an additional 65 whole-time equivalent positions in the 2026 service plan. These are being recruited and include consultants, nurse specialists, psychologists, physiotherapists, radiographers, occupational therapists, medical scientists; a whole team. Recruitment is ongoing across the regions. For example, in our supra-regional centre in Tallaght, five additional consultants will be in place by September. It takes a while to recruit a consultant because not only do we have to find and recruit them but they have to give notice elsewhere. It takes time but they are in place. These specialist posts will enhance services for the most complex patients.The Senator mentioned, however, that services have not been what they have needed to be and that women have had to look abroad. As the Senator is aware, we try to fund that for them proactively through the endometriosis surgery abroad interim scheme. This is a specific two-year scheme established by us to support patients waiting for surgery for endometriosis who do not have a date in Ireland or whose cases are too complex. Since the launch of that scheme in October, it has engaged with over 150 patients and received 50 applications. We are working to approve additional centres, including in Greece, which has been a request for some time. That is in development. I fear, however, that Romania is not possible for very specific clinical reasons that I think we discussed.

The clinical community has leaned into this in a big way. The Institute of Obstetricians and Gynaecologists held its annual conference on 6 March, focused on endometriosis, with participation from experts across Europe and advocates from Ireland. Endometriosis is now included in GP training, with additional education resources being developed. I can get the Senator more details. Our clinicians are working with specialist services across Europe. They have attended endometriosis intensive courses across Europe. Several HSE clinicians are now undertaking fellowship training in complex gynaecology in Europe. Two fellowship posts are also funded across our two supra-regional services to train professionals for future service delivery. The first two candidates will complete their fellowships this month and recruitment for the next cycle is ongoing. We are also supporting trying to get British Society for Gynaecological Endoscopy accreditation, which is an important step. This is a big and significant body of work undertaken by our clinical community.

We are also trying to promote awareness of endometriosis. It is wonderful to have the opportunity to discuss it here today. A national menstrual awareness campaign is being developed, to which, of course, endometriosis is not limited, but it must be understood in that context. It will have a particular focus on endometriosis and improving public understanding of symptoms and available supports. Just last week, I spoke with a girl whose position in a bar in Cork was not advanced because she had taken so many sick days when she was in the accident and emergency department in desperate pain, and it was not well understood. This is why we now have two education officers recruited to deliver the menstrual information specialising in endometriosis, MISE, programme that promotes mental health, education and awareness of endometriosis in schools, workplaces and sports clubs. I ask everybody to ask their local community to bring MISE in to try to tell the story better.

Finally, as the House will be aware, Ireland took up the Presidency of the Council of the European Union. I get four ministerial conferences on everything to do with health, and I have prioritised one of them specifically for endometriosis. It will be on 3 December. We are inviting specialists from all over Europe and patient advocates to discuss this issue in Ireland. I am sorry, I realise I have gone way over time.

Mark Daly (Fianna Fail)
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No, the Minister is grand. She can continue if she wishes. No. I call Senator McCormack.

Maria McCormack (Sinn Fein)
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Go raibh maith agat. This is fantastic. So much good work has gone on here. The two education officers recruited, Kathleen King and Cate O’Connor, are absolutely fantastic. The MISE programme is outstanding. Ms King is a medical scientist who has 30 years' experience researching endometriosis. MISE is a fantastic initiative. There are so many positives here. Education and awareness is massive, and it is great that one of the ministerial conferences is being used for endometriosis. We have come so far on this journey.

I have one other question. Does the Minister have a date or some sort of a timeline for when we might know about the addition of Greece? I understand the situation with Romania. A lot of people ask about the timeline for Greece, however. With everything else rolling out, it would be good if we could get an update again when we are back in September. It seems, though, that the progress the Minister has been promising is really under way. The extra colorectal surgeon and all the additional surgeries mean we are on the right track. Hopefully, we can keep making progress.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am so grateful to the Senator and to everybody who has raised awareness of endometriosis. I thank Senator McCormack as well for highlighting Kathleen King and Cate O’Connor.

We are now better and more profoundly aware of the impact of endometriosis on women’s lives and we really are trying to expand the specialist services. I might come back to the Senator with information on Greece, because it is the subject of particular work at the moment. I hope, though, that the Senator can see the authenticity and sincerity with which we are trying to approach this work.

As part of my St. Patrick’s Day visit to Germany, I made a special effort concerning endometriosis, along with my counterpart, the German health minister, who is the minister for health for 80 million people, an enormous position. I was there to meet her as part of the St. Patrick’s Day programme. Instead of our meeting happening in a government office, she and I went to an endometriosis clinic in the Charité hospital in Berlin, which is a specialist service. We had our bilateral meeting there, with our two flags on the table. We had our meeting in a women’s health clinic, in an endometriosis clinic, at the Virchow clinic, which is a part of Berlin's Charité hospital.Then we had a meeting with the wonderful Professor Sylvia Mechsner, together with advocates and patients. Professor Mechsner, who I hope is coming in December, has developed an endometriosis treatment pathway that is a real multimodal approach. Despite this technical capacity the Germans are, like us, struggling with costs and capacity. We are not on our own in terms of the needs to improve services. The Minister, Ms Warken, and I were determined to try to use our platforms as women ministers for health in Europe and the platform of St. Patrick's Day to amplify the experience of endometriosis not just in Ireland and Germany but on a pan-European basis. I have of course invited the Minister, Ms Warken, to the endometriosis ministerial conference in December.

I do not have time to speak further but this is a body of work the Oireachtas has leaned into in a huge way, as advocates have done many times. I really want to acknowledge and apologise again that before now, the services were not the way they should have been and the reaction was not always what it should have been. Many women were cared for and cared for enough but there are so many who were not. I really acknowledge that in everything we do. I hope the Senator can see every effort is being made to try to genuinely turn the tide on that and turn it forever.

Mark Daly (Fianna Fail)
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I thank the Minister for being with us to take that important Commencement matter.