Mark Daly (Fianna Fail)
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I welcome guests of Deputy George Lawlor from Women's Shed New Ross. You are most welcome to Seanad Éireann.

I thank the Minister for coming to the House.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am pleased to introduce the Health (Provision of Contraception Prescribing Service in Retail Pharmacy Businesses) Bill 2026 to the Seanad. The Bill proposes to include pharmacists as prescribers of contraception in clearly defined clinical circumstances, in addition to their existing role in dispensing. It will also ensure that the service will be available free of charge under the free contraception scheme. It is a big expansion of what we have been trying to do for women. The plans for this were published in 2025. We had a comprehensive engagement with stakeholders and pharmacy sector representatives. To enable pharmacy prescription, the Bill needs to amend the Health Act 1970, the Irish Medicines Board Act 1995 and the Pharmacy Act 2007.

The service will involve the prescription of short-acting contraception, such as the contraceptive pill, the patch and the ring, by pharmacists, who already supply emergency contraception. The service will be free of charge to women aged 17 to 35, who are covered by the free contraception scheme.It will also be available to private patients with the fees for this service determined locally by the pharmacy. It is almost certainly going to be less costly and more convenient than returning to a GP for every prescription. People would have to go to the GP in the first instance for the first prescription, but thereafter for the next four and a half years they can go back to the pharmacy and get the prescription renewed there. It is likely to be cheaper for those private patients and much more convenient.

The clinical basis for pharmacies prescribing is provided for in the Health (Miscellaneous Provisions) Act 2024 and similar to the common conditions service, regulations for this service are going to have to be published after the Bill is enacted. The Bill and the secondary legislation, training and clinical protocols that will follow it will support the terms and conditions for this service, as laid out in the community pharmacy agreement.

I will take Senators through the provisions of the Bill. Section 1 amends the definition of "scheme provider", previously limited to medical practitioners, for the provision of prescriptions. The Bill expands the definition to include retail pharmacy businesses entering into an agreement with the HSE for the provision of primary prescription services to women. It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly. Section 4, the final section, provides the Short Title for the commencement of the Bill. Sections 1 to 3, along with the clinical statutory instruments to be drafted, align the relevant Acts to accurately define the new service. The sections also provide for clinical protocols, rules, codes of conduct and training provisions for pharmacists who would like to provide the new service, and I hope they will be many.

I would also like to note that I introduced amendments in the Dáil to remove the term "medical devices" from the Bill. That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.

To sum up, the most important thing is that the Bill will improve access to hormonal contraception, including but not limited to the free contraception scheme. It will widen the range of services that can be delivered in the convenience of one's local pharmacy. It will improve patient choice and convenience. It will save money for private patients and, separately, for the State, by reducing costs for the free contraception scheme. It is going to provide essential additional capacity for additional women's health measures.

We have spent a lot of time trying to expand what pharmacies can do. We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do. They are the first point of contact for medical contact. Pharmacists are extremely well trained. They have been in university for five and often six years. They are exceptionally good medical practitioners and they are trusted by the community. I want to see more done much more naturally in a pharmacist's than in a GP clinic. We can expand access to GPs, who will have the commensurate space in their practices due to people going to pharmacies for common condition services and the free contraception scheme. This will free up space otherwise needed for more complex consultations in GP surgeries. We are trying to move as much as we can into pharmacies. 2026 is a big year for that because we have launched the common conditions service and now have 95% of pharmacists signed up to it. People can go in and pay €30 or €35, whatever it happens to be, and get a quick diagnosis and a prescription there and then. Now we are adding this as well, for the convenience of women. Yes, that first prescription has to come from a GP because we know that many women have complex conditions, maybe blood pressure, or are of a certain age whereby there has to be an initial clinical assessment done. Thereafter they will go back to the pharmacist to get their blood pressure checked, have a consultation and have the prescription renewed for the next four and a half years. It is a fantastic thing for expanding women's health and access to healthcare generally. I hope the Seanad will agree.

Maria Byrne (Fine Gael)
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I thank the Minister for coming to discuss this really important Bill today. I thank her personally and her Department for all they are doing for women's health since she came into office. The roll-out of this important Bill and the many other prescription services that can now be accessed through the pharmacy are really important. As the Minister said herself, people were queueing up to get a doctor's appointment and those appointments now will be available for people with more complex health issues. I understand that for the first appointment they need to go to the doctor but after that, it will be through the pharmacy. Pharmacists have a huge role to play. I compliment the IPU and its president and members for their involvement and willingness to step up to the plate. The Minister listed some of the different issues that can now be dealt with there. They are quite common issues which do happen in people's lives on a regular basis. Not having to go to a doctor for a prescription certainly saves people money but also time. For most people, especially for the less minor things like a urinary tract infection or conjunctivitis, people just want them dealt with and to move on with their day. They are not impeding most of the time.

Certainly I think that the contraception is going to be free for most people and for private patients it will be a lower price than normal. This is a really important step. I am sure the Minister has more things that she will be bringing forward in terms of the role of the pharmacy. People feel very comfortable in going to their pharmacist. Nine times out of ten, people have the same pharmacist and they build a relationship with that person. Even before this, people were often asking the advice of the pharmacist rather than going to the GP. It is a very important step. I compliment all involved. The Minister has the full support of Fine Gael.

Teresa Costello (Fianna Fail)
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I welcome the Minister. She has made herself very available to the Seanad during this term. I understand how busy she is but we really do appreciate the time she has given and how she has listened to us. I mean that very sincerely. I welcome this Bill. It is practical and sensible legislation. It reflects how healthcare is evolving in Ireland. It is about making access to care easier and reducing unnecessary delays. The Minister spoke about pharmacists and their qualifications, which just brought me back to my childhood. We had a pharmacist whose name was Mattie. He worked out of Glenview. My grandparents and parents had such faith in him. He was a miracle worker in our community. People still talk about him to this day. He is long since retired. The existing pharmacists in our community are approachable and knowledgeable and deserve that respect to be given the extra trust to carry out extra work. They are one of the greatest strengths of our primary care system. The Bill builds on that trusted relationship. It is allowing them, under strict clinical protocols, to provide the repeat prescriptions for certain forms of short-acting contraception. It is not replacing the GPs but just complementing them and allowing them to focus on more complex issues and patients who have more complex needs.

The programme for Government committed to continuing the expansion of access to free contraception and this legislation delivers on that commitment in a practical and patient-centered way. The Bill benefits women outside the free contraception scheme and women aged over 35 are able to avail of the service privately where clinically approved, at a cost that is expected to be lower than the cost of attending a GP. It is a welcome step in improving accessibility and affordability. Just as importantly, the legislation contains important safeguards. As the Minister explained, patients must first receive the assessment and prescription from a GP. Pharmacists will operate under nationally approved clinical protocols with mandatory training and clear professional standards. Women with complex medical conditions or higher clinical risks will remain under the care of their GP, and that is really important. Likewise, long-acting reversible contraception such as implants and intrauterine devices will continue to be provided through appropriately trained medical professionals. These safeguards ensure that patient safety remains at the heart of this new service. The legislation represents good use of public resources. Every repeat prescription that can be safely managed in a pharmacy is one less routine appointment occupying valuable GP time. It creates additional capacity within general practice for patients with chronic illnesses, mental health concerns, children's healthcare and more complex conditions.It creates the additional capacity within general capacity, including patients with chronic illnesses, mental health concerns, children's healthcare and more complex conditions. It is also a cost-effective reform. Under the community pharmacy agreement, the agreed reimbursement for a pharmacy consultation is significantly lower than the current allocation for a GP consultation, so it delivers value for taxpayers while improving patient convenience. I acknowledge the constructive engagement between the Department of Health, the HSE, the IPU and all those involved in developing this service. Their collaboration demonstrates how healthcare reform can be delivered through partnership and careful planning. As it is rolled out, it is important that the Government continues to monitor its implementation and ensure pharmacists receive the necessary training and support and maintain close collaboration with GPs to ensure a seamless continuity of care for patients.

Pauline Tully (Sinn Fein)
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Cuirim fáilte roimh an Aire chuig an Seanad. I welcome the Bill. We will be fully supporting it. It makes sense. It will reduce barriers for women and make access to contraception easier, which is always going to be welcome. It will also ease pressure on primary care. It is a welcome step in the expansion of community pharmacy and women’s healthcare services.

The free contraception scheme is still limited to women aged 17 to 35. The scheme should be reformed to cover all hormone therapy for all women and girls from adolescence through to and beyond menopause, and not restricted to those within certain age brackets.

Women's health is not embedded as a core service across primary and community care services. I acknowledge that there have been huge improvements on what is available for women, compared with a few years ago when there was nothing, but still far too often conditions affecting women are seen as a specialty or mystery when there is a range of supports and advice that women could receive through primary and community care services. A structured approach is needed to drive improvements in care for women in their local communities.

Sinn Féin has proposed a structured women's healthcare scheme in primary care, which would include general practice, pharmacy, nursing and allied primary care professions. The scheme would ensure appropriate support for women and girls at every stage of their life. Current services and supports are somewhat disjointed and can be costly. I welcome the Bill and will be supporting it.

Patricia Stephenson (Social Democrats)
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Senator Harmon and I are sharing time.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Patricia Stephenson (Social Democrats)
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I thank the Minister for coming in. This is a really positive step. I am delighted she is pushing it forward. By and large, the oral contraceptive is incredibly safe. A lot of well-studied medicines are available. Over-the-counter oral contraception has been recommended by the WHO since 2019. I understand that this process has been endorsed by the Irish Pharmacy Union, which is unequivocal that there is no clinical reason for this not to be done.

I recognise that it is going to alleviate pressure on GPs and expand access for many women, who simply do not have access to a regular GP. The Minister's commitment to further expand what pharmacists can prescribe and dispense is really positive. It has been happening in the North for many years and has worked very well.

Freeing up space for GPs is crucial. We also have to be mindful of the burden it will place on pharmacists without the correct resourcing for pharmacies to deliver the scheme to safeguard against them withdrawing from this or any future scheme simply because they feel they do not have the resources to deliver it in a timely manner. As Senator Costello explained beautifully about her own community pharmacist, they are highly trained experts with extensive knowledge, which this Bill acknowledges, but it is about making sure that they have the capacity to do it well and sustainably.

Families tend to stay with one pharmacy through generations. There is trust at a time when we have little access to our GPs. Many people do not have a regular GP. They rely on online GPs or it can take a month to get an appointment. I know a lot of women my age who cannot go to a GP so they are still spending the €20 to get their repeat prescription from a GP for their oral contraception. The prescription is free when they go to the pharmacy and they have their PPSN, but the process of getting the prescription costs them €20 because they simply cannot get a GP appointment. Women in that category are falling through the gap. I recognise that the Bill is going to address that, which is brilliant. It really is a positive move.

It is also a positive move for migrant women, women who cannot access a GP appointment or women who are forced to avail of online GPs, as I mentioned. It also includes women who do not have access to transport and maybe women experiencing coercive control in a domestic violence situation who cannot pop down to the GP, whereas accessing a pharmacy in a high-street shop is much easier. It creates a sense of additional safety around that.

I want to re-emphasise the piece around the workload for pharmacists. I know the Minister will be working with the Irish Pharmacy Union and moving forward on that, but we must ensure that pharmacies are staffed and resourced in an appropriate way.

The National Women's Council has found that 31% of women experience barriers in accessing the free contraception scheme as it stands. There are obviously concerns about the age restriction, although I know that is changing. I believe the age category for accessing free contraception is to increase in the next women's health action plan but perhaps I misread that. The Minister might refer to it in her response. It may be the case. We do not know yet. We would support an expansion of the scheme to women of fertile age. Just because a woman is over 35 does not necessarily mean she can afford access to contraception.

Laura Harmon (Labour)
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I welcome the Minister to the House. The Labour Party welcomes this Bill, which will allow pharmacists to prescribe contraception in certain circumstances. It is a sensible step that will help to improve access to the free contraception scheme, which was launched in 2022. We all know that many barriers exist in Ireland in terms of cost, geography or simply time for many people when trying to access a GP. That is particularly true in rural areas or socially disadvantaged areas. Empowering pharmacists to renew prescriptions is a sensible solution to one part of that problem.

We believe the age range for the free contraception scheme should be extended beyond the current range of 17 to 35. There are women well into their 40s and beyond who need access to contraception. In our view, raising the age to 40 at a minimum would cost just €5 million. We believe this should happen without delay.

As was mentioned, research by the National Women's Council has pointed out other barriers to access that exist with regard to the scheme. Its research found that 31% of women experience barriers to access to contraception. There is a real issue with access for migrant women, including those in IPAS centres, who will not have the PPS number needed to access the scheme. There are also issues around cultural beliefs that shape attitudes to contraception in certain migrant or perhaps Traveller communities and we should ensure that women in these communities are met with sensitivity and appropriate support to enable them to access the scheme in whatever way works for them.

We believe this Bill is a very positive and welcome step. I commend the Minister on it. It is also a timely reminder that we need to ensure the scheme works for every woman in this country. That means expanding age limits and looking seriously at how we remove any existing barriers to access.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Senators for their support and enthusiasm for this legislation. It is very practical and will improve access to healthcare for women.

On the age range, this scheme was introduced in a phased way to protect the taxpayer. The emphasis was on the youngest women first, recognising that they probably had less money and that they were not as likely to be at the phase of trying to conceive as somebody in their late 20s or early 30s. The intention was to focus and build over time. I would very much like to continue to extend it. We reckon that for every year we extend the scheme, the additional cost is about €1 million. The extension to 36- to 40-year-olds is likely to be €5 million. The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding.

I remind Senators that they have also asked me to fund various other programmes. We could be here talking about menopause and how we would like more specialist menopause clinics, which we are extending. It is important that Senator Tully raised this. I have put an emphasis on women's health generally. We have not had an emphasis on women's health historically. I pay tribute to my predecessor, Stephen Donnelly, and to a previous Minister, now Tánaiste, Deputy Harris, who both began the women's health task force. We have seen nearly €200 million invested in women's health specifically as a consequence of that. However, it is still true to say that women's health has not been understood as a distinct thing. For example, cardiovascular disease presents entirely differently in many cases with women. Heart failure has different symptoms in women than in men. We know that. We have a Her Heart Matters programme to try to dedicate more resources and understand the differences between women and men when it comes to conditions of that kind. This year, we have provided funding of €2 million to the Health Research Board specifically for research on women's health to differentiate it and make it different.In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more marginalised groups. It is about trying to find and understand different ways to make contact with them and make sure they have the health they are entirely entitled to.

I forgot to mention the hormone replacement therapy, HRT, arrangement, which is now free for women. I do not have concerns about pharmacists' continued participation. It is always wonderful to see advocacy for private businesses by the Social Democrats. They have been enthusiastic in signing up to the common conditions service. It is a service that generates fees for pharmacists. It is an opportunity to work at the top of their profession. I have found them to be really enthusiastic about this whole programme about expansion. It is far from withdrawing. They are able to hire more people. We have put more supports into being able to train at a totally different level. We want to give them the respect they need. I am more interested, if the Senator will forgive me, on supporting patients and access to patients.

Patricia Stephenson (Social Democrats)
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Not all pharmacists are business owners.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more. I believe in pharmacists and community pharmacy. It is an exciting opportunity for any pharmacist to continue to participate in these different schemes.

First and foremost, and most importantly, this will make a big difference to women. I would like to go further with the free contraception scheme. It is a question of how we balance the budget and different needs that we all recognise for people. How do we do that in the most sensitive, appropriate and intelligent way over time with the funding that is available?

Mark Daly (Fianna Fail)
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When is it proposed to take Committee Stage?

Maria Byrne (Fine Gael)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Mark Daly (Fianna Fail)
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When is it proposed to take the next Stage?

Maria Byrne (Fine Gael)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Mark Daly (Fianna Fail)
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When is it proposed to take the next Stage?

Maria Byrne (Fine Gael)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.