The Minister of State, Deputy Butler, is very welcome to the House. I want to give a very special welcome to Ballymore Eustace branch of Irish Countrywomens' Association, ICA, and Ms Marie Cooney who organised it, the group's president and sister of Liam Lawlor, former Member of this House. They are very welcome. Mr. Ray Coffey from Newbridge is also very welcome. I call Senator Pauline O'Reilly to move the motion
Provision of Free HRT Treatment: Motion [Private Members]
I move:
“That Seanad Éireann:
recognises that:
- menopause is known to be a challenging period in the lifetime of every woman, no matter when, during that lifetime, it occurs;
- it is a turning point for women, not just reproductively, but also can come with a range of biological and psychological symptoms that can lead to vasomotor conditions, cardiometabolic disease, neurological disorders and mental health problems;
further recognises that:
- hormone replacement therapy (HRT) is a recognised treatment for many of the associated symptoms of menopause, notably for vasomotor (hot flushes, night sweats), cardiometabolic (insulin resistance, hypertension, diabetes) issues, osteological disease (osteoporosis, osteoarthritis) and mood changes or indicators of depression and anxiety;
notes with concern that:
- inflation and the cost-of-living crisis affects women and girls disproportionately, according to the World Economic Forum;
- a support group for women, The Irish Menopause, say that the cost of HRT is a major barrier to women taking up the treatment; standard prescriptions can cost between €30 and €70 a month; according to this group, women have halted treatment because they cannot afford the cost;
acknowledges that:
- the Government in Budget 2023 reduced the VAT on non-oral HRT medicines to 0%;
- the Women’s Health Action Plan 2022-2023 promises to ‘grow the available women’s health supports, services, and expertise in contraception; menopause; and gynaecology’ and to ‘changing the approach to menopause care to increase the public supports available to women before, during and after menopause’;
- Budget 2024 prioritised women’s health in the area of contraception by expanding the funding for free contraception for women from 17 to 31;
calls on the Government to:
- provide HRT free of charge to all women who need it.”
I second the motion.
I will say at the outset how lovely it is to see the Minister of State in the Chamber for this really important day. This is World Menopause Day and it is kind of coincidental that I am bringing forward this motion, which is about free hormone replacement therapy, HRT. However, it is also a really good opportunity for us in this House to speak about the importance of women's lives and the fact that 50% of the population is going to hit the menopause. Some people are impacted and some are less so, but recognition must be given that even if a person is not impacted in terms of symptoms, it can be medically indicated that HRT is wise.
Going back a few decades ago, we simply were not living as long as we are now. That means that in the second half of our lives, we really have to make up for the fact that history has changed and we are more likely to get things like osteoporosis and diabetes. HRT plays a role in protecting us through that second half of our lives for want of a better word.
Over the last couple of years women and, indeed, men have been flooding the airwaves with their stories of menopause and the deep impact it has on families and communities, but most particularly women. We have a long history of silence when it comes to women and what goes on in our bodies and for us in terms of our health.
It has been absolutely really cathartic for an awful lot of people to share their stories but it is quite heartbreaking and devastating that it came to that for so many people. They had to actually ring up radio stations across the country. It is not just national radio stations; I hear it all the time across local radio stations. People are at the point of desperation, try to seek help and are not getting it.
I spoke in the Seanad maybe two years ago about menopause and nobody was speaking about it. It was purely because we were all so moved by the stories and we all spoke about it at the time. We do not want another two years saying, "Let us keep listening to women.". We can only listen for so long. Eventually, we want something to happen. The Minister for Health, Deputy Donnelly, and the whole Department - and I thank the Minister of State - have stepped up to the mark when it comes to women's healthcare. The Green Party did negotiate to put free contraception into the programme for Government but things have moved much beyond that. I am hugely grateful that we have been able to work as colleagues across the three parties in order to prioritise women's healthcare.
Even when we look at menopause, for instance, there are now six dedicated menopause clinics. There have also been guidelines set for GPs and other healthcare professionals for what to look out for when it comes to menopause. Indeed, there has been a public awareness campaign. One really interesting thing that has happened over the last couple of years, however, is also this radical listening programme that the Department engaged in - radical listening to women. It found that 86% of women said that going through the menopause has a big impact on their lives. We know that menstrual health in general means that people are losing days from work, and that includes through menopause. That is around the 45% level. Indeed, approximately one quarter of women find they are out of pocket from lost earnings because they have to leave work for various days off. We have a long way to go when it comes to acceptance within the workplace but we are definitely moving in the right direction.
In recognition of those 86% of us who are saying they are impacted by menopause, it is time to not just listen but to ask what we are going to do about it. Most women I know are not at a stage where they are looking for a menopause clinic. They are going to their GP or pharmacist and looking for support that way. It is quite straightforward, or at least it can be quite straightforward if somebody is looking out for it and if they know themselves what they need.
HRT is already provided by the State for those who have a medical card. That is really important to say. It is around the €6 million mark per year. We have estimated that it would cost approximately an extra €4 million to take all women into that bracket. We know organisations like The Irish Menopause say that cost is a significant barrier. We know also from surveys that have been done that cost is a significant barrier and people might ask why. For somebody who has X amount of earnings, for a cost of €20 or €40 per month, can they prioritise their health? We are asking women all the time to find money to pay for menstrual health products, contraception and HRT. The issue here is that many women are torn between putting food on the table for their children and prioritising themselves. It is, therefore, pushed out. The medical professionals would say that the earlier menopause is addressed, the better it is for a person's health outcomes.
Some people may need to take HRT for a long period of time. The majority of people take it for a much shorter period of a few years. Again, the cost to the State is relatively little. In terms of the cost to the State of doing nothing on the issue of menopause, we have the issues of bone health, diabetes, which I mentioned earlier, extreme depression and also that of marital breakdown, which has been reported by many people in this situation. People say they do not know what is going on for them and they are not feeling great. The people around them are also going through that experience.
I ask that we start the process of examining free HRT for everyone. It is the fairest thing to do. Some people have asked why we should have universal healthcare.
That is meant to be the direction in which we are going anyway in healthcare. It is also not universal because it is women who are directly impacted, and they are the ones who face the biggest impact when it comes to the cost-of-living crisis. I have heard so many stories in recent years, as I am sure has the Minister of State, of people seeking help and not receiving it. I am not putting the blame on anyone for that, other than the State. The right guidelines have been put in place in terms of educating people so that they know what questions to ask when they go to a doctor but we still have the issue of cost to address. I know that since we entered government, funding for women's healthcare has increased year-on-year. In fact, I believe it doubled last year. Why not make that investment now in women in the second half of their lives in order to have better health outcomes? Can we really say it is full equality when we look at what is needed in the earlier stages of one's life, if we know what the health outcomes are of doing nothing for many people and the kind of pressure they are under?
I look forward to being supported by colleagues. I hope I will be. I am not the Minister. There is only so much I can do. The Minister, Deputy Stephen Donnelly, reached out to me today and thanked me for raising it and for pursuing issues around women's healthcare. I know that it is a commitment from the Minister, and that we have to do all we can as politicians in order to make that journey easier and to get the full co-operation and consensus that this is the right thing to do for everyone.
I thank our colleague Senator Pauline O'Reilly and her colleagues in the Green Party for proposing this very important motion. It is great to have the opportunity to discuss it, coincidentally on World Menopause Day. We cannot discuss women's health enough because such discussions were sorely lacking for years. It was never discussed in these Houses or beyond it and that has stored up an awful lot of problems.
Senator O'Reilly rightly pointed out that funding has increased year-on-year since the start of this Government. That is something we in government can be very proud of, whether that is IVF, period products or contraception. This is another piece of the puzzle and it is very important that we are discussing it and that we have started the process. As Senator O'Reilly says, we need to look at what it is going to cost the State, which is already paying €6.3 million for HRT under the two statutory schemes that we have in place. As we know, that does not cover everybody. Senator O'Reilly and all of us across the House have been listening to women in recent years since this conversation has kicked off. They describe how due to gender inequality, the patriarchy and the gender pay gap they do not have the money to support themselves and their own good health as they age because women prioritise everything else and everyone else in their lives ahead of themselves. That is the position traditionally. Due to a lack of period products, the cost of contraception and the cost of the menopause, basically the whole cost of reproduction from the start to the very end falls on women's shoulders. It is not something we should stand over. As a rich society and one that is moving towards greater gender equality, it is something we need to look at.
There are cost implications. Everything has a cost but it would be a good investment in public health to have it because depression is often diagnosed and women are needlessly put on various treatments and HRT protects against diabetes, bone health and osteoporosis. The saddest statistic I have seen relating to the menopause is the peak in suicides among women during the menopause years. It is heartbreaking that women are not getting the support they need. If HRT can prevent that and prevent the absolute devastation that suicide leaves on families and communities, it can only be a good investment in our future. Marital breakdown has been touched on as well. We know that impacts negatively on families, children and communities so we need to make what will probably be a small investment into providing HRT as a standard free treatment for everybody. It would be a small investment in the overall health of our nation. The menopause impacts half the women of Ireland, if we are lucky enough to live that long. I know that not every woman reaches the age where she even enters the menopause but thankfully we are living longer and it is an investment in the individual health of those women and also the health of families and the entire community. It is a very worthwhile investment.
I have heard from women who have been prescribed HRT who have not been able to access it, or even when they have, they have not been able to access other supports that are very helpful like yoga, pilates, acupuncture, and various therapies that have been proven to be very helpful. It is something that we need to perhaps look at beyond that. In my own community in north County Dublin there has been a lot of community-funded yoga, pilates and fitness classes for women at a very low cost or free of charge and supported by local authorities. That is supporting a healthier community overall.
The funding for the HSE has not been what we were expecting or what we need for this year. It will be a difficult ask to find extra money to provide free HRT but it is something we need to put on the list. It may not be realistic that we will get it this year but it may be a conversation for next year. If money is found for other things in the health service, this should be at the top of the priority list. It would be very good to move towards a universal availability of HRT products.
I have loads more to say but I have run out of time. I hope that in the lifetime of this Government we will be able to see this as well as support for the other initiatives we have taken because they are all interlinked. They all add up. They have all been very warmly received by the women of Ireland. It is something that I constantly hear from women when I am out and about in my constituency. I hear back that they are delighted with the free IVF; that contraception has made a big impact; and that the public information campaign that we ran on menopause has really impacted people. This would be a very positive step. I commend Senator O'Reilly on bringing this motion here tonight. I hope our Fine Gael colleague might be able to have a word with the Minister for Public Expenditure, National Development Plan Delivery and Reform, Deputy Donohoe, about the money for it and we might be able to get the funding.
Senator Clifford-Lee would have a better chance than me. It is good to see the Minister of State, Deputy Butler. As always, she is very welcome to the House. She is a regular attendee here and when she addresses us it always makes great sense.
I commend Senator Pauline O'Reilly on proposing this motion in Private Members' time tonight. It is extremely important. As a male I do not have a full understanding of the intricacies of menopause and all of its various consequences but it is clearly extremely important and it is something that has been overlooked for way too long. The Government has taken women's health seriously. The first time we had a strategy on women's health was in 2022. It beggars belief that it took until 2022 to have a strategy. That has happened because of the commitments in the programme for Government and people like Senator Pauline O'Reilly, Senator Clifford-Lee, and others who have not let this lie. They have constantly campaigned to make extremely important changes. They are only incremental because there is a lot to be done. The funding we are talking about here should not be even up for discussion; it should just be available, end of story.
I have no doubt this motion will shine a light on the issue. It will remind the Government of its responsibilities and what it should be doing and what should be taken as a given. I was disappointed that the Department only got an extra €800 million in the budget. To be quite honest, it should have got far more than that.
We are 11th of the top 15 countries in terms of what we spend on health. We are nowhere near what we need to spend on health. I have always advocated that we do not need significant tax cuts but what we need is significant investment in areas like health and housing. I sometimes feel that I am a lone voice articulating that but-----
The Senator should join Fianna Fáil. He would be more suited.
I am probably more effective where I am.
We need to have a health system that is functioning. It is never going to be perfect - I do not think there is a health system in the world that is perfect - but it needs to be properly funded. There should have been a minimum of €2 billion or €3 billion extra dedicated to health. The system has let down the health service by not funding it properly. Efficiencies need to be found, and I agree that to go €1.2 billion over budget is not acceptable and that there is a lot of waste. However, there are a lot of areas of health that are not funded in the way they should be. Women's health is certainly one of those.
We should not have to be here. Senator Pauline O'Reilly should not have been obliged to table this motion. In a modern, well-funded, successful First-World economy, we should not even be having this discussion. In the past two or three years, we have made significant progress on, for example, period poverty, a matter in respect of which Senator Clifford-Lee and others worked very hard. For the year and a half or whatever is left of this Government's term, can we just get this right? Can we just put in the money? No Senator should ever again have to put a motion like this before the Seanad. It should just be considered part of what happens in a democracy where we value people, where we treat people equally and where we look after people's health. This is a critical issue.
Again, well done to the Senator. She has my full support, not just today, but in any way that I can campaign within Government. We are only Senators but we still have a voice. Whatever needs to be done to get this over the line and not be in this situation going forward, that is what we need to do, and we need to commit to that.
It is interesting that we are talking about another area where women are not treated equally in this society. I have just come from a briefing with the Gaelic Players Association on how female players are not being treated on parity, and here we are talking about another issue where we are not treated on parity.
As others have said, the experiences of menopause are incredibly diverse from one woman to another. It is a pervasive challenge that many women face. I welcome the discussion and thank Senator O'Reilly for tabling the motion. There is a lack of awareness, difficulty in accessing help and support and a general lack of seriousness when it comes to addressing menopausal concerns. The issue extends across various aspects of women's lives, impacting the community, the workplace and even the healthcare system.
Menopause has been a taboo subject. When we look back and remember our mothers going through menopause, we see how it was covered up and the secrecy and shame around the hot flushes and all of that. While we remember our parents, everybody knows that menopausal women are not just individuals going through this natural phase of their life. They are our wives, partners, mothers, sisters, friends, colleagues and bosses. It is high time that we acknowledge their experiences and ensure that they receive the support they deserve, precisely when and where they need it.
Others have mentioned the significant toll on the mental health and overall well-being of countless women. There is also a lack of proper training for healthcare professionals concerning the menopause. Women have the right to access timely, accurate and trustworthy information that can guide and support them through this phase of their lives. We have seen the disinformation around hormone replacement and the impact that had for many years. Furthermore, it is imperative that advancements relating to menopause become an integral part of broader gender sensitivity and unconscious bias training for all healthcare staff. This is essential to enhance the overall quality of care for women and to ensure their unique healthcare needs are met and respected.
Last year, Sinn Féin carried out an online survey asking for women's experiences during the menopause. Some of the findings of that survey were quite stark and demonstrate that many women still face stigma, lack of confidence in discussing menopause with healthcare professionals and insufficient support. The findings include the following: 88% feel there is still stigma in Irish society around the menopause; 97.9% believe the Government is not doing enough to support women experiencing menopausal symptoms in Ireland; 33% are not confident discussing menopause with their GP or consultant; 45% received support or medical advice but felt it was not sufficient and 36.10% did not receive any advice at all; 85% do not believe that healthcare professionals in Ireland are educated enough in perimenopause or menopause; and 81% want to see their workplace implement menopause policies.
I have to draw attention to some of the points in the motion which I do not entirely agree with, especially the line about budget 2024. This funding for contraception was provided last year except it was for those aged 16 to 30. There was no new developments funding for the scheme this year and, in fact, there is not a single reference to the scheme in the budget 2024 expenditure report and the funding provided last year was only for September to December. Given that others, even on the Government side, have said we have not prepared for existing levels of service, ELS, the carryover or demographics for the health service in budget 2024, it is a stretch to claim that women’s health is being prioritised in budget 2024.
In contrast, Sinn Féin’s alternative budget proposed €20.5 million for the maternity strategy and women’s health action plan, as well as €20 million to expand the contraception scheme and €15 million for fertility services. We also proposed 400,000 additional medical cards and to abolish prescription charges, which would expand free access to medicines, including HRT for those least able to afford it, and to reduce the maximum monthly cost of medicines for households to €50 from €80, which would cover and bring in many other families. We also proposed to develop, with GPs, a structured care programme in women’s health in primary care to ensure that services and information are available locally and GPs are supported to support women and ensure comfortable, fully informed environments for discussing their healthcare options.
As I said, it is welcome to have the debate and it is good that people are here talking about why the system needs to be changed with regard to menopausal women. As the Minister of State is present, I want to raise the issue of another group in society who also need hormone replacement, and that is the transgender community. She might provide an update on access to hormone treatment for the transgender community. In 2018, the then Minister for Health, Deputy Harris, met with the trans community to determine how the health service could work in line with international best practice when it came to the provision of hormonal treatment for trans people. However, in 2021, a freedom of information document revealed that the waiting times can be up to a decade, and a ten-year waiting list is essentially no healthcare service at all. I remind the Minister of State that there is another group in society who need hormone replacement therapy and I ask her to give an update.
Like others, I welcome the decision taken by Senator Pauline O'Reilly to bring forward the motion. We are often left wondering what it is about women's health in this country that the Legislature and the apparatus of Government have for so long sought to ignore the basics of women's health. It is not all that long ago that we moved on contraception, we were blisteringly late to address termination of pregnancy and, now, it is not until it is brought to a head in a case like this that we address the menopause.
I was taken aback by the lack of understanding and information about menopausal issues until it was addressed on “The Joe Duffy Show” probably two years ago. Those of us who are in public life and dealing with constituents are well aware of the struggles of people right across society, and maybe we are more in tune with issues than others, but I was taken aback at that stage by the extent to which the cohort of GPs were failing women. Women were telling their stories on radio about failing to get the attention or the understanding of a GP. We then had the usual list of denials, such as “We were not trained” or “We did not know”. However, I come to the conclusion that if the menopause was something that could be experienced by men, we would have it sorted out a long time ago.
There would be additives in a pint of Guinness that would have addressed the issue. I do not mean to be facetious or in any way undermine the veracity of this issue. For far too long it was presented as something that women have not spoken out about. Why would they or how could they? They saw it as a taboo in society. Well done to Senator O'Reilly for bringing it forward - really well done - but it casts a dark shadow on this State that, in 2023, a Senator has to bring forward a motion like this. The full embrace of our health system is not capable or has not been capable of addressing this issue without delay.
There is no doubt that, as an issue, it has to some extent not been talked about, and it is hard to understand why that is. Of course, going on what we read and people we talk to, different people experience it in different ways. People have been discouraged from taking HRT by some professionals who will ask what about your bone structure or what impact is it going to have on your potential to get cancer and all these kinds of negatives? There are many women who suffer the early onset of menopause, some in their late 20s and early 30s, and it is hard to think they would not have access to the kind of information necessary to be able to avail of HRT in the first instance, or even to purchase it and pay for it themselves, and it is of course expensive. Now, at least, the passage of this motion can begin a process towards ensuring it is not an issue anymore. It is free of charge, without any discrimination, and we can talk openly about it and get to a point where we do not or should not have to talk about it. It is a treatment for a condition, it is free of charge, general practitioners are educated on it, and that it is part of our school system, where young adults and students in their teens and late teens have really developed a better understanding of sexual health then those of us of an older generation. It is important it is part of that discussion, and it should be part of it.
A previous Senator talked about trans right issues. It is a really important issue. There is a certain section of society that uses social media to denounce and demean people who are in the trans community. We need to have those conversations now in an educational setting among teenagers and young adults. It is important the taboo is removed, that the State recognises the importance of the provision of the treatment, and that we do not have to discuss it anymore.
Since the Minister of State, Deputy Butler is here, I hope we can have a debate maybe next week in this House about the funding of our health service. I know Senator Conway referenced it earlier, and that there is a battle going on at the moment. It seems to be between officials and Ministers. The Minister of State is in the middle of that. Of course we need value for money, but in a big organisation, that can be difficult. We need programmes that are funded, and here is one that Senator O'Reilly has identified. Let us move towards that. I listened to her explanation on radio this morning where she talked about somewhere between €10 million and €15 million. To me, that seems like a very small amount of money in the greater scheme of things and a way of recognising belatedly that this State recognises the requirements of women in society and has due regard for their health and well-being. We should not just talk about it. We should put our money where it is needed, address this issue once and for all, and then have discussions around other programmes in the health service. From what seems to be making its way into the public, it is going to be very challenging next year. I understand where it is at about overruns and how we do not want to always accept that they have to happen but they do happen every year. Let us have a debate about it next week.
I welcome the Minister of State here today, and support Senator Pauline O'Reilly in her call around access for women to hormone replacement therapy. We have spoken on this before and had many discussions and debates. It was mentioned once about the word "menopause" being mentioned more times in this Chamber than in a lot of previous Seanadaí and Governments to date. We are openly discussing something that has not had a lot of time for discussion, and that is really crucial.
We know it is a normal life event. Like so many things for women, it is going to happen to every single one of us. The challenge is that sometimes women are not as familiar with the fact that the symptoms can be tackled. There are ways to manage these symptoms, and even to associate symptoms with the menopause.
When we spoke before, we talked about how different all of these changes are. Things like brain fog, tiredness, irritable bowel syndrome and even the loss of oestrogen can cause cardiovascular issues which, again, have an impact on bone and heart health. In general, there are those who experience poor concentration, anxiety and depression. As I said before, due to a lack of information awareness, many women suffer in silence and sometimes do not realise how effective HRT can be as well. We know in our health service there are inequalities on a geographical level as well. There are inequalities in access to services throughout the country, and this an issue particularly in the west, which is the area I am looking at. It is not that is a cure-all for everything but it is a way to help women, and having access to it for free is something that would really be welcomed by so many women.
I know a lot has been done, especially in the Department of Health, with regard to the Minister, Deputy Stephen Donnelly's and the Government's focus on this. I know they are looking at ways to make it more accessible, like removing the VAT and so on on HRT, which is really important. What Senator O'Reilly is looking at here in making her call is that we note how inflation and the cost of living affects women and girls disproportionately. That is very well known. We know the most deprived group here are single mums, for example. Looking across the country, probably the most deprived group of people are single mothers. We know that from the Pobal deprivation index. It is very important that we are looking at how we are going to support all women who will be going through this. I know the Minister of State is very supportive of this as well.
The other thing I would like to mention is that so many groups are coming on board now. I know the Minister, Deputy Paschal Donohoe, and the Minister of State, Deputy Hildegarde Naughton, today launched a menopause in the workplace framework for the Civil Service. I used to work in Enterprise Ireland and Science Foundation Ireland. It is very important to realise there are a lot of women who work in the public service and for the State who could access these treatments. I know other companies are coming on board in giving leave and supports for women with regard to the menopause. It is crucial we are looking at access to supports for their health. That is what Senator O'Reilly is doing.
It is crucial we are looking at supports. I ask the Minister of State to comment on something. We had the Sláintecare healthy communities programme. We have our primary care networks that are now being opened throughout the country. There is one that has just opened, the Grove Hospital in Tuam. Those primary care networks are going to be crucial for delivering care, particularly in rural and regional areas. For example, I know there are six specialist menopause clinics this year. How can we rely on those services and support GPs? I know there was a GP manual or guide issued last year. How are we going to engage with those groups? Will GPs be run off their feet or are there practice nurses within GP practices who are going to support women? How do we support getting access out to women across the board on this? I thank the Minister of State for her time.
I thank the Minister of State and commend Senator O'Reilly on bringing forward this private members' motion. I am very happy to support it along with my colleagues in Fianna Fáil. I am delighted the Minister of State is here to take the motion. I suspect she can empathise not just with the motion but with every menopausal woman out there in the world. All of us are fighting to put a smile on our faces every day and to get up and face the world.
It is a challenging place and life is not fair, but it is certainly not fair for women. This is one of the hidden challenges most women battle with in silence. It is very isolating and it is physically and mentally crippling. This motion today also talks about the economic disadvantage it inflicts on women.
I support the motion and I want Deputy Butler, as the Minister of State, to go back to the Government and say that this House is actively urging and demanding it to provide free HRT to all women who require it in our country. We are a rich and developed nation and a very privileged country but our privilege should extend to providing women with this treatment. It is not a panacea or a magic wand. It does not work for all women and it is not a solution for all women going through menopause. Even for those for whom it does work, it can involve trial and error. It does not always work the first time and you have to get the exact dosage right. It is also costly every time you visit your GP. It is really expensive. Women who are lucky enough to have a medical card can go to their GPs but, if you do not have a medical card, you have to pay the €50, €60, €70 or whatever it is to visit your GP, if you can get an appointment.
You can spend a lot of time and money investigating what is wrong with you when it actually happens. You can be sent from Billy to Bob and from pillar to post with different doctors, none of whom have expertise in menopause because - guess what? - it is not their specialty because they are men and it does not affect them. What they do is study and get qualified in the disease they treat. It is like saying you are not going to treat a teenage diabetic child because you do not get puberty. Some specialists actually say that menopause is not their specialty. Every medical professional who is going to treat patients needs to look at the patient first and not just at the illness. In looking at the patient, they need to recognise that certain female patients of a certain biological age will most likely be going through the menopause. If they were to keep that in mind, it might help with accelerating the treatment they are trying to deliver to their patients.
However, the only thing the Government can do is to ease the financial burden so I really do hope that the Minister of State and the Government can support the motion and build on the amazing work this Government has done for female healthcare. I refer to free contraception and associated GP visits, the action on period poverty and the awareness programme and listening programme around menopause. All of those are great and positive supports for women but we need to go further. We and the Government have not done enough yet although a great start has been made. I really hope the Government will be able to support this initiative. Well done to Senator Pauline O'Reilly.
I take Senator Pauline O'Reilly for tabling this motion and allowing me and others the opportunity to discuss this important issue today, on World Menopause Day. As Senator Fitzpatrick has said, I have lived experience of the issue and can stand here and speak about the menopause with authority. I often have the opportunity to respond to a debate in the Dáil and Seanad and find myself speaking about something I do not have lived experience of but I can tick this box.
Hear, hear.
The Government has rightly decided not to oppose this Private Members' motion. The Minister, Deputy Stephen Donnelly, was in touch with the Senator earlier in that regard. This decision was made in light of the strong support of the Minister for Health and the Government for improving the health experience and outcomes for women and girls in Ireland.
It is fair to say that, as has been acknowledged here, progressing women’s healthcare has been a key priority for the Minister, Deputy Donnelly, the Department and the Government over the last three years. It is included in the programme for Government. The Ministers of State in the Department - now myself and the Minister of State, Deputy Naughton, and formerly myself and the Minister of State, Deputy Rabbitte, and the then Minister of State, Deputy Feighan - often comment that the Minister is surrounded by women in the Department and that we are well able to have our voices heard. I go back to the point on lived experience. However, I accept that it has been widely acknowledged that the area of women’s health has historically been under-researched and underdeveloped in many areas. We have been determined to change this.
The establishment of the women’s health task force in 2019 gave women’s health the attention it required. Significant investment combined with targeted supports, built on the foundations of listening and responding to women in Ireland, has led us to positive change. We were all struck by those Joe Duffy radio programmes over two or three weeks in which women got the opportunity, for the first time, to have their say. They felt they could come on and were very open in speaking about many private things that women did not previously have the opportunity to talk about. Senator Dooley referred to the fact that women were prepared to talk and have their voice heard. In 2021, the task force completed and published the findings of a series of listening exercises, which included a radical listening exercise to help us to understand where women wanted us to begin in tackling health inequalities. What we were told informed the ten key actions found in Ireland’s first women’s health action plan, which was published in March 2022.
Menopause is a key action within this action plan. The plan commits to changing the approach to menopause care in Ireland. It commits to increasing the public supports available to women before, during and after menopause. The women’s health action plan puts a spotlight on menopause. The radical listening exercises enlightened us on how the women of Ireland feel during what is often a most challenging time of life. I would like to share with Members what Irish women told us to help them to understand how important our focus on the issue of menopause is. The women’s health task force heard that menopause was a taboo subject and something not spoken about by anyone, which makes it an extremely isolating experience. It heard that women felt dependent on mothers, sisters and close friends to provide information where it was not available in the mainstream. A number of women reported feeling isolated, unsupported by society and dismissed. They said that their symptoms were not taken seriously. The topic of menopause “felt secretive and closed”, contributing to a “taboo or stigma”. Women reported under-recognition of symptoms of perimenopause and menopause in themselves. Some women said they were at a very low point during menopause.
The taboo and stigma around menopause have only recently been challenged through public discourse and Government action. In October 2022 and March 2023, a national awareness campaign was launched by the Department of Health with the message: “Let's take the mystery out of menopause. Let's talk about it.” The campaign ran across TV, national and local radio, streaming, online, social media and search. The success of this campaign is clear as two thirds of those surveyed told us that it increased their knowledge of the symptoms and impact of menopause. It is important that we continue sharing this message and continue to talk about menopause openly. As well as the awareness campaign, a dedicated webpage on menopause was launched on the gov.ie site as a one-stop shop for information on menopause. This is another step towards educating ourselves about menopause and the impacts it may have on women.
In addition to increasing awareness and education about menopause, new care pathways and services have been developed. There are now six specialist menopause clinics open and operational across the country. These public clinics are for women who have complex experiences of menopause. It is estimated that approximately 25% of women in menopause have these complex needs. The clinical teams within this setting also provide advice and guidance to GPs in the community to support the effective management of menopausal symptoms for women closer to home within primary care. These clinics are located in the National Maternity Hospital, Nenagh, the Rotunda, the Coombe, University Hospital Galway and Cork.
Women have often expressed feeling dismissed by healthcare providers when it comes to their menopause experiences so, in partnership with the Irish College of General Practitioners, ICGP, we have launched a quick reference guide for menopause. It provides practical and evidence-based advice on diagnosis, lifestyle interventions, safe prescribing, alternatives, testosterone therapy and more. This was published in October 2022. Since the publication of this guide, the ICGP has launched a menopause theory course, which is available on the ICGP education platform on demand. This course was launched in March 2023 and is currently available free of charge to all Irish healthcare professionals. The HSE’s national women and infants health programme is engaging the maternity networks regarding the establishment of a professional menopause network. It is envisioned that this network will be comprised of clinical leads in this area, with representation from the ICGP.
In addition to all of this progress, I am delighted to inform the Senators that, earlier today, a framework on menopause in the workplace was launched, as the Senator has referenced. This has been developed in partnership between the Department of Public Expenditure, National Development Plan Delivery and Reform and the women’s health task force.
It provides an overarching structure to guide Civil Service organisations in developing menopause policies and identifies ways that they can support employees, such as offering practical workplace adjustments and supports. I was delighted to be part of the Dungarvan and West Waterford Chamber initiative in this regard. Last year, it was the first chamber of commerce to launch menopause supports and initiatives for women. It ended up winning a national award. I was delighted for that organisation because its members were prepared to speak out and speak openly about issues that are not always spoken about. The framework includes a policy template that can be adapted for use across the wider public service. This is a very welcome development. It is fitting that it has been launched today on World Menopause Day.
Menopause is not uniform and can present differently for individual women, both in symptom severity and duration. HRT is recognised as a treatment for many of the associated symptoms of menopause, for example, hot flushes and mood changes. HRT replaces hormones that are at a very low level in the body around the time of perimenopause and menopause. Not all women experiencing menopause may be clinically eligible for HRT, which is prescription based. Women may also choose not to take HRT and to address their symptoms through alternative therapies or lifestyle changes. It is important that women and healthcare providers are educated on the use of HRT and other options and that together they explore all the available options available to them. I understand from the HSE that while HRT is used as a treatment for menopause, it is also used as a treatment for other conditions across multiple clinical areas. These include the replacement of cortisone in Addison’s disease and the replacement of thyroxine in thyroid disease, for example.
On the cost of HRT, to assist those women who choose to take HRT, the HSE currently operates two schemes that offer financial assistance to people in receipt of prescribed HRT medication which are on the reimbursement list. These HRT medications are available to medical card holders, subject to the statutory prescription charge. My understanding is approximately 43,000 women are able to avail of HRT under the general medical services, GMS, scheme. Eligibility for a medical card is determined by the HSE in accordance with the Health Act. However, in certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces financial circumstances, such as extra costs arising from illness. Second, under the drugs payment scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines, which includes some HRT medications. Approximately 27,000 women receive support in this way. As mentioned, in budget 2023, VAT was removed from HRT to assist women further with the costs associated with HRT.
Menopause is just one area we focused on since the publication of the women’s health action plan. That plan commits to improving health outcomes and experiences for all women across the life course. A number of other significant developments have taken place. I will outline some of those. For example, we launched the free contraception scheme for 17- to 30-year-olds, which is being expanded to 31-year-olds in 2024. The opening of additional see-and-treat ambulatory gynaecology clinics brings the national total to 14 clinics. We have also opened six regional fertility hubs. There has been development of six regional endometriosis hubs and two supraregional specialist centres for complex endometriosis care. We have further developed on the sexual assault treatment unit across the country. We are tackling period poverty for the first time through the removal of VAT on period products and various initiatives with local authorities and NGOs.
The first time I heard period poverty being discussed was when my colleague, Senator Clifford-Lee, raised it. A significant number of issues related to women and women's healthcare are always discussed in this House. There is an opportunity, which is great. Somebody mentioned the word "menopause" was used in the House more than ever before in the lifetime of this Seanad. It is great there are opportunities to discuss such important health issues for 51% of the population. I thank each and every one of those Senators. I was also struck by the fact that while most of the speakers were female, it was great to hear the voices of men as well.
Implementation of the services I listed represents significant development and advancement for women's health nationwide. I know there is a lot more to do. My colleague, the Minister, Deputy Stephen Donnelly, is committed, along with the women’s health task force, to continue to drive progress in women’s health. This includes looking at all of the ways that we can achieve better health outcomes and experiences for women and girls in Ireland. I spoke to the Minister today regarding the motion, which I fully support. My understanding is that as we only had the budget last Tuesday, the recent budget allocation did not include the provision of this roll-out. The Department estimates it would cost between €8 million and €10 million. It is not an exact amount, but in the overall frame of things it is not a huge amount of money either, with all of us working together and pressing the Minister. The service plan for 2024 for the HSE obviously has to be worked out.
As I said, we are only a week out from the budget, but in the context of a budget of €22.5 billion, free HRT is value for money and would make a significant difference to an awful lot of people. I was struck by what Senator Dolan said about single mums and deprivation. You would hate to think that any person does not receive HRT because they could not afford it. Many people can afford it and can avail of it. Some 60% of the population have medical cards and doctor-only cards, which can help greatly, and we also have the drugs payment scheme. As a woman, I would hate to think that anybody who needed to avail of HRT would not be in a position to do so. I give a commitment that I will again speak to the Minister about it. It was great to hear all the voices on the same page today and women speaking for women.
The Minister of State has given me huge confidence that we were not far off, when we came to our conclusions that this would cost the State very little. All the things she pointed out indicate this is only a little more than what is already being done, but would be something that would have a deep impact.
The Minister of State spoke about the women's health task force. It has been set up for a relatively short period. While a huge amount has been achieved in the past few years, it is difficult to tell somebody who is going through a very difficult time that amount of money is not being found to do something that will have a deep impact on the rest of their lives. The "Let's take the mystery out of menopause" and talk about it campaign worked very well. As I said, let us talk about it but let us actually do something as well.
I thank all the Members. As the Minister of State quite rightly said, both men and women have spoken, which is important. I will not individually thank one gender over another because it is important that everybody speaks about it, but I thank everybody for being here. Senator Clifford-Lee spoke about the fact that women prioritise other people. We all know that. It is why we sometimes do not prioritise our healthcare. Even for those who can afford HRT on the face of things, what they are actually doing is saying they can afford it but are making a choice to spend the money on somebody else because most people are tightening their belts. If somebody does not choose it, it then has a lasting impact on public health. It is a no-brainer.
Senator Conway mentioned that men are part of the conversation, which is very important. As others said, we are a First World economy. This should not be a conversation we are continuing to have. We have moved quite fast as a country on many issues around women's healthcare, including access to abortion, IVF and contraception. There is now an opportunity for us to advance in this area.
On Senator Boylan's contribution, it is important to raise the point that in our mothers' time there was significant disinformation about HRT. That has now changed. As politicians, we also have a job to ensure that disinformation does not continue. In the vast majority of cases, HRT is perfectly safe and is something that is health-giving.
All of the time, it is about having conversations with GPs.
Senator Dooley mentioned this conversation was probably kicked off by Joe Duffy’s show. I stood up in the Seanad – at the time we were in the convention centre – and spoke about it from my heart and I was vilified by many. There were two camps: women who said this is how they are feeling and those pushing back, saying “We are doing a fine service. What are you talking about? Women come to us. We know exactly what is going on.” However, that is not the reality faced by women.
We have an obligation, even when it is hard, to say that the healthcare women are getting is not good enough and then put in place the public policies that will change that. I met with the GPs after that. I am delighted that the Government and the Department have been able to work together to come up with a framework and guidelines to help all healthcare providers understand what to look for. That has been a huge step forward and I commend the Department on that.
Senator Dolan raised and, interestingly, the Minister of State picked up on, lone parents. That strikes a chord with many of us because many people who come to speak to us are struggling lone parents. Those are the people I am thinking of. They may not have access to a medical card. It is tiny for the State but it has a huge impact. It then has an impact on child poverty reduction. I just came from a meeting with the Taoiseach in relation to the child poverty unit. When we talk about the sacrifices people make because their children need something, this is exactly what we are talking about.
Senator Fitzpatrick spoke about how it is a hidden challenge. She was strong on getting this done.
We have 40% women in this Chamber. That is why, as the Minister of State mentioned, we talk about it. It is our lived experienced.
I thank the Minister of State for the commitment she gave. As she and the Minister, Deputy Donnelly, know, I will not stay quiet about this - I rarely do when it comes to these issues. I am delighted to have the full support of all my colleagues today.
Question put and agreed to.
When is it proposed to sit again?
Tomorrow at 9 a.m.
Cuireadh an Seanad ar athló ar 6.02 p.m. go dtí 9 a.m., Déardaoin, an 19 Deireadh Fómhair 2023.
The Seanad adjourned at 6.02 p.m. until 9 a.m. on Thursday, 19 October 2023.