As the Deputy will be aware, the Health (Assisted Human Reproduction) Bill 2022 passed Second Stage in the Dáil on March 23rd 2022 and has been referred to the Select Committee on Health for Third Stage. This legislation encompasses the regulation for the first time of a wide range of practices undertaken in this jurisdiction, including domestic surrogacy. The surrogacy provisions of the Bill outline the specific conditions under which surrogacy in Ireland will be permitted, including a requirement for all surrogacy agreements to be altruistic and pre-authorised by the new Assisted Human Reproduction Regulatory Authority. The legislation sets out a court-based mechanism through which the parentage of a child born through surrogacy may be transferred from the surrogate to the intending parent(s)It is not within the scope of the assisted human reproduction (AHR) legislation to include provisions in respect of statutory leave. Responsibility for various forms of family-related leave comes under the remit of the Minister for Children, Equality, Disability, Integration & Youth and that Department has informed my officials that legislative changes in respect of all forms of family leave must be developed in the context of the broader legal situation concerning parentage or pertaining to any other relevant issue.Separately, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government. This model of care comprises three stages, starting in primary care (i.e., GPs), extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF, and other advanced AHR treatments), with patients being referred onwards through structured pathways.Phase One of the roll-out of the model of care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with infertility issues at this level of intervention. The completion of Phase One of the roll-out, envisaged before the end of this year, will result in fully operational Regional Fertility Hubs in each of the six Hospital Groups across the country.Phase Two of the roll-out of the model of care will see the introduction of tertiary infertility services, including IVF, in the public health system. Substantial planning, development and policy work is required to establish the scope, design and requirements for this component of the model of care. At this juncture, the design and scope of this aspect of the model of care have not been finalised as detailed consideration of a range of issues including service and treatment design, eligibility and access criteria, and associated resource implications is required. This work will also need to be informed by the final Health (Assisted Human Reproduction) Act, the progress of this Bill, and associated regulations that will be developed following the enactment of this legislation. My officials are continuing engagement with the HSE in relation to the necessary programmes of work required to further advance consideration of the issues arising for commencing Phase Two of the roll out of the model of care. As precursors to the development of this, the priority has been to establish the necessary services at secondary level and to develop a regulatory framework, both of which are progressing well.While advanced AHR treatment, such as IVF, 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 understand 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, or other advanced AHR treatment, privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.Nevertheless, the Government and I are fully committed, through the full implementation of the model of care for infertility, to ensuring that patients always receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
