Mark Daly (Fianna Fail)
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I welcome the Minister of State to the House. She is most welcome to Seanad Éireann.

Patricia Stephenson (Social Democrats)
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I thank the Minister of State for coming in. I wish to discuss the third phase of the women's health task force and action plan. Women's health has been neglected for too long in Ireland. Our pain has been minimised. Our voices are absent from medical research. Since my time as a Senator, I have been contacted by many women who have shared their health journeys with me. It is usually stories of frustration, long delays, disbelief at the system, disappointment and the experience of medical gaslighting. Some women outlined the impossible positions they have been put in financially that they cannot afford essential medication needed to manage their conditions. I have raised the question of Ryeqo with the Minister for Health and its funding through the drugs repayment scheme.

The action plan expands the GP programme for endometriosis diagnosis. I am grateful for that, but I am unclear if this is going to be mandatory for all GPs and if this is going to extend to all women's health conditions or specifically endometriosis. If a GP is not trained in women's health and gynaecology and if he or she is not listening to a patient or do not believe her, how are such women going to get a referral, and ultimately a diagnosis? Why do we not have more GPs across the country who can recognise the symptoms of polyendocrine metabolic ovarian syndrome, PMOS, adenomyosis and endometriosis, premenstrual dysphoric disorder, PMDD, and send patients for appropriate tests.

The task force does not go far enough to increase the number of expert gynaecologists providing front-line care. We are still sending women abroad. What is the Department is doing to attract expert clinicians to provide for women's health in Ireland? I was recently contacted by a woman called Aisling who had a successful endometriosis treatment in Ireland after undergoing the EndoSure test in the UK, which diagnosed her with both endometriosis and adenomyosis. Initial tests in Ireland found nothing wrong with her, so her GP would not refer her on to a consultant. She was fobbed off with hormonal contraceptives, which did absolutely nothing. She had to pay out of pocket for the tests in the UK. Aisling did find an excellent GP who helped her get treatment, but GPs like this seem to be rare.

Will the HSE be looking into and investigating the EndoSure testing procedure for Ireland? Will she provide a timeline for exploring that and doing that investigation? It could drastically improve diagnosis for endometriosis and adenomyosis in Ireland. I wish to highlight a very worrying aspect regarding the treatment of women-specific conditions. I have talked about medical gaslighting before. There is also the issue of gatekeeping. I have been contacted by women whose GPs are refusing to send them to gynaecologists. There are clinicians in the private health system who refuse to sign off on medical forms so women can avail of the endometriosis surgery abroad interim scheme, ESAIS. Women have been told that the pain in their heads or just bad periods. I am sure the Minister of State has heard similar things in her experience. It is kind of part of the ongoing oppression of women in Ireland that their pain is downplayed and they refuse to get objective investigation into their systems.

I welcome the prominent role that endometriosis has in this action plan. We still have no official statistics in Ireland about how long women are waiting for diagnosis and finally to be told that the pain is not in their heads and their pain is real. I am pleased to hear of the roll-out of the State-funded in vitro fertilisation, IVF, for women with endometriosis who are experiencing fertility issues. It is something that I have called for in this Chamber before. It is important, therefore, that we get early diagnosis for endometriosis instead of women languishing for years in pain, by which time they might have aged out of the eligibility for the IVF scheme. I wish to ask about some of the elements that are missing from the plan. There is no mention of adenomyosis, PMDD and PMOS, which was previously known as polycystic ovary syndrome, PCOS. These are all hormone related conditions affecting women which are poorly understood.

The plan has some mental health initiatives, which I am sure the Minister of State engaged with as well in her capacity. The commitments to suicide and self-harm reduction are brilliant. I am not sure if that strategy is going to incorporate PMDD. Will it be taking holistic care and interdisciplinary care into account? I also welcome the national menstrual health awareness campaign. Again, linked to that, is that going to include PMDD? Up until that point, it has been missing. Is that going to link into the Department of education in secondary schools to ensure that menstrual health and PMDD are being taught to girls and boys equally? There is a commitment to pledge €2 million into research, which is fantastic. Is that going to be multi-annual funding for women's research? We have a huge gender gap when it comes to women's research in Ireland. Ireland is not awash with senior academics in women's health. We have loads of early and mid-career people who are fantastic. How can we build them up to ensure that the funding in place for their academic research to prosper?

I welcome the perinatal mother and baby unit. We have spoken about this in Chamber before. How can we extend that? Perinatal is obviously acute crisis. What are we doing to expand the postnatal supports into the community? The Year of Care campaign has called for a year of holistic support. That is focused community support, both physically but also mental recovery from the birth. We need to get to that stage in Ireland.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator for the way she has portrayed this in relation to welcoming the positives because we have made a lot of changes in the past six years especially. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank the Senator for the opportunity to update the House on the third women's health action plan that was launched on 8 July. To be fair, the Senator asked about 25 questions, so there is absolutely no way I will be able to get through them all. I have to put on the record that in the past five years the Government has made considerable progress in women's health, publishing three women's health action plans setting out practical actions and targeted investments to improve experiences and health outcomes for women and girls across Ireland. Since the establishment of the women's health task force in 2019, more than €180 million in additional funding has been invested in women's health. That was needed, and we all agree wholeheartedly on that.

The Department of Health now has Deputy Jennifer Carroll MacNeill as Minister, but also two Ministers of State, namely Deputy Jennifer Murnane O'Connor and me. In the previous Dáil, it was the same in that there were two female Ministers. That is reflected in what we have seen in relation to the women's health task force, and from all the female Members in this Dáil, the last Dáil and the Seanad, who brought to the fore the fact that women's health had not been funded and was not given the respect it deserved. The plan will build on our knowledge of women's health through research and innovation and will spotlight important areas such as endometriosis and cardiovascular health.

Recently, the Minister announced €2 million in funding for women's health research. This is the first time Irish research funding has been dedicated specifically to women's health. The Minister has put a huge focus on endometriosis since she came into the role. It is important to note that, during our Presidency of the EU, one of the four major conferences that will be held in Ireland will be on endometriosis. Another will be on mental health, I am delighted to say.

The €2 million investment aims to address a historical gap in knowledge and understanding of women's health issues and the impact of gender on health outcomes and experiences. Major improvements are happening across services: enhanced access to proactive and preventive healthcare to support a better quality of life; the embedding and upscaling of women's health initiatives put in place through the implementation of the previous women's health action plans, including, as the Senator knows, free contraception, specialist menopause services, mental health services, ambulatory gynaecology clinics and postnatal hubs; the promotion of social inclusion, connectedness and equity to improve the experiences of marginalised groups of women; and the spotlighting of key areas that women and girls have asked us to prioritise, including endometriosis.

We know that endometriosis is one of the most common gynaecological conditions in Ireland, affecting approximately one in seven women, although the true number is unknown. This plan will continue to focus on how we can improve access to specialist endometriosis care and treatment.

As the Senator knows, we have established two super-regional specialist centres, one in Tallaght University Hospital and another in Cork, alongside the development of five regional endometriosis hubs. There was specific investment of over €5 million in the provision of these specialised services between 2021 and 2025. This includes investment of over €2 million last year to further drive the development of these services.

The national endometriosis framework recognises the importance of timely fertility support for women. It promotes integrated care between fertility and endometriosis services, with structured referral pathways supporting women to access the most appropriate care for their needs. Fertility specialists can investigate and manage endometriosis and, where clinically indicated, refer patients for publicly funded assisted human reproduction treatment.

On the Senator's question, any consideration of the introduction or use of saliva-based genetic tests for endometriosis in the Irish public health service would be a matter for the HSE, in consultation with clinical experts in the field of endometriosis and the Department.

Malcolm Noonan (Green Party)
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Before I invite Senator Stephenson back in, I welcome members of the Young Entrepreneurs Club to the Gallery. They are guests of the Minister, Deputy Jennifer Carroll MacNeill. Cuirim fáilte romhaibh go léir. We have a note here about no homework, but I want to allow that voucher to be carried forward to September, if that is okay, because it will still be relevant then.

Patricia Stephenson (Social Democrats)
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I thank the Minister of State, Deputy Butler. On the €180 million, the annual health budget last year was €27 billion. I am aware that women's health supports are covered in the annual health budget. In that context, the €180 million since 2020 for women's health feels shockingly small. I have tabled a parliamentary question on this and the Department's response will share the breakdown of where the €180 million goes. It is a question around the commitment to multi-annual funding for research and how we are using that funding. I appreciate that the Minister of State will not have the answers because the Department is getting the breakdown of the €180 million for me at the moment. If the free contraception scheme, the new State-funded IVF for women with endometriosis and the free hormone replacement therapy are covered under that, it seems even smaller in many ways. It is shockingly small compared with the overall health budget.

I appreciate that the Minister of State cannot answer this on the fly because the Department has not got the data yet, but it is something to consider when we examine the overall health budget versus the women's health budget. The latter feels very small, worryingly small, including when we take into account the decades of underinvestment.

Mary Butler (Waterford, Fianna Fail)
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That is where I do not agree with the Senator. I believe €180 million of funding ring-fenced for women's health, when we have come from a low base, is absolutely unbelievable. If you look at the women's health action plan for the period 2026 to 2027, you see it is all about listening, investing, delivering and repeating in respect of women's health. We are listening to women, investing, delivering and repeating. The plan runs in two-year cycles, ensuring targeted actions and continued momentum for improvements to the health experiences and outcomes of women and girls in Ireland. For example, HRT would be funded under the drugs budget, which is a massive €4 billion per year. It would not be coming out of here.

We now have 18 see-and-treat ambulatory gynaecology clinics. That has all happened in the past six years. We have 16 funded eating disorder teams. When I came into this post in 2020, we had one. We have six regional fertility hubs. Have we more to do? We absolutely do, but what we have is a dedicated focus, dedicated funding and a Government that wants to keep delivering for women's health.

Malcolm Noonan (Green Party)
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I also welcome guests of the Tánaiste, Deputy Simon Harris, from County Wicklow. They are all very welcome. I congratulate them on their recent Tailteann Cup success.