Paul Murphy (Dublin South West, RISE)
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530. To ask the Minister for Health when will Government funding be available for public IVF; and if he will make a statement on the matter. [7497/24]

Stephen Donnelly (Wicklow, Fianna Fail)
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As the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.

The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.

This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (e.g., IVF and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.

Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of secondary treatments, and both medical and surgical interventions.

Phase Two of the roll-out of the Model of Care relates to the introduction of assisted human reproduction (AHR) treatment provided through the public health system at tertiary level. In particular, the first steps have been taken towards achieving the ultimate objective of Government, which is a wholly publicly-provided fertility service.

As an interim measure, funding has been made available to support access to AHR treatment via private providers from September 2023. As well as IVF and ICSI, this allocation is also being used to provide, initially through private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.

Referrals for AHR treatment by private providers commenced in the week beginning September 25th 2023 after details of how the new initiative would be initially rolled out – including regarding the set of criteria which prospective patients should meet in order to access fully-funded AHR services and the specific services to be initially funded – were agreed by the Department and NWIHP and then brought to Cabinet in July 2023. The criteria were developed and finalised further to engagement and consultation with experts in the field of reproductive medicine, with the clinical parameters of the access criteria including the assessment of such areas as age, body mass index (BMI) and other health and well-being elements.

These clinical parameters were reviewed in the context of both the potential success or otherwise of the advanced fertility treatment itself but also the health and well-being of the intending birth mother and any resultant pregnancy inclusive of the management of maternity care, delivery and health of any child. The approach adopted by the Department of Health in relation to defining clear parameters regarding specific clinical criteria for AHR is in line with many European and international counterparts, allowing for necessary accountability for the cost-effectiveness use of public funds and the safety of patients and any consequent pregnancy that may result. More details on public fertility services generally, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/

The access criteria and the scheme generally will be kept under review as new evidence becomes available, an understanding of how the service provision is working in practice emerges, and when the AHR legislation – currently at Committee Stage in the Dáil – is finalised.

It is important to note that a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I understand that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them. In this regard, according to figures from the HSE, a total of over €40m was spent on what it termed as fertility drugs in 2022.

In addition, there is other support available in that patients who access IVF, or other advanced AHR treatment, privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.

My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.