I move: "That the Bill be now read a Second Time."
Health (Assisted Human Reproduction) Bill 2023: Second Stage
Is Senator O'Loughlin seconding the Bill?
I welcome the Minister. I am pleased, together with my colleague, Senator O’Loughlin, to bring the Health (Assisted Human Reproduction) Bill 2023 before the House today. This Bill is of significant importance to me. A huge amount of time and effort has gone into bringing it to this point, including hours of consultations with patients, doctors, stakeholders and meeting with the Minister’s office back in 2020. My colleague and I owe a huge gratitude to the Office of Parliamentary Legal Advisers, OPLA, and Kate Butler, who was one of the drafters who helped us navigate the technical elements of the Bill, in particular.
The aim of the Bill is to ensure that we have publicly funded and accessible IVF treatment available to our citizens. The Bill aims to provide for the establishment of a body called the assisted human reproduction, AHR, treatment advisory committee to advise on criteria for eligibility for financial assistance with such treatment. The functions of the committee will include: the financial criteria eligibility for financial assistance; the age; previous treatment; welfare of the child; and any other criteria as prescribed by the Minister. The advisory committee will be asked to prepare a report, no longer than 12 months after its establishment, providing such advice and recommendations. This will be presented to both Houses no longer than three months after it is received by the Minister for Health.
Obviously, this is not achievable with the stroke of a pen. I would like to acknowledge the Minister's Department and the work he is doing to ensure we see the first roll-out of publicly-funded IVF in September, as promised in the budget. My vision, and that of Senator O'Loughlin, regarding the provision of IVF, is that we will see properly funded fertility hubs doing IVF treatments in publicly-owned facilities. Until capacity is reached, however, we have provided for the use of private service providers in our Bill.
Today, our Bill puts the funding of IVF on a statutory footing and sets up a treatment advisory committee to advise on the criteria and eligibility for financial assistance. I know many critics say it is not feasible to include every single medical procedure in legislation as science is moving so quickly. However, the reason we have decided that IVF treatments need stand-alone statutory status is that we rank 40th out of 43 European countries when it comes to the provision of IVF treatment. We are almost the lowest. One in six couples will experience infertility worldwide. This is more than 16% of couples who will experience infertility. We do not have exact data from Ireland but I speculate it is much more than this as we tend to start our families later.
Having a family for those who desire one is primal. You never think that having a child will be a problem until you try and then it becomes all-consuming and affects every aspect of your life, work and relationships. For many, private IVF clinics are just out of reach as the cost per cycle is between €5,000 and €7,000. At the moment in Ireland, IVF is an exclusive right of the rich. This is not fair or equitable. Everyone in my view should be given the chance to have a family. This is not a new right. This is something offered generously by our EU neighbours and we are falling hugely behind. Placing the funding of IVF on a statutory footing is warranted in the circumstances where we have so much catching up to do as compared to our EU neighbours. It is a drastic measure but we are in the circumstance where we are still waiting for the Health (Assisted Human Reproduction) Bill 2022 to come to the House, and we have not seen one cent paid to couples to date to subsidise their IVF treatment. The placing of funding on a statutory basis is essential.
Our Bill sets about to amend the Health Act 1970. This is the same Act that was amended to allow for the insertion of a charging clause in the Health (Regulation of Termination of Pregnancy) Bill. We are not seeking to do something that has not been done previously when it comes to really important legislation that deals with healthcare and the family.
Saying all this, I note the budgetary funding that has been put in place this year for the roll-out of IVF, which I hope will commence in September. I further note the work of the Department regarding the selection criteria that is going on in the background, which we have mirrored in our Bill in the establishment of an advisory committee. I acknowledge the Minister's amendment and we are happy to agree to it on the basis that movement is happening in the background. I know there is concern from intending patients regarding the failure of the Minister's Department to publish the selection criteria to date. I hope that he can give us a timeline regarding the publication of that information in time for September. We also await the Health (Assisted Human Reproduction) Bill, which sets out the regulatory framework, and hope the Minister will be able to bring that before both Houses of the Oireachtas before the recess. As the Minister well knows, our Bill in no way impedes Government legislation.
There will be people tuning into the debate today who are thinking of holding off starting IVF and who are waiting for the publicly-funded scheme. To them I say this: do not wait. They should talk to their doctor or IVF provider. As someone who has struggled with infertility, I know how difficult it is. In 2020 during the Covid pandemic I shared my story in this House and it was then that I, along with my colleague, Senator O'Loughlin, started to pursue the goal of publicly-funded IVF for those coming after me. I was a Senator in this House in 2016 when I first came to learn of my infertility struggle. I was ducking and diving between meetings and IVF clinics for more than four years in the hope of a successful pregnancy. I did five cycles and had many ups and downs on the way, culminating in the birth of my twin boys in December 2019. The financial and emotional cost that IVF has on individuals and couples going through infertility is horrific. The financial cost in other countries is covered by the state, yet in Ireland we provide nothing.
Thankfully, the stigma and isolation in relation to IVF is improving, thus helping with the emotional impact of infertility. However, it is up to the State to put in place a properly funded model so that individuals can concentrate on their well-being when undergoing IVF and not the cost on them. I got hundreds of responses when I opened up initially in this House about my journey. I did many interviews and now when discussing it with colleagues, it is not really a big deal. I like to think I somewhat contributed to normalising IVF. To fully normalise it, however, we need to see it funded properly, and if placing its funding on a legislative basis achieves that, we need to do it.
We know all Private Members' Bills are not perfect but this one is very well drafted. We are happy to accept amendments on Committee Stage, to come to a compromise and to ensure we do not have any duplication of work or bodies. We hope this House can support this legislation.
I really am delighted to be standing here today with my brave, open and courageous colleague, Senator Catherine Ardagh, who just laid bare her life over the last number of years. I really appreciate it. I have learned a lot from Catherine since we started on this journey with regard to drafting this Bill. I came to this Bill not from personal experience but from listening to and understanding the experience of family and friends and by reading about others. We have put countless hours and huge work into this Bill over the last number of years. Together with Senator Ardagh, I want to add my voice of thanks to Ms Kate Butler and the Office of Parliamentary Legal Advisers, OPLA, for their patience and support in getting us here today. I also thank Professor Mary Winfield for her invaluable advice along the way.
Fertility issues in Ireland are much more common than many of us realise. As many as one in six couples in this country will experience fertility issues, which affect men and women equally. In many ways, this is an equality issue. It is about equity of access to the supports that are needed by some to start their own families. Money should not dictate whether people have access to fertility treatment or not. At the moment, however, it does. We all know people who have remortgaged homes or, indeed, put off buying their own homes because of the need to pay costs related to IVF. I know the Minister agrees that Ireland needs to have a service that is safe, effective and, most importantly, accessible. As it stands, that is not the case and the State does not do enough to support couples who, of course, are not facing just financial challenges but that huge impact on their lives of worry, waiting and maybe failing, and the pain of all of that.
This, of course, is not just an Irish issue. Infertility is a worldwide health issue with infertility rates increasing in recent years in all communities in both the developing world and developed world. It is not only a medical condition but it is a social condition.
At present, Ireland is in the very shameful position of being ranked 40 out of 43 countries when our fertility policy is benchmarked internationally. That is simply not good enough. That was the very reason Senator Ardagh and I started on this journey. Assisted human reproduction is one of the fastest-growing healthcare industries in recent years with IVF experiencing the most significant increase in demand. On average, there are 6,000 cycles of IVF treatment completed in Ireland each year. At the moment, infertility treatment, such as IVF, takes place in private and not-for-profit clinics in Ireland. Assisted human reproduction is not regulated in Ireland, although it has been practised since 1987. We are looking forward to seeing that brought forward in regulation very soon, however. I thank the Minister for his work on that.
The number of treatment cycles per annum in Ireland grew in the period 2009 to 2020 from 7,859 to a peak of 11,359. While all those who experience fertility issues in Ireland might not need IVF or intracytoplasmic sperm injection, ICSI, many of them will require some form of assisted human reproduction treatment. Those in need of fertility programmes find themselves paying between €6,000 and €10,000 per cycle. As I mentioned, that situation compares very unfavourably with most of our European counterparts.
The cost of IVF realistically, with blood tests and consultations, comes out at nearly €10,000. At the moment, only fertility drugs are covered by the drugs payment scheme or a medical card. Private patients can claim tax relief on fertility drugs, but that is it. There is nothing else to support those in this situation.
Approximately 9,000 couples are availing of IVF here at the moment, but it is estimated that 3,000 women travel abroad every year for fertility treatment in Europe. People who are desperate to have a child are most vulnerable and hugely open to exploitation. They sometimes pay ransom amounts of money to fulfil their wish and desire to be parents.
Senator Ardagh and I have campaigned tirelessly for a properly funded public health IVF scheme. We were delighted when the Minister in budget 2023 confirmed additional finance and supports for publicly funded IVF treatment. That was a hugely important step. We look forward to seeing it being realised. It is another example of Fianna Fáil’s ambition to transform healthcare in this country. This Bill is a further building block for the proper provision of fertility treatment in Ireland and seeks to complement the Minister’s AHR legislation of 2022. Since we publicised that we were introducing this Bill, some people have been in contact with me and Senator Ardagh to say they were concerned this Bill might impact on the previous Bill. I assure anybody listening this will not delay or impact the current AHR Bill and certainly will not affect the roll-out of public funding for IVF treatment in September 2023.
Our Bill proposes that the committee will advise and make recommendations to the Minister for Health on the criteria for eligibility for financial assistance with fertility treatment, in addition to the age of persons that can obtain treatment, the welfare of any child that may be born as a result of such treatment and any other criteria determined by the Minister. This places the responsibility of whether there will be public funding in the form of full or partial coverage and the attached conditions - such as medical indication, single-embryo transfer, number of cycles and up to what age - in the hands of experts in this field. We do not claim to be experts. We are coming at this from a humane and compassionate point of view and have the luxury of being able to introduce this as legislators.
In a survey by Sims IVF that was conducted last month among 1,088 respondents, 54% said they would consider delaying further treatment until public funding is rolled out. The remaining 46% said they would not delay further treatment, even if funding came through this year. We have nearly half of those couples putting their plans on hold in the hope of receiving State assistance. We are clear we want this to happen as soon as possible, but we have to send a message to those thinking of putting plans on hold: please do not do that. We all know or at least know of someone who has gone through the process and from them we know the mental toll and emotional distress the process can have. We need to make progress on this. Some 18% were angry over the length of time it is taking to get public funding and concerned about the exacerbation of waiting lists for treatment, while 12% of people lacked confidence in implementation of public funding, querying whether the roll-out will be means-tested and if patients with medical cards will be prioritised. I hope this Bill and the Minister’s clear commitment to delivering the roll-out on a universal basis will help alleviate any anxieties that may exist in the general public.
The World Health Organization is clear that infertility is a disease and should be treated as such. We provide excellent services for a host of other diseases in our public health service and fertility should be no different. I thank the Minister for his work to date on this issue and for his collaboration, especially on the women’s health agenda.
I thank Senators O’Loughlin and Ardagh for bringing forward this legislation, particularly Senator Ardagh for her work on this and for sharing her journey with us. It is the journey of so many but many suffer in silence or do not speak out. I think we can all agree that if this issue affected men, the money would have been allocated decades ago. Because there are many more women Members of the Seanad now, these issues are raised here more and more, and rightly so. Without the presence of the Senators mentioned and others working on this issue, many more families would continue to suffer when trying to access something which is provided, as Senator Ardagh pointed out, across the European Union. We are far behind in providing that service and, as the Senator pointed out, many people are being exploited by unscrupulous medical professionals charging for treatments. Many medical professionals do great work but some are providing services they know are not viable and extracting money from vulnerable people. Legislation is required to regularise the situation and make sure people get what they are entitled to and are protected while getting those services.
I applaud the work of the two Senators who have brought this matter forward. I commend their sincerity and praise Senator Ardagh for how well she has spoken publicly about her personal journey. An IVF journey is, for anybody, an emotional roller-coaster and very difficult. Many people spend their entire financial future – myself included – on the hope of a child. It is worth every cent but financial security is mortgaged for the hope of holding that baby. I know that from my journey of 13 IVFs, five miscarriages and two surrogacies, the ultimate one resulting in the birth of my fantastic daughter.
IVF funding is desperately and urgently needed. I note the Minister’s statements from last year as the surrogacy committee was sitting to the effect that the AHR Bill was being stalled waiting for the outcome. I went back over statements in this House and elsewhere which indicated that there was a precondition of the AHR Bill being in place before IVF funding could be facilitated. Professor Mary Wingfield, at a meeting of the joint committee on 14 April 2022, spoke of the fact that funding of IVF is not in the AHR Bill and that the regulatory authority was not being prescribed oversight mechanisms for IVF funding. That is a peculiarity. I wonder why not. It should have been at the centre of the AHR Bill. That is the appropriate place for it. That is not to take from today’s Bill, but it would have been the appropriate place for it. I raised that in June of last year.
I had previously raised the need for criteria. People like Selina Bonnie are part of the reproductive justice group and will be here in the audiovisual room on 3 May at 12 noon. I ask all to attend that. They will talk about the discrimination in access to fertility for women with disabilities and disabled women.
Her particular story is horrific. Before she was offered IVF treatment, or any fertility treatment, she was asked to give a guarantee that her child would not be disabled. I have raised this matter with the Minister and to be fair he was horrified when he heard it last year, and I have raised this matter with him many times since and at every opportunity.
IVF funding has been in place in this State for a good number of years but in very limited circumstances. If a woman has cancer, her eggs can be frozen and, indeed, the same applies to men so sperm are frozen. In fact, ICSI treatments and IVF are provided. Professor Wingfield gave testimony to that when she participated in meetings of the Joint Committee on International Surrogacy. Facilities even go as far as to ship embryos to clinics in countries in cases where women who have had hysterectomies, as part of their cancer treatment, are unable to carry their own babies and, consequently, need to avail of surrogacy. Professor Wingfield emphasised that IVF funding is already provided so we did not need legislation just to extend it. However, I appreciate that we need to have a formality when it comes to criteria and thus ensuring an inclusive, fair and equitable criteria when it comes to accessing IVF. We must also ensure we have a fair situation when it comes to the treatment of people with fertility issues. It is an anomaly that families are supported to ship embryos abroad for surrogacy and yet the women who require assistance because of their cancer treatment are denied parenthood in this State.
I am a little bit perplexed because last Friday, I received a statement from the office of the Minister for Health and I wonder where AHR is in the legislation. We have heard through the grapevine that certain criteria will be excluded from the legislation and that prospective surrogacy and retrospective surrogacy will be thrown into the one pot instead of retrospective surrogacy being treated separately legislatively and having easy access to the courts. We have been told that the green list is extremely narrow and is so restrictive as to be prohibition of surrogacy by stealth and I hope that it is not the case.
Last December, the Minister gave me an excellent briefing on surrogacy. At that time he advised me that people were working through their weekends in order to make sure that the legislation would arrive on time and be done in a timely manner. I am a little bit perplexed that last Friday at 5.50 p.m. I received a note which states the process of drafting new provisions is being undertaken in tandem with the drafting and finalisation of substantially proposed consequential and other amendments to the 11 Parts and 134 pages of the published Bill. So if we needed legislation to be rushed through last year, and the legislation could not be delayed indefinitely for surrogacy, yet now we are drafting a whole heap of other amendments, I wonder what the legislative draftspersons were doing last year. Clearly, they were not doing things like this that are absolutely necessary and required.
On the restrictive interpretation of elements of the surrogacy report compiled by the Joint Committee on International Surrogacy, I note that to date, there has been absolutely no engagement with any member of the committee, including myself. That is an absolute disgrace.
I hope that we are going to see AHR included. The only hope that I have concerning a timed amendment is that given that it is down to seven months, that it means the AHR will be delivered and in place by that time and that any preconditions are there. I say that because I absolutely support this Bill and laud these experiences. However, tomorrow a couple will walk again into the High Court where he has a terminal illness and that child is going to be left without a parent in this State. This weekend, mothers and second fathers around the country will not have access to see their own child because of a failure. Also, on numerous occasions a High Court judge has repeatedly mentioned that the State has failed to legislate for parenthood. He does so not because he is ignorant of the separation of powers but because counsel for the State keep informing the court that legislation is imminent when in actual fact, if I am to believe all that I have heard on the grapevine because nobody has bothered to brief me directly, then we could be years away from actual parental applications to the court and in the most expensive court in the land, which is a disgrace. However, I commend the Bill and thank the Leas-Chathaoirleach for his indulgence.
I thank the Senators for bringing this Bill to the Seanad. In particular, I recognise Senator Ardagh for the courageous way in which she has not just championed this issue but spoke of her own personal experience.
Senator Seery Kearney has made a powerful speech that will be hard to follow. She has asked many pertinent questions and got to the heart of the concerns that so many people have about this issue. I hope that the Minister gives her direct responses, particularly concerning timelines because I think that a number of us share the Senator's concern about timelines. We have heard reassurances before and, frankly, they have not been delivered on. Let us see how much clarity we get today and I would welcome clarity.
Sinn Féin has long called for a much-needed regulatory framework for assisted human reproduction treatments and related research. Of course, we passionately believe that AHR should be part of a properly financed national health service. We have long spoken about the need to address the difficult question of international surrogacy arrangements. This is an area we need to give serious consideration to and we must get it right. I understand there are very complex moral and ethical issues that need to be addressed. I acknowledge that the Joint Committee on International Surrogacy, which was established last year, did great work in a very tight timeframe. We need a rights-based approach that will protect those involved and does not lend itself to permitting the exploitation of any kind but which fundamentally recognises the situation that some families have found themselves in.
I will speak briefly about retrospective parentage because it is an important issue. I am very conscious of the issue and the uncertainty that many families in this position face every day. This uncertainty has caused immeasurable stress and strain and we are obliged to alleviate that as soon as reasonably possible. There are many cases affected by this issue. My colleagues and I have spoken to many families who are living with this stress and strain every day. Indeed, some months ago members of the Sinn Féin Party heard a very powerful presentation on this very topic. A case I remember in particular is that of Antoinette and her husband, Barry, from County Offaly, whose children Eanna and Doireann were born in Kyiv. Antoinette and Barry have spoken here and publicly about the stress placed on them by the current legal limbo. The law, as it stands, means that when those children arrived in the State, Antoinette was not legally their mother despite the fact that she is recognised as such in Ukraine. It is heartbreaking to hear these stories about families who are in this legal limbo.
I cannot say any more than what was said in the previous speech. Sinn Féin is very happy to support this Bill. We really need to see delivery in an inclusive fashion and along the principles of a fully funded national health service.
I am proud to stand here with my colleagues today and commend them on the work they have done on this extremely important Bill. IVF is a treatment for infertility. As my colleague, Senator O'Loughlin, has said, the WHO views infertility as a disease. IVF is quite an effective treatment for that disease but, unfortunately, IVF treatments have not been fully publicly funded and I hope that this Bill will move things along. This matter is something on which the Minister has engaged with both Senators Ardagh and O'Loughlin over a number of years because infertility is a very important issue that is experienced by many thousands of couples across the country.
I refer to the points the Leas-Chathaoirleach made at the start of this debate. While he did so with the best of intentions, he mentioned that infertility was a problem that affects women and if it affected men then we would have seen a solution a lot sooner.
It does affect men. Infertility is not a female-centred issue. It affects men as well. It is fair to say that the shame and stigma and medical burden often disproportionately fall on women, but pinning infertility as a women's issue or a woman's fault is completely incorrect. We need to break away from this narrative and speak about it in an open fashion. It has been kept under wraps. People have been speaking about it, not even with their friends or family but among themselves.
Women have carried a burden because it is seen as the most natural thing and that our primary function in life is to bear a child, and when women cannot do so, it is devastating for the whole family unit. Senator Ardagh very generously shared her personal experience. I know a lot of people really connected with it. Having been a colleague of hers for a long number of years and a friend, I know how it impacted her. I know how hard she worked to keep the show on the road while she was undergoing very difficult treatment. She is to be commended on the work she is doing along with Senator O'Loughlin and the Minister. Having gone through that journey and having two beautiful boys at home, she knows there is work to do to make sure the road is easier for those who come after her. I commend her on this.
The funding aspect of this is very important. It needs to be universally funded. This universal funding, as the Minister knows, will help to defeat the stigma and shame of it. It would be seen almost as a normal health procedure and treatment in the system and not something abnormal. This is why it is so important that it is publicly funded and that we see this rolled out without further delay. Every month that goes by impacts on people's journeys. I ask that we send a strong signal from the House today that this is a priority of the Government and that it is a part of our normal health system.
The Minister has made great progress in recent years. We can look at the achievements of every previous Minister for Health but I do not think any of them achieved what the Minister has in the area of reproductive healthcare. This is to be commended. It is something of which we as a group are very proud. This is an extra piece in the jigsaw. I know the Minister is prioritising it. We will see extra funding for it and families will see real delivery. There are still issues to be teased out in the legislation but I know people throughout the House will work very positively and productively with the Minister and Senators O'Loughlin and Ardagh to have some real workable legislation and proper funding and access. This is what this is about. It is about creating universal access to treatment. It has always been the Fianna Fáil way that people have access to healthcare when they need it and as they need it. People who access IVF are going through enough as it is. They do not need to have a financial burden to deal with also.
I congratulate Senators Ardagh and O'Loughlin. I know how hard they have both worked on this. It is a big day but there is still a road to go and we are here with them on that road.
I welcome the debate. It is interesting legislation to say the very least and it is very positive. The entire debate is important. It is an issue that affects couples and affects males and females, as Senator Clifford-Lee rightly pointed out. It affects different people throughout their lives. The primary issue is with regard to trying to get pregnant for the first time. Secondary infertility is also a big issue but it is probably not mentioned by many people.
It is a big issue for couples. It is amazing how our generation is speaking about these issues. I compliment my friends in particular on how open they are about speaking about big issues in their lives. Our parents probably did not speak about these issues but we have moved to the next level. This is a normal conversation that could be had at Christmas when we learn so much about our friends whom we went to school with. Secondary infertility is a massive issue for couples and it needs to be acknowledged.
The proposal made in the budget to have IVF available in September caught the imagination of many people. It was a key issue that people who have been dealing with this for so long bucked up and said it is very important. Thousands of people in Ireland go through this every year. We need to make sure we hit the timeline proposed. It is 20 weeks to September and time is ticking. People are asking about the criteria and the funding mechanism. They are asking when, where, how and who, and what should be their plan. The purpose of my contribution today is to ask for clarification on where we are going regarding the funding mechanism promised to make sure we hit the September deadline.
I remember last Christmas quite well when people were speaking about it. They said it was nine months before it would be free. We have had debates and we listened to people's stories. It is a significant issue that affects people. Of all the issues we speak about, trying to make sure people have the ability to have a family is significant. It is a primary issue in so many ways and it affects males and females. This is a significant point. This is across the board in so many ways. Couples are struggling. In many ways they appreciate that this is being spoken about and debated. This is why the Bill is so important.
I compliment Senator Ardagh on speaking about this in 2020. It broke the seal on a very important issue in Irish society that needed to be spoken about. Since the announcement last year that funding would be made available, expectation has built up. People are saying the Government must listen to them on the big issues in society. They are looking forward to the scheme. I hope we get clarity today on what the funding mechanism will be and the timelines. Are we on time? Will we hit the targets that have been proposed?
The universal element is very important. Unfortunately, and this sounds totally snobby, it was those with the ability to pay who had access. That was totally wrong. It was bizarre in so many ways. I hope the new universal scheme will take that away and people will have the ability to access this very important medical procedure they need to have a family. I compliment Senator Ardagh on tabling this Bill and allowing for this debate. It is very important. We need to move forward with the timelines which are so important.
I very much welcome today's Private Members' Bill and the opportunity to discuss the very important topic of assisted human reproduction. I will begin by recognising the work of the two Senators sponsoring today's Bill, Senators Fiona O'Loughlin and Catherine Ardagh. Both Senators have worked tirelessly in advocating for these new services in women's healthcare, for new investment, and for urgent progress to be made in the provision of fertility treatments and services, including advanced treatments such as IVF. I have just been passed a sticky note with "Urgent IVF" on it. It is happening at formal and informal levels.
I add my voice to the commending of Senator Ardagh on sharing her own journey. It is interesting to hear language such as "stigma" today. There should be absolutely no stigma around fertility, no more than there should be around any disease in healthcare. Nonetheless, when Senator Ardagh started to share her journey, it was not something that was commonly spoken about. One of the roles we must all play as Members of the Oireachtas is to normalise topics and issues that should be normal, such as menopause, endometriosis and many other issues. I commend Senator Ardagh on sharing her journey because these things are not easy to do.
I acknowledge the broad political support there has been and continues to be across the House for the investment in and roll-out of new, modern healthcare services for women. When I was appointed in 2020, I made it clear that we needed a revolution in women's healthcare. We were not interested in things getting a little better year after year. Our ambition has been and still is to move faster than ever before, make up for decades of underinvestment and provide new services and financial supports in many important areas, including menopause, gynaecology, endometriosis, contraception, maternity services, breast-feeding, perinatal supports for both physical and mental health, eating disorders and, of course, the subject of today's Bill, which is fertility.
To that end, we have invested in women's healthcare at a completely new level over the past three years. In 2021, I allocated €17 million for new developments, followed by an additional €31 million last year and a further €50 million this year. Taking those allocations over the past three years into account as well as the full-year costs, by next year, before we add any new development funding, there will be a new €150 million in base funding for women's healthcare services that was not there three years ago. Great credit is due to Senators for their political support, to the many people in civil society for their ongoing advocacy and support and to the officials in my Department, the HSE and our clinical partners around the country. As a result of their efforts, we are seeing that money turned into what matters, which is the provision of new services for women around the country. We have more obstetricians, gynaecologists, midwives, nurses and health and social care professionals in post. We have new breast-feeding clinics, a new national network of same-day gynaecology clinics, perinatal teams, new training and supports for GPs, new specialist endometriosis and menopause services, which is really important, and, of course, we have a new national network of six regional fertility clinics.
These clinics are beginning this year to introduce fertility services for intending parents, both men and women. As their number is scaled up over the years, we will build towards our ultimate goal, which is to provide advanced assisted human reproduction treatment, including IVF, on the basis of fully public provision. We all know people who long to become parents and who are faced with the difficult reality of fertility issues. Providing financial support to assist couples to avail of assisted human reproduction treatment will make a real difference. It is a complex issue that requires careful consideration. Critically, we must ensure decisions are evidence-based and have due regard to patient safety, good governance and appropriate regulation. We must also ensure the provisions in the Government's Health (Assisted Human Reproduction) Bill 2022 meet international precedents and that good practice is considered.
My Department and the HSE have looked to other jurisdictions to establish what is working best. It is important to note that in Ireland, potential demand has not been definitively quantified and is likely to increase as the services become more widely available and less expensive for those looking to avail of them. We may need to adopt a phased approach, ensuring resources are directed to the greatest benefit of those seeking treatment. The plan for providing advanced AHR treatment will involve using private providers while building up the public capacity. Work is well under way on finalising the drafting of the Health (Assisted Human Reproduction) Bill 2022, which I hope to have passed through all Stages during the summer term.
I acknowledge the huge amount of work undertaken by the two Senators in putting together today's Private Members' Bill. As Senator Ardagh said, they initially met with officials in my Department in 2020 and have been working closely with the drafters to ensure they put forward technically robust and well-drafted legislation. The Bill, in essence, seeks to establish a body, the assisted human reproduction treatment advisory committee, to "advise on criteria for eligibility for financial assistance with assisted human reproduction treatment". I fully support the broad intent behind the Bill, including that there be secure, recurrent funding within the HSE for AHR treatments this year and into the future.
I am happy to inform the House that I instructed my officials last year to begin to gather exactly the sort of expert input the Senators have rightly called for in their Bill. A significant body of work was undertaken to develop eligibility criteria. I have personally met with HSE clinicians, private providers, patient advocacy groups and Deputies and Senators to discuss the issues. There are open lines of communications between the advocacy groups, clinicians, private providers and my Department as we seek to do two things, namely, finalise technical aspects of the Government legislation and draw up eligibility criteria. The expert work rightly called for in today's Bill is well progressed. Where we have got to, which is a seven-month timed amendment, makes a lot of sense. The Bill is important and, if agreed by the Seanad, will act as a backstop to ensure that exactly the work that is being called for is done.
The Health (Assisted Human Reproduction) Bill 2022 would have gone through all Stages and been passed last year if not for the changes requested. I was asked to pause it in order to bring in what are extremely complex and important surrogacy amendments on Committee Stage. As such, I am slightly taken aback to hear criticism from Sinn Féin of the timelines. That party, along with others, asked me to stop progressing the Bill in order that the surrogacy amendments could be added. I agreed to do that. It is disappointing to have the same people who asked for the timelines to be delayed now criticising those delays.
I was also disappointed by the contribution of Senator Seery Kearney, including her clear criticisms of officials in my Department and those drafting the legislation. The Government Bill would have passed last year, as I said, if not for the requested changes. The Senator noted we are still working on parts of it, which we are. We are doing so because the people who would have been engaged in finishing it moved to doing the complex work involved in the surrogacy amendments, for which the Senator has powerfully campaigned for a long time. I put it to Senators that if the House asks me to pause legislation and redirect the resources of my Department to amending legislation that is incredibly complex and that normally would take several years to work its way through the system, and if the officials in my Department, with my oversight and with a strong push from both Houses of the Oireachtas, seek to have that done in a shorter time, then I do not think we should be criticising them. It is very unfair on the officials to do so and it is a bit rich.
The amendments are being finalised. The Attorney General's office is looking at them with a view to signing them off. I will then bring the Bill back to the Cabinet for final agreement, after which I will put it, including the amendments that incorporate the substantial new work on surrogacy, to the health committee. The latter will decide when it wants to take Committee Stage. I expect it will be an intensive debate. My hope, for the reasons on which we are all in agreement, is that the committee will take Committee Stage quickly and the Bill will then go forward for Report and Final Stages in the Dáil and Seanad. I hope we will get it through in this term. It needs to be in place from September.
IVF services will be provided initially by private providers. It was proposed to me that rather than using private providers, we should have public-only service delivery. However, it would take many years to scale that up. I made the call that we will do both in parallel. We will begin immediately to scale up public provision because that is ultimately the way we want to go.
In the meantime, we cannot ask intending parents to wait three years, five years, seven years or whatever it would take to build up these services, so I have allocated a very substantial amount of money to help with subsidising care from this September.
I acknowledge that many colleagues are saying there are intending parents all around Ireland waiting to know if they will qualify and, if they do, how much of a subsidy there is going to be. I want to say two things on that. First, I acknowledge there are a lot of people waiting and we are therefore moving that on as quickly as we can. Second, as soon as I have a draft on that, I will be discussing that with colleagues in the Seanad and the Dáil to make sure we get it right. Inevitably, some people will be very happy and, inevitably, some will fall outside of the criteria and may not be so happy, but we are going to have to make some calls around qualifying criteria, as they do in every country.
I would like to talk briefly about the model of care more broadly because there is a lot more happening as well as IVF. It was put together with my Department and the national women and infants programme. There are three stages, starting in primary care with GPs, and a lot of additional support has been put in place for GPs. Second, we have secondary care in these new regional fertility hubs and then, where necessary, tertiary care, IVF, intracytoplasmic sperm injection, or ICSI, and other advanced treatments. Phase 1 has involved the establishment of these regional fertility hubs, and these are there to manage a significant proportion of patients. We talk quite rightly in the House about IVF but, in fact, the majority of patients will not need IVF and they will need these secondary treatments, and that is what the national network of regional clinics is for. The completion of phase 1 is envisaged later this year, so there has been a lot of progress from a standing start last year. We will have six fully operational regional fertility hubs around the country.
Phase 2 is the introduction of the tertiary fertility services, including IVF, through the public health service. In this regard, funding was allocated in the budget to support access to advanced assisted human reproduction, AHR, including, crucially, to allow the commencement of phase 2 of the model of care. This investment will facilitate the first steps to be taken towards the provision of the publicly funded service. In particular, it will allow the historic development of the first national advanced AHR centre, including IVF and ICSI, through a wholly public clinic, and I am happy to say that is scheduled to be open next year, in 2024. Subject to the provision of additional funding in the future, it is envisaged that additional advanced AHR centres will be developed and become operational on a phased basis around the country. The allocation for this year is being utilised to support the regional fertility hubs to expand their scope of service by introducing, for example, the provision of intrauterine insemination, IUI, which for certain cohorts of patients can be very effective, less complex and less intrusive than some other types of AHR treatment.
It should be noted that the majority of the other jurisdictions which publicly fund do so on a partial rather than a full basis and that it is the norm internationally that such specific criteria as we discussed would be met. It is important to say there is already very significant funding for IVF in the country, and it might be more than we realise. First, as was pointed out, there are some very small patient cohorts for whom it is already provided. Second, there is a tax rebate for people who avail of services, which is modest but it is there. The one area where there is a very significant spend is on medicines. Fertility medicines typically cost thousands of euro and patients only have to pay €80, or €160 if the medicines are accessed over two months. Therefore, in fact, patients going through IVF already receive a State subsidy of thousands of euro per cycle and it is something we need to acknowledge. In fact, when we checked the amount for 2021 just for the fertility drugs covered by the State, believe it or not, €40 million had already been paid by the State for these drugs. Obviously, we are going to go significantly further than that, but it does tend to get ignored that, in fact, there is a multi-thousand euro contribution already being provided by the State.
I want to do a few things. First, I thank the two Senators for today's Bill but also, in particular and as important, for the ongoing support, advocacy and pressure at times for advancing fertility treatments and for advancing women's health services. I extend the same thanks and acknowledgement to the entire House because there is a lot of common ground across the House and across politics in terms of investing in women's health services, in fertility, which obviously is for men and women, in surrogacy and in a lot of different areas. Through the lifetime of this Government, we are on track to have fundamentally changed, upgraded, reformed and modernised fertility services and women's health services broadly throughout the country. I thank Senators for their ongoing work, support, advocacy and disagreement, where that is warranted, and no doubt sometimes it certainly is warranted.
My commitment to the House is that we are absolutely focused on bringing in IVF treatment this September. I met with the group just two weeks ago and the first and last thing I said to them was “September”. It is September. We will have the proposals in shortly on the draft eligibility criteria and we remain absolutely committed to making sure the State support for IVF and for the treatments, as well as for the medicines, which is already in place, kicks off from this September.
It has been really worthwhile coming in today. It is great that the Minister has been able to give us an important update in regard to the AHR Bill and the work that has been going on in the background, including the criteria and the roll-out of the fertility hubs. I commend the Minister on all the work he has done in women's health and the facts speak for themselves in regard to spending. I know documents produced by the Department show that, in 2021, €17 million was spent on women's health and we are now at a figure of nearly €150 million for 2024. That shows the Minister's commitment to women's health, which includes IVF. I have no doubt what the Minister says today will happen and we will hold him to that.
I thank the Minister for coming in, taking this debate and agreeing to a short adjournment for the seven months. We all look forward to celebrating some sort of delivery of IVF come September.
I thank the Minister and the Members. The question is, “That the Bill be now read a Second Time.” Is that agreed?
We are looking for the timed amendment. It is that motion.
I propose that we take Committee Stage next Tuesday and then we will let the House-----
I propose we adjourn this debate.
We do not have to order it for next Tuesday, but to have timed the amendment, we would have had to wait until it was on the Order Paper. We can reschedule. I propose that we read the Bill a Second Time and then we will schedule Committee Stage for when the Minister comes back with proposals.
An amendment that was agreed by Cabinet is not before the House. Is that what we are saying?
That seems to be the case.
Question put and agreed to.
I propose a suspension of the House for five minutes and we will come back to it.
Cuireadh an Seanad ar fionraí ar 1.50 p.m. agus cuireadh tús leis arís ar 1.55 p.m.
Sitting suspended at 1.50 p.m. and resumed at 1.55 p.m.
When is it proposed to take Committee Stage?
On Friday, 20 October 2023.
Is that agreed? Agreed.
Committee Stage ordered for Friday, 20 October 2023.
When is it proposed to sit again?
Next Tuesday at 12.30 p.m.
Is that agreed? Agreed.
Cuireadh an Seanad ar athló ar 1.57 p.m. go dtí 12.30 p.m., Dé Máirt, an 25 Aibreán 2023.
The Seanad adjourned at 1.57 p.m. until 12.30 p.m. on Tuesday, 25 April 2023.