Health Strategies

88. Deputy David Cullinane asked the Minister for Health if she will ensure the urgent development and implementation of a fully funded national endometriosis strategy and comprehensive national service, including regional multidisciplinary centres of excellence, improved access to diagnosis and specialist treatment, and dedicated surgical capacity; the funding allocated for these services in budget 2027; the timeframe for delivery; and if she will make a statement on the matter. [72940/26]

We have had a number of discussions about endometriosis. I know a new framework has been put in place. However, I have met hundreds of women who have spoken about their experience. The Minister may have seen the "Prime Time" investigates programme that talked about women waiting an average of 14 years for diagnosis and treatment. Much more needs to be done. I ask the Minister to set out what that will look like, what resources have been put in place and what advancements have been made in relation to diagnosis and treatment.

I thank the Deputy. I acknowledge the amount of work he has done on this issue, the range of people he has met and the advocacy he and others have advanced on behalf of women with endometriosis. It is not an area I understood when I took over as Minister for Health. I am glad to have had the opportunity to learn so much more about it. I hope that in the past 12 to 13 months we have taken steps to provide a real step change in the type of care that will be provided, not only now but, more importantly, building for the future, because things like surgical fellowships take longer to bed in. In the immediate term, I was trying to make sure there was a scheme that would fund upfront surgeries internationally. It is not perfect, but it has enabled 74 women to have surgeries in the past 12 months. That would not have happened otherwise or the surgeries would have been more difficult to fund. As I said, it is not a perfect system but it is one that was trying to address a real and immediate need. For the longer term, we are creating different types of surgical training pathways through fellowships, with partnerships with different institutes abroad, for example in Bordeaux, Germany and the UK, to try to provide longer term training schemes so that we are able to provide the best possible surgery here rather than sending women abroad to get the type of complex surgery they have needed. There are people already on these fellowships. One of the most important things we have done is not only enable and fund the menstrual information specialising in endometriosis, MISE, scheme but actually make it the HSE education scheme. I have recently given an additional very significant €300,000 to the MISE scheme to allow it to expand its work to provide training on endometriosis in workplaces and schools all around the country so that we can drive better awareness of endometriosis at the earliest stage. We provided an additional €500,000 to increase surgical activity in quarter 4 of 2025, resulting in an additional 142 domestic surgeries. Although some of the recruitment is slower than I would like, we have also continued to recruit specialist positions in endometriosis for the super-regional centres.

We are trying to attract specialists and that is more difficult.

Women have told me time and again that they were not believed, were not listened to and were left in pain for years. A family member of mine is one of those women and she was waiting a long time for access to the clinic in Cork. She was in a lot of pain and had to take a long time off work and I was taken aback when she told me the full extent of what she was going through. I have met hundreds of women and have heard those stories. When you know someone who is affected, you know we need to do so much more. We have to find a process, first, to allow women to tell their stories because there is a lot of pain there among people who have not been diagnosed, who have been misdiagnosed or who did not get the treatment that they need. That is part of it and we have to listen to those stories. We have to face up to the fact that they were failed, but we also have to put the resources in place. That means the regional centres have to be properly resourced with the full teams, all the necessary staff and all the different options open to women. As we saw in that "RTÉ Investigates" programme, even a doctor had to travel abroad to have surgery. That is the extent of it. The Government has a long, long way to go.

I am very aware of that. Indeed, I met a doctor who travelled abroad for surgery. I was personally offended that a doctor in our hospital system would have to use her HSE salary to fund her surgery abroad. I really do accept what the Deputy is saying. I accept that women have not been heard. That is why I brought them not once but twice into the Department of Health to tell their stories to the CEO of the HSE, the Chief Medical Officer and the chief nursing officer. Perhaps the Oireachtas committee will convene an opportunity to do that in the Oireachtas as well. The Deputy is correct about women not having been believed. That is why we changed it to a presumptive diagnosis approach given that women are - it was a endometriosis advocate who used this line - the best narrators of their own experience and the best narrators of their own pain. We have so much more to do on pain management as well. We have not got that right yet. There is activity, though. For example, I visited the super-regional centre in Tallaght in July for the launch of the women's health action plan. Surgeries there increased by 19% between quarter 2 of 2025 and quarter 2 of 2026.

Referrals increased by 60% in the same period.

What we need is a fully funded strategy and service. We need to make sure that when a woman has endometriosis, there is a proper diagnosis in the first instance. Obviously, there has to be the highest level of awareness in primary care and GPs have a responsibility, but when they make referrals, these cannot be into nowhere with women waiting for years. Those referrals have to be into the specialist centres. In reality, what women say to me is that we need processes to hear all of the failures but really what they want is to be believed in the first instance, to have an early diagnosis as quickly as possible and then rapid access to treatment. We expect that in every other area of healthcare. The Minister more than anybody will be aware of all of the failures in women's healthcare. There are a lot of failures and this is just one of many. I hope the newfound awareness in society generally, it has to be said, in the medical fraternity, in the political world and elsewhere will lead to more advances and better and faster diagnoses, but also treatment options for women.

I agree. To update the House, the HSE is supporting and encouraging services to get international accreditation with the British Society for Gynaecological Endoscopy. That is a first. That is new and better. I have directed that €2 million go into health research, including for endometriosis. That is the first time Irish research funding has gone directly and specifically to women's health. As part of the EU Presidency, we will have an EU endometriosis conference on 3 December 2026 - the Deputy is very welcome to come to it - to try to raise awareness at European level and to use the Irish Presidency to put a focus on endometriosis insofar as we can. Two permanent two-year endometriosis fellowships have been established across Cork and Tallaght. They will be recruited on a recurring basis so that we will have a pipeline of expertise into HSE public endometriosis services. On medical awareness, the Deputy is so right. We wrote to all GPs about this I thank the Institute of Obstetricians and Gynaecologists, whose annual conference on 6 March focused on endometriosis. All of these are different, better, newer in the past period-----

-----within this Dáil because of the Deputy's work, because of his party's work and because of my work. All of us together, I hope, are making some difference but I acknowledge that if a women is in pain today-----

-----that has not changed for her.