I welcome the Minister of State, Deputy Martin Heydon.
Nithe i dtosach suíonna - Commencement Matters
Homeless Persons Supports
I thank the Cathaoirleach for selecting this important matter. I am glad to have the opportunity to talk about it today. I welcome the Minister of State and thank him for agreeing to come to the House to take this matter. I value and appreciate that. I know it is a busy day for him. As he is a key Minister of State in the Department of Agriculture, Food and the Marine, I take this opportunity to congratulate him and his Department on the collaboration with Bord Bia Bloom Festival, which kicks off today. Undoubtedly, the Minister of State would prefer to be at the festival in the sunshine meeting and greeting the farmers and those in the horticulture sector, but he will surely have an opportunity to do so. I am thankful for the collaboration between Bord Bia, the Office of Public Works, OPW, and the Department of Agriculture, Food and the Marine, which has made this a successful festival and now an international event.
I am here to talk about the Youth Homeless Strategy 2023 to 2025. I refer to the context of the recent reports published on the monthly homelessness statistics, but I am not here to comment on them in any great detail because they cover the full gamut of homelessness and the challenges around it. I do, though, welcome the openness and transparency of the Government to publish these monthly figures. This is a commitment in itself, and it is good because it allows for a greater scrutiny of homelessness on a month-by-month basis.
Turning to the youth issue, we know addressing youth homelessness is one of the key aims set out in the Housing for All policy. There has been a rise in the number of young people experiencing homelessness and this is deeply concerning. This morning, just before I came into the House, I went to the Grafton Street are to have a look around. There is evidence there of young people who are homeless and sleeping in doorways. It is clear from seeing and talking to some of those young people that the issues involved in their being homeless include drug addiction, mental health issues, exiting from prison, exiting from institutional or State care and low academic achievement because of constricted academic opportunities due to social exclusion, disadvantage and family break up. All of these elements feed into homelessness. A complex range of issues impact on young people.
I am conscious, as is the Minister of State, that the Government has signed the Lisbon Declaration of the European Platform for Combating Homelessness, which commits to working to end homelessness in 2023. We have a long and hard task ahead of us, and we must all work together to support those young people at risk of becoming homeless. The latter is key. This is about being on the same team and working to see how we can address the issue. I wish, therefore, to commend the Government's youth homeless strategy. As the Minister of State will well know, the strategy contains 27 distinct actions to prevent young people from entering homelessness and to improve the experience of young people in emergency accommodation. The latter is an issue. For many young people, it is not working out for them. For some reason, they feel they cannot operate within emergency accommodation. We must look at that aspect. It is a particular matter that we must address. We must consider whether we need to work on another range of supports in this context.
The other question, of course, is how we can assist young people to exit homelessness. I touched on the issues of people exiting the prison services, State care and being impacted by disadvantage. The Traveller community is another specific area we need to focus on in the context of homelessness, as well as those of mental health and vulnerable people.
Transitioning from institutional care into a community and life is difficult. It is one of the hardest tasks for people. For young people aged 16, 17 or 18 who are pushed out of institutional care, who are not equipped for this and who do not have emotional and educational supports, this is one of the most vulnerable times in their lives. In many cases, no one gives a damn about them. No one cares and no one supports them. They have no contacts. In many cases, their families have totally broken. Youth homelessness, therefore, is an extremely important issue. The youth homeless strategy is key in this regard and I would like to hear the Minister of State comment on how we can now work together to deliver on the 27 distinct actions in the strategy. I thank the Minister of State.
I thank Senator Boyhan for raising this important matter. Regarding his initial comments, I look forward to attending Bloom this afternoon with my ministerial colleagues. It is a great opportunity and great credit is due to Bord Bia, an organisation that we support extensively through our Department. It comes directly under my remit in the Department. Great credit is due to Bord Bia for what is a fantastic event. More than 100,000 people will visit Bloom in the coming days and get to see the best of our horticultural sector. This is a sector that is facing significant challenges. It is important that the urban-based, non-agricultural population get to understand and appreciate the quality of our Irish food and where it comes from. There is so much for us to be proud of, so I look forward to attending Bloom later today. I thank the Senator for his comments on this subject. I will pass them on to Bord Bia and to my officials in the Department as well.
Moving to the important issue of youth homelessness that the Senator raised today, I take on board his comments. I acknowledge what he said. I am taking this matter on behalf of the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, who, unfortunately, cannot be here. I do take on board the points the Senator made. It would probably be easier, we could say, for Governments not to publish these monthly figures and to perhaps hide away from such a challenging issue, but this is not the Government's approach here at all. We are determined to tackle what is a major crisis in homelessness. I refer specifically to the significant challenges of youth homelessness and to that cohort of young people who have the potential to become homeless and to trying to make interventions in this regard.
In line with commitments in the programme for Government and Housing for All, the youth homelessness strategy was published in November 2022, as the Senator is aware. The strategy aims to help young people aged 18 to 24 who are homeless or at risk of becoming homeless. As the Senator said, it sets out 27 distinct actions to prevent youth homelessness, improve the experiences of young people accessing emergency accommodation and assist young people in exiting homelessness. This is the first youth homelessness strategy in over 20 years and is a significant milestone in the Government's efforts to eradicate homelessness.
It is important that we have a strategy like this because, as we know, homelessness is not just about the availability of property. There are always so many other underlying challenges and complications that go beyond just the provision of housing itself.
The development of the strategy was, therefore, informed by a wide range of views. A number of consultations were held by the Department of Housing, Local Government and Heritage in the first half of 2022 with key stakeholders, including Government Departments, agencies, the NGO homeless sector and, most importantly, young people with direct experience of homelessness. In total, 29 young people aged 19 to 26 participated. The 27 actions within the strategy are concrete and deliverable, and enable a stronger, co-ordinated national approach to tackling youth homelessness. Critically, they also address the complex nature of youth homelessness.
A steering group has been established under the auspices of the national homeless action committee, NHAC, to drive the delivery of all actions within the strategy. The membership consists of representatives from relevant Government Departments and agencies, local authorities, NGO members of NHAC and a youth organisation. Two quarterly meetings of the steering group have taken place at which actions were discussed and progressed. One of the key actions in the strategy is to develop a pilot of a housing-led intervention, supported housing for youth, SHY.
SHY will be a housing-led intervention for young people who are homeless or who are identified as a vulnerable cohort within the strategy and who may be at risk of experiencing homelessness in the future. It will provide a range of accommodation options, including shared accommodation and one-bedroom units, as well as supports to build on the clients' strengths, skills and relationships to enable them to fully integrate into their community and engage with education and the marketplace. Participation in SHY will be time-limited with the end goal being that the client is in a position to live independently. That time limit is really important in terms of building people's resilience and not having to become dependent on the very supports that there are to assist them. The SHY project is progressing well, a series of meetings have already taken place with a focus on eligibility, conditions and supported transitioning.
I thank the Minister of State for that very comprehensive response. I am particularly interested in his reference to the SHY pilot. It is progressive and good. I am looking forward to monitoring and keeping up to date on that. The in-person consultation with the key stakeholders will provide very valuable feedback in terms of this Commencement matter. As the Minister of State said, all those 27 key objectives in the strategy are robust, strong and achievable. That is good to hear. This collaborative approach, and working closely with our city and county councils and councillors, who are the on ground working with people, will achieve the results. I always say to city and county councillors that it is up to them to keep asking the questions and to keep pushing the agenda in their local city and county council halls and seeing them through to delivery. It is important. The needs are complex, but Tusla has a huge role in all this too. That joined-up thinking to address those complex needs will make the difference. I thank the Minister of State again very much for his time here today and for his comprehensive response.
Senator Boyhan is absolutely right. The major strength of the strategy is that it is more than the Department of Housing, Local Government and Heritage, with the Department talking to NGOs, coming up with a strategy and talking to those with the lived experience, to those who work in the voluntary sector and to other Government Departments. This goes beyond housing. It deals with health and many different areas, such as employment opportunities, etc.
On the SHY pilot, an in-person consultation event with other key stakeholders to further progress this action is scheduled to be held in the next two weeks. There is real momentum here and progress is being made. That is something we can continue to discuss in this House. The Senator can raise the issue again to follow through on that. All actions in the strategy are considered on an ongoing basis. The steering group will continue to meet to ensure the actions are progressed as scheduled.
The Senator can take it as a given that the Government has this matter as a top priority. It is a big challenge for us, and the strategy acknowledges that there are multiple, inter-related causes of youth homelessness and the experiences of young people in the emergency accommodation system are distinct from those of the rest of the homeless population.
This strategy was developed with the understanding that young people should be valued in their own right, and they are key drivers in achieving their own cognitive, emotional, social and economic development. The Government recognises that by supporting young people who are at risk of becoming homeless, we can help to prevent a cycle of longer-term homelessness. That is really what we all want to achieve here in reaching our longer-term goals, as the Senator outlined. I thank him for raising this important point today.
Fire Service
On Tuesday, Senators Gallagher and O’Donovan spoke on the issue of the pay of whole-time retained firefighters, pointing out that negotiations with the Local Government Management Agency, LGMA, have broken down and that strike action has been served on the relevant parties. We heard about how a whole-time retained firefighter earns approximately €700 per month which equates to 99 cent per hour. They must be on call 24-7, 360 days a year. They must stay within 3 km of the station at all times, attend the station within five minutes of a call and attend eight weeks of compulsory training in their first year in order to qualify as a firefighter. We can all understand why strike action is being taken over the abysmal level of pay.
On Tuesday, the Minister of State, Deputy Calleary, on behalf of the Minister, Deputy Darragh O'Brien, responded that, “Should a period of industrial action commence on 6 June, local authorities will put in place appropriate contingency measures to ensure the ongoing provision of essential services is maintained.” I have been contacted by multiple councillors in Tipperary, Galway and Meath off the back of that response. They do not know how that is going to work or whether it is going to be possible. Many simply cannot see how the councils will be able to ensure the uninterrupted provision of firefighting services without their local retained firefighters. What will happen if, God forbid, there is another Creeslough? What will happen if there is a big industrial fire? Who will be expected to step up?
There is another aspect to this that compounds the problem in what may be a very dangerous matter. The local authority water workers are planning to go on strike as well, so there will be fewer firefighters and, if there is a major water leak in a town or a burst pipe, no one will be there to fix it. We will, therefore, have no water either. That sounds like the perfect storm just waiting to happen. One glance at the Irish Water map shows water outages all over the country. We would not have time to list them here this morning. On 7 and 8 June, and on a rolling basis after that, the local authority water workers will not be there to fix them.
Will the Minister of State please take that into account as he outlines how the Department will make sure that local authorities are able to continue their service this month and ensure they are fully equipped and prepared to handle whatever accidents may occur in these areas?
I would like to start by thanking Senator Keogan for raising what is a very important issue. It is important we discuss this in advance of any potential action. The provision of a fire service in its functional area, as the Senator will be aware, including the establishment and maintenance of a fire brigade, the assessment of fire cover needs and the provision of fire station premises, is a statutory function of individual fire authorities under the Fire Service Acts 1981 and 2003. The Department of Housing, Local Government and Heritage supports fire authorities by establishing policy, setting national standards for fire safety and fire service provision, providing a central training programme, issuing guidance on operational and other matters and providing capital funding for priority infrastructural projects and the procurement of essential front-line fire appliances and equipment.
Under the Fire Services Acts 1981 and 2003, 31 local authorities provide fire prevention and fire protection services for communities through 27 service delivery structures. Local authority fire services are delivered by approximately 3,300 local authority staff engaged at 217 fire stations nationwide, with 16 of these stations being staffed by full-time firefighters, a further four are a mix of full-time and retained, and 197 are staffed solely by retained firefighters.
The Minister, Deputy Darragh O'Brien, is aware of the challenges associated with the recruitment and retention of retained fire personnel experienced by some local authorities. That is the reason the Minister, Deputy Darragh O'Brien, directed the management board of the national directorate for fire and emergency management, NDFEM, to review the delivery and sustainability of the local authority retained fire services, with particular emphasis on the recruitment and retention of staff. That review was published in December 2022 and is entitled, Retained Fire Services in Ireland - A Review of Recruitment and Retention and the Future Sustainability of Service Delivery.
Following the dissolution of discussions at an independently chaired facilitation forum on priority industrial relations issues identified in the report, SIPTU has notified all local authority chief executives that retained firefighters intend to begin industrial action from 6 June, with phased weekly escalations of actions to follow on 13 June and 20 June.
In preparation for proposed industrial action, officials from the national directorate for fire and emergency management in the Minister's Department, working closely with the Local Government Management Agency, LGMA and chief fire officers, have prepared a guidance document for local authorities. This is based on the provisions of the 1992 code of practice, SI 1 of 1992, the Industrial Relations Act, 1990, Code of Practice on Dispute Procedures (Declaration) Order 1992, to ensure a consistent approach to managing the consequences of industrial action in the retained fire services through establishing effective contingency arrangements to ensure a fire service response, proactively ensuring the health, safety and well-being of staff, and protecting communities to the maximum extent possible during the dispute.
The guidance aims to provide a consistent approach to planning for the contingency provision of emergency fire cover by local authorities for the duration of the industrial action period. To this end, senior fire service management is meeting with local SIPTU representative committees in each local authority to establish agreed local contingency measures. SIPTU has confirmed, in response to the LGMA, that the provisions of the 1992 code of practice on dispute procedures, including essential services, enabling co-operation and contingency planning and the continued provision of essential services, will be adhered to by all SIPTU members during the course of this dispute.
The following principles have been agreed with SIPTU and should be implemented for the duration of the dispute by staff and management: public safety will be safeguarded by staff and management at all times during the dispute as a top priority; there will be no compromise in the fire service health and safety measures; and, given these constraints, management will engage locally to enable firefighters to take industrial action, recognising non-engagement in work that is not urgent or essential for the duration of this dispute. In addition, a national fire safety awareness campaign will run over traditional and social media for the duration of the proposed industrial action to reinforce home fire safety messaging.
To be quite honest, that is a copy and paste from what we heard the other day. The only line that is new in the reply is, "To this end, senior fire service management is meeting with local SIPTU representative committees in each local authority to establish agreed local contingency measures." They are the measures I asked about. I want to know what those measures are. Communities and businesses want to know what those contingency measures are.
I refer to what happened in Blanchardstown at the weekend. What will happen if our fire service is not on the ground? The Minister of State does not know what is going to happen. What happens if there is no water? It appears one arm of the State does not know what the other arm in local government is doing. We will have no people working in our water services in local authorities next week. Firefighters will be out at the same time. It does not make sense that there is no joined-up thinking on this particular issue. It is a catastrophe waiting to happen. I am disappointed by the answer I have received. Nobody has addressed the fact that water services in local authorities are going on strike next week.
Schools are holding leaving certificate examinations next week and hospitals will also be affected. All of the everyday things we need in our communities will be affected. On the Uisce Éireann website yesterday, reference is made to these issues running into next week. They will not go away. In all fairness, the reply is a cop-out. We need to look after our firefighters. The Uisce Éireann issue needs to be addressed within our local authorities and the staff need to be looked after.
The Senator might not have heard my initial response and taken all of it fully on board. The key element is that SIPTU has confirmed it will adhere to the 1992 Act. We have a responsibility not to scaremonger. Public safety will be safeguarded by staff and management at all times. The Senator referenced Blanchardstown. If I were a member of the public looking at this debate, I would think no member of the fire service is going to go to a fire incident like that. It has made it quite clear-----
The Minister of State is once again relying on the goodwill of our fire service.
SIPTU has committed to that, in line with the 1992 Act, and we should not stand up in this House and allude to people that if there is a fire emergency, the fire service will not attend. I will get to my point about the retained fire service. I deal with the retained fire service in Kildare and know how it needs to be treated better. However, let us not scaremonger in the House and try to tell people that if there is a serious fire incident, the good men and women of the fire service will not respond because, through their representative body, they have committed to doing so.
What is clear from the findings of the retained review report is that the work-life balance of retained firefighters need to be addressed. I absolutely accept that, as does the Government. Work is under way through agreed structures to begin implementing the recommendations set out in the report to ensure the sustainability of the retained fire service as an attractive employment option. I do not doubt how hard it was for retained firefighters to make the decision to seek industrial action. We respect that it will do that and recognise that the non-emergency element will not be dealt with during the dispute period. During the most recent discussions between management and SIPTU, substantial progress was made in addressing the work-life balance concerns of retained firefighters, as acknowledged by SIPTU.
A positive conclusion of the process to the satisfaction of all parties has not been possible to date. However, management remains available to recommence discussions with a view to resolving outstanding industrial relations matters. The Minister, Deputy O'Brien, encourages all parties to use the agreed industrial relations processes set out in the Building Momentum pay agreement to bring matters to a satisfactory conclusion as soon as possible.
Mental Health Services
The Minister of State is more than welcome to the Chamber. I want to put on the record my correspondence in the past 24 hours from the Minister of State, Deputy Mary Butler, who contacted my office. She said she is taking questions in the Dáil today and is unavailable to attend this debate. I acknowledge that.
This is a very serious issue. I ask for an update on child and adolescent mental health services, CAMHS, in the Cork-Kerry region, community healthcare organisation, CHO, 4. The CAMHS issue in Cork and Kerry is beyond belief. The need in the community is frightening in many ways. Parents, teenagers and children have come to my office weekly to ask for an update on when they can get appointments.
When I began researching the current waiting lists in CAMHS in the Cork-Kerry region, it frightened me. There are 888 children looking for services in the region. That comprises approximately 20% of the entire national profile. Over one year, 343 children and teenagers, or 50% of the entire national waiting list, is in the Cork Kerry region. That is unbelievable. In the north Dublin city area, nobody is waiting. It is frightening that Cork-Kerry has a waiting list of 50%, but in one part of Dublin there is nobody waiting.
Politics is one thing. These are people who are under enormous stress and pressure. A lady came to me a few weeks ago to tell me her daughter has not gone to school this year. She is waiting for an appointment. She is on a long-term waiting list and is considered to be a priority. She is in second year. I am pulling my hair out to see what we can do for the family. Other families have been through bereavement, eating disorders and depression. It is the tip of an unfortunate iceberg. If people do not get interaction at this stage, unfortunately the trouble only builds and goes further. I am deeply concerned about this waiting list. For one region to have over 50% of the long-term waiting list creates a major problem for me.
The Mental Health Commission published a report which stated that roughly 431 extra posts are required to cover the service nationally. The issue in the Cork-Kerry region needs to be examined. We need to have a serious look at our staffing resources nationally. Is it now time to start redeploying personnel? There are ten CAMHS teams in Cork, not all of which are fully staffed. There is a serious lack of personnel to deliver services on the ground.
The Minister of State, Deputy Butler, is very concerned about this issue. I hope to meet her in two weeks' time to see whether we can get a plan in place to deal with this issue. I have no issue with Dublin having nobody waiting more than 52 weeks. However, 50% of the waiting list being in the Cork-Kerry region means there is a regional issue that needs to be addressed.
I look forward to the Minister of State's response. We need to start a real debate. Staff need to be redeployed. There needs to be a completely different ethos nationally with regard to how we deal with the Cork and Kerry region. If there is not, this waiting list, in particular for those waiting more than 52 weeks, will continue.
I thank Senator Lombard. I know this is an issue that is particularly close to his heart which I have heard him raise and articulate on a number of occasions, particularly how much it impacts the Cork and Kerry area, the region he is from. It is timely that we get to discuss this here today and shine a light on it.
The programme for government commits to improving all aspects of CAMHS in line with Sharing the Vision, Connecting for Life and the annual HSE service plans. The total allocation for mental health services in 2023 is more than €1.2 billion, which includes €137 million for CAMHS. A key objective is to improve access and address CAMHS waiting lists in the 75 CAMHS teams nationally, including Cork and Kerry, in light of increasing demand and case complexity. A significant development was approval by the Minister of State, Deputy Butler, under budget 2023 for a new post of youth mental health lead at assistant national director level in the HSE, and a new clinical lead for youth mental health to provide more integrated services overall.
Approximately 2% of young people will require the specialist CAMHS service. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen has increased by 21% in that same period. Waiting lists vary across community healthcare organisation, CHO, areas, as the Senator acknowledged. While some areas have relatively short waiting lists, regrettably, waiting times are longer in other CHOs. The HSE is actively working to reduce the CAMHS waiting list and there are a number of service improvement initiatives taking place as a result of the Maskey report and the Mental Health Commission interim reports. The HSE funds a wide range of agencies, such as Jigsaw, that provide prevention or early intervention mental health supports to young people.
In collaboration with local CAMHS services, a waiting list initiative is under way in six CHO areas, including CHO 4, specifically targeting those waiting longer than nine months. CAMHS community services in Cork Kerry Community Healthcare are delivered across ten community sector teams and also a child and adolescent regional eating disorder services, CAREDS, team. In addition, Cork Kerry Community Healthcare provide a CAMHS liaison service at Cork University Hospital and the Mercy Hospital.
There has been a recent significant increase in the number of new referrals to CAMHS in this area. In September 2022, CAMHS received 219 new referrals in the month. In March 2023, this figure had increased to 267 new referrals. This has had an impact on the number of children waiting for services. As per March 2023 data, the total number of children waiting more than 12 months to be seen is 341.
The HSE is committed to improving access to all of its services. In this regard CAMHS teams in Cork Kerry Community Healthcare are taking a multifaceted approach to improving access to their services. An ADHD waiting list initiative has been approved for funding and, once operational, it is anticipated that the ADHD team will remove 120 children from the waiting list over six months. As the numbers waiting to access CAMHS in north Cork are particularly high, innovative telemedicine clinics are being developed for this area. Furthermore, additional consultant-led clinics are provided at weekends to support children and young people in north Cork to access assessment and supports.
I understand the human impact of this on these young adults, who need this support from the State, and on their families and the constituents the Senator deals with on a daily basis. I want to reassure the Senator and the families that the Government is aware of this issue. These waiting lists are not acceptable and we are working across agencies to bring all the different groups together that can impact this to make that change and to make significant progress on those unacceptable waiting lists.
I thank the Minister of State. I want to home in on the data in regard to the 12-month waiting list. The Minister of State’s figures are from March 2023 and state that there were 341 children. My figures are from February 2023 and there were 343, so we have literally taken two children off that long-term waiting list in a month. I do not want to do the maths on this but if we are to continue to take just two per month off the long-term waiting list, I am already grey and I would be bald by the time this thing is over. We need to have a serious look at what needs to be done. I realise there are staffing issues. However, we can do it in other areas. If Dublin can be down to zero with regard to 12-month waiting lists, what is it doing that we are not doing? What can be taken from the Dublin experience, and in particular the north Dublin area, where no child is waiting more than 12 months while we have 341 children waiting? It is a frightening statistic.
It is not about politics. Deputy Mary Butler is a brilliant Minister of State and a lovely person. However, this is something that we have to look at. An initiative has to be put in place nationally. It has to involve everybody in the entire services because unless we get people into Cork and Kerry shortly, I do not know what will happen. This is as serious as it gets.
The Senator is dead right. It is as serious as it gets. What the Senator outlined is not acceptable in terms of the progress, which is why a number of initiatives across our multifaceted approach are being set up, including the ADHD team I mentioned, which will hopefully take 120 off the waiting list in a six-month period, as well as a number of different initiatives. I appreciate how frustrating an experience it is for families whose children are waiting to receive a service. I assure the House the Government remains committed to the development of all aspects of mental health services nationally, including those for children and young people. The Minister of State, Deputy Butler, recently completed a series of three high-level round-table discussions, bringing together the Department of Health, the HSE and other key stakeholders across the youth mental health area to drive improvements in CAMHS, with a focus on executive leadership, clinical expertise and service provision. The Government is awaiting the outcomes of all audits under way on CAMHS nationally, including the final report of the independent review by the Mental Health Commission currently under way across all 73 CAMHS's teams nationally. This will help to inform any next steps necessary regarding CAMHS.
I take the Senator’s point on board. Good practice has made serious inroads into waiting lists. We need to take that good practice and make sure it is implemented in Cork and Kerry. I thank Senator Lombard for raising this very important issue today.
Medicinal Products
I welcome the Minister of State, Deputy Heydon, to the Chamber and thank him for being here to issue the Minister's response. The Minister of State will be aware that hormonal replacement therapy, HRT, has seen somewhat of a resurgence and there has been a huge increase in demand in recent years. This is in large part due to a public information campaign run by the Government on the benefits of using hormone replacement therapy when going through menopause or perimenopause but also because of the work of many individuals, organisations and public representatives in highlighting the need for better menopause care for women.
The population of Ireland is 51% women and every single one of us will at some point or other go through perimenopause and menopause. It is a very normal part of the ageing process and just presents a new chapter in life, and it should not be one that presents health difficulties. For some women, it gets to a situation where they cannot go to work, they cannot function and they cannot go about their daily life. These medicinal products are very important. They are not luxury products; they are essential to just going about your daily business, looking after your family, going to work and living your life.
As a result of the increase in demand, these products are quite expensive and they have become more difficult to get. I am aware there are shortages of a lot of medicines in the country, so it is no surprise it is impacting HRT medicines as well. One woman told me that her prescription would normally be a particular volume of medication, with a 100 g tablet, but they are no longer available and she has been told to buy the 200 g tablets and just take them every second day. It does not sound like the type of prescribing I would like to receive from my doctor or pharmacist, but needs must, and that is all that is available for her and these are essential tablets.
A big part of the reason that I wanted to raise the matter this morning is that there is a huge disparity in pricing among pharmacies. To give an example of a very commonly used product, the Oestrogel pump pack is often prescribed with oestrogen tabs.
Across three pharmacies, the price ranged from €23.59 to €33.95 and €44.12. One pharmacy is nearly double the price of the other for the same product. Pharmacies are not giving the full six-month prescription. People have to come back month on month, incurring prescription charges, additional hassle and cost that should not be there. Why is there this disparity in pricing? Why are pharmacies charging wildly different prices for the exact same product? Why can a woman not fill her six-month prescription, bring it home and be done with it for six months, rather than having to traipse back into the pharmacy each month?
Women in the Republic are ordering HRT products from the North or further afield and getting them posted to them because it is easier. It should not be easier to order from the North than to pop to the local pharmacy, nor should it be cheaper. They are significant problems women have to deal with. Credit to the Government for the menopause campaign running in recent months and the advertising campaign that has happened. Alongside that, we have dispelled myths that were there for many years suggesting HRT causes cancer and is bad for you and that you need to suffer and go it alone. It could be seven to ten years of going it alone. That is how long a woman can be in need of this type of medication, maybe even longer. For some, it is shorter. It varies woman to woman.
I developed the Fianna Fáil women’s health policy last year in consultation with thousands of women across the country. A policy recommendation in that document is to make HRT products free. I would like the Minister of State to respond to that. We owe it to women at that stage to make these essential medical products free and get rid of issues with access, cost disparity and the hassle involved in accessing these products.
I thank Senator Chambers for raising this important issue relating to women's health and for her ongoing work in respect of it. The Minister for Health sends his apologies that he cannot be here.
Other important initiatives include the development of six specialist menopause clinics to treat complex symptoms of menopause. Five of the six planned clinics are currently open and operational at hospital sites around Ireland. There are three clinics in Dublin, one in Galway and one in Tipperary. The sixth clinic, located in Cork, is due to open later in 2023. These clinics treat complex symptoms of menopause.
In relation to the costs for HRT medications within the public system mentioned by the Senator, the onus is on a company to apply to the HSE to have a medicine added to the reimbursement list under the community drug schemes. Many HRT products are currently reimbursable by the HSE on both the general medical services, GMS, scheme and the drug payment scheme, DPS. Medical card holders can access these reimbursable HRT products, subject to payment of the statutory prescription charge. The DPS ensures that no individual or family pays more than €80 per month towards the cost of approved prescribed medicines, which includes the reimbursement of HRT products. The DPS threshold was reduced to €80 per month on 1 March 2022 in recognition of the rising cost of living. The DPS is not means-tested and is available to anyone ordinarily resident in Ireland.
While there are no plans to make the provision of HRT products free of charge, the removal of VAT from non-oral forms of HRT medication since 1 January 2023 has also improved access to HRT treatment for women across the country.
Finally, neither the Minister for Health nor the HSE has any role in the setting of prices for medicines dispensed privately in pharmacies. These are commercial matters for the pharmacies themselves.
I thank the Minister of State for his reply. I note the achievements in women’s health under this Government that have been significant and transformative. We have come from a low base. We had a lot to do and have achieved a lot in recent years. I mentioned the menopause campaign. Of course, the women’s health lead in the ICGP was significant. I worked with the Minister for Health to put that in place, and the menopause measures as well.
The problem with the DPS is, because pharmacies will not dispense the full six months, people are coming back month on month. They never pass the €80 threshold so do not really benefit from that. I acknowledge that it is there. If they could get the full six-month prescription in one go, they would benefit because they would max out at €80. Maybe it would be worth looking at allowing people draw down the full six-month prescription they get from their GP. I acknowledge the position regarding medical card holders, but that is not everybody. I am talking about universal access.
We have done much in this country for different stages. We have made contraception free for a certain number of women. That is fantastic for younger women. Now we have started to fund fertility treatment for women at a certain stage in their lives. For women at a later stage in their lives, we owe it to them to try to do something financially on a product that is essential, that you cannot do without and could be taking for a decade or more.
I ask the Minister of State to take this back to the Minister to reflect on the need - while we have addressed younger women and those in mid-life - to look at women of more mature years and to do something on that front. If work could be done on getting access to prescriptions whereby people could draw down the full six months, the DPS would then be of benefit. At the moment, it is not really applicable. I appreciate the indication towards that.
The point the Senator makes about the six-month dispensing not happening is practical. That matter is not referenced in the response I have from the Minister for Health. I will bring it back to the officials and Minister to highlight it to them. It is all well and good to talk about the DPS but for those getting it monthly and not passing the €80 limit, it will not have the benefit it can have. The State wants that benefit to be there.
The response I was given clearly states that it is not the plan to have this free, but that is under the impression the DPS covers everybody of all income types and none. The DPS is universal. We need two things: for the companies to apply for the drug to be covered under the DPS, which we do not control, and for it to be dispensed in a form that would allow that to happen. I am not sure if there are clinical or medical reasons for it not being dispensed for six months. If there is a requirement to go back to the doctor to check the position in that regard, that might be a consideration. I will bring the points the Senator made back to the Department of Health and the Minister.
Cuireadh an Seanad ar fionraí ar 10.18 a.m. agus cuireadh tús leis arís ar 10.30 a.m.
Sitting suspended at 10.18 a.m. and resumed at 10.30 a.m.