As the Deputy will be aware, a commitment to introduce the model of care for infertility, which was developed by officials in my Department in conjunction with the HSE’s National Women & Infants Health Programme, is included in the Programme for Government, “Our Shared Future”. This model of care will ensure that infertility issues will be addressed through the public health system at the lowest level of clinical intervention necessary. It will comprise three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF and other advanced assisted human reproduction (AHR) treatments). Structured referral pathways will be put in place and patients will be referred onwards for further investigations or treatment as required and as clinically appropriate. It is intended that, in line with available resources, this model of care for infertility will be rolled out on a phased basis over the course of the coming years.
Phase One of the roll-out of the model of care has commenced and involves the establishment, at secondary care level, of Regional Fertility Hubs in maternity networks. which will facilitate the management of a significant proportion of patients presenting with infertility issues. Funding of €2m was provided to the HSE to commence Phase One of the roll-out of the model of care in 2020. This was utilised specifically in respect of the development of the first four Regional Fertility Hubs – namely, Cork Maternity University Hospital, the Rotunda Hospital, the National Maternity Hospital and the Coombe Women & Infants University Hospital.
Additional funding of just over €1m is being made available to enable the continuation of Phase One of the roll-out in 2021, including through the setting-up of the final two Regional Fertility Hubs, to be located in Galway and Limerick.
The roll out of Phase One has been slowed due to the management of the Covid-19 pandemic by the health service broadly and its impact upon the provision of elective health services, including fertility services.
Phase Two of the roll-out will see the introduction of tertiary infertility services, including IVF, in the public health system. Phase Two will not commence until such time as infertility services at secondary level have been developed across the country and the AHR legislation is commenced. Drafting of the AHR legislation is ongoing, in conjunction with the Office of the Attorney General.
It should be noted that while AHR treatment is not currently funded by the Irish public health service, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I am aware that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them.
In addition, there is other support available in that patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.
Overall, the implementation of the model of care will help to ensure the provision of safe, effective and accessible infertility services at all levels of the public health system as part of the full range of services available in obstetrics and gynaecology.