Written Answers Nos. 668-689
668. Deputy Pádraig Rice asked the Minister for Health to provide an update on the development of a new model of care for trans healthcare; the timeline for same; the consultation and collaboration taking place with the trans community and relevant stakeholders; and if she will make a statement on the matter. [73491/25]
Amharc ar fhreagraThe Deputy will be aware that, as outlined in the Programme for Government 2025, the Government are committed to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. The provision of proper, appropriate and integrated gender healthcare services is something that I want to ensure is in place for those who are questioning their gender identity or are experiencing gender incongruence or dysphoria.
In an effort to improve the gender healthcare services in this country the HSE have initiated a new clinical programme for gender healthcare and an updated clinical model for gender healthcare services is being developed. This work will also inform an implementation plan for its delivery and the work is expected to conclude in 2026.
As part of the development of the model of care, the existing and emerging evidence base, including international evidence on health outcomes, and data on the clinical needs of those presenting to clinical services over the years, will be reviewed. The Model of Care will consider all available information, and will not be aligned with any one study, report, or set of guidelines.
The HSE commenced the systematic review on the evidence base with respect to co-existing clinical needs in gender diverse people with support from the HSE Library Service. Interim results of this review were made available for public consultation during the month of August 2025. The HSE are now reviewing any submissions and completing the evidence review of this topic.
Another main element of the work will include a review of the experience base which encompasses an understanding of the experience of service users, their families, healthcare workers in gender healthcare and other stakeholders. As this is an area of healthcare where there are many public voices, all efforts will be made to hear from those with who have lived and living experience. In this regard, a number of lived experience engagement design sessions, attended by a number of advocacy groups, have been held to inform the development of a plan to maximize stakeholder engagement.
A cross-speciality Clinical Advisory Group has been established with the Royal College of Physicians of Ireland and convened in June 2025 to support the Model of Care design and development. In addition, a working group, which has a number of representatives with direct lived experience has also been established and the first meeting took place recently.
Developing a model of care for Gender Healthcare Services is expected to be a complex process and the HSE and department officials will work closely together to support the process, ensure transparency and keep the patient at the centre of the process.
It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for persons with gender incongruence or dysphoria.
669. Deputy Pádraig Rice asked the Minister for Health her views on the closure of the national gender service’s waiting list to new clients from 1 March 2026; the engagements she has had with the national gender service and the HSE in respect of this issue; and if she will make a statement on the matter. [73492/25]
Amharc ar fhreagraThe Deputy will be aware that, as outlined in the Programme for Government 2025, the Government are committed to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion.
The provision of proper, appropriate and integrated gender healthcare services is something that I want to ensure is in place for those who are questioning their gender identity or are experiencing gender incongruence or dysphoria.
On being informed of the National Gender Service plan to close the waiting list to new clients from 1 March 2026, Minister Butler and I immediately arranged to meet the HSE CEO, Mr. Bernard Gloster, to discuss this urgent matter. Following that meeting, the HSE informed the National Gender Service that, under the National Waiting List Management Policy and associated HSE protocols, waiting lists may only be managed in accordance with established, documented procedures that ensure fairness, transparency, and compliance with governance standards.
I am fully committed to ensuring that health services continue to be provided to those who need them, as would be the case with any other service. Minister Butler and I will continue to engage with the HSE to ensure that this happens.
670. Deputy Seán Ó Fearghaíl asked the Minister for Health if she will address the concerns regarding the treatment of women with endometriosis raised in correspondence (details supplied); and if she will make a statement on the matter. [73493/25]
Amharc ar fhreagra671. Deputy Seán Ó Fearghaíl asked the Minister for Health if she will address the request for reimbursement of costs incurred for endometriosis treatment raised in correspondence (details supplied); and if she will make a statement on the matter. [73494/25]
Amharc ar fhreagraI propose to take Questions Nos. 670 and 671 together.
It is recognised that endometriosis is a significant health issue for women in Ireland today and the HSE acknowledges that it is a difficult condition to diagnose and treat because of the variation of presentations which can impact the physical and mental wellbeing of patients. Endometriosis is a chronic disease with high recurrence rates, for which there is no definitive cure.
On 18 October I launched the National Framework for the management of Endometriosis. The Framework sets out for the first time in Ireland a defined clinical pathway for women with endometriosis, which spans primary to secondary care to specialist complex care in tertiary settings.
Most women experiencing signs and symptoms of endometriosis present to their local GP in the community. In line with clinical guidelines, GPs are encouraged to initiate treatment for suspected endometriosis and may refer women with suspected endometriosis to general gynaecology services in their local hospital.
Regional Specialist Centres for moderate cases have been established in the Rotunda, the Coombe, and Limerick, with clinics under further development in Galway and the National Maternity Hospital.
Two supra-regional specialist centres, in Tallaght and Cork, have been established for the management of complex endometriosis cases.
All endometriosis sites are operational and taking referrals. Treatment including surgical intervention is being provided across the network.
Additional funding has been provided this year to expand these services through the recruitment of more personnel to provide multidisciplinary care at both supra-regional and regional level.
The Framework was officially published in October of this year. Funding of over €5 million has already been invested in specialist endometriosis services since 2021. In addition, endometriosis surgeries have been and continue to be performed in other acute gynaecology services.
The HSE has carried out an analysis of the short term and medium-term requirements to build adequate capacity, improve clinical pathways and increase expertise within our endometriosis services. The HSE’s budget for 2026 will be €27.4 billion, an increase of 6.2% on 2025. This investment will enable expansion and improvement in our health services, including endometriosis.
The Endometriosis Surgery Abroad Interim Scheme commenced from the 18 October and will operate in addition to the existing treatment abroad pathways, including the EU Treatment Abroad Scheme, the EU Cross Border Directive and Northern Ireland Planned Healthcare Schemes. The interim scheme will cover costs for the transport abroad and for healthcare provided, paid directly to the hospital.
Where a person accesses private healthcare in Ireland there is no facility for the cost of that care to be reimbursed by the public health system.
672. Deputy Ken O'Flynn asked the Minister for Health whether any gaps, deficiencies, or capacity constraints were identified during the national pandemic command post exercise conducted in March 2025; to list each issue identified under the headings staffing, laboratory capacity, IT systems, public health infrastructure, and points of entry; and to outline the remedial actions approved by her Department in response. [73499/25]
Amharc ar fhreagra673. Deputy Ken O'Flynn asked the Minister for Health whether her Department received a written report, lessons learned document, or formal evaluation arising from the March 2025 national pandemic command post exercise; the date it was received; which senior officials reviewed it; and whether the report is available for publication. [73500/25]
Amharc ar fhreagraI propose to take Questions Nos. 672 and 673 together.
The HSE’s Exercise PANDORA, held on 6 March 2025, was a national command post exercise designed to exercise the HSE’s response capabilities to an escalating highly pathogenic avian influenza emergency, informed by the HSE Operational Pandemic Plan (HSE OPP). The aim of the exercise was to assess operationalisation of the HSE OPP.
A report on this exercise was compiled by the HSE and submitted to the Chief Medical Officer in my Department on 21 July 2025. The outcomes of this report are helping to enhance pandemic preparedness both within the HSE and within my Department. As this exercise was conducted by the HSE its publication is a matter for the HSE.
The Health Protection Surveillance Centre (HPSC) is Ireland's specialist service for the surveillance of communicable disease and Ireland's national International Health Regulations (IHR) Focal Point. The IHR are a binding international agreement governing how countries manage public health risks that have the potential for cross-border spread.
SPAR is the acronym for the States Parties Self-Assessment Annual Reporting tool. This is an online questionnaire used by the 196 IHR Member States to report annually to the World Health Assembly on their progress in implementing the 15 core IHR capacities, such as surveillance, laboratory systems, and points of entry. The data, including Ireland’s annual response, is compiled and disseminated by the World Health Organisation (WHO), details of which are available on the WHO website: www.who.int/emergencies/operations/international-health-regulations-monitoring-evaluation-framework/states-parties-self-assessment-annual-reporting. My Department, in collaboration with the HSE, consistently reviews levels of compliance with the IHR core capacities.
674. Deputy Ken O'Flynn asked the Minister for Health the current surge staffing capacity available to the HSE for infectious disease screening during periods of elevated risk, expressed in whole time equivalent posts, by staff grade, and by region; and to state whether her Department has identified any staffing shortfalls relative to surge planning assumptions. [73501/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
675. Deputy Ken O'Flynn asked the Minister for Health the maximum laboratory surge capacity available nationally for infectious disease testing during an elevated risk event, including PCR and genomic sequencing; the maximum weekly throughput assumed in national planning; and the turnaround times used by her Department for preparedness modelling.; and if she will make a statement on the matter. [73502/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
676. Deputy Ken O'Flynn asked the Minister for Health whether her Department has identified any constraints in laboratory throughput, reagent supply, staffing availability, or logistics that would limit surge testing capacity during a public health emergency; and to outline any actions approved to address such constraints. [73503/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
677. Deputy Ken O'Flynn asked the Minister for Health whether the national Outbreak Case and Incident Management System and the National Immunisation Information System are fully operational on a national basis; the dates on which each system became operational; and whether either system has undergone stress testing to assess performance under surge conditions. [73504/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
678. Deputy Ken O'Flynn asked the Minister for Health whether her Department has received any reports identifying risks or limitations in HSE public health IT systems during periods of elevated demand since 2020; and to outline the actions taken in response to any such reports. [73505/25]
Amharc ar fhreagraAll public health IT systems came under tremendous pressure caused by elevated demand triggered by the pandemic, as the volume of track and trace activities and the volume of notifications to the National Health Protection Surveillance Centre (HPSC) ramped up exponentially overnight. The subsequent need to manage a national campaign for everyone to receive a Covid vaccine in a very specific order, in particular locations, in mass vaccination clinics, hospitals, GP surgeries and community pharmacy, and within a shortest time possible, also put the health system and associated IT systems under pressure.
The HSE took steps to address this at the time and continues to invest in these systems for the future. At the time a new CRM solution was developed to provide a state of the art Track and Trace System. The legacy system used by HPSC could not be replaced to tactical actions were taken to respond to the emergency including additional ICT infrastructure and the use of BOTs to automate large volume data processing. A new Covid vaccination system was developed at pace and scale and with sufficient resilience to withstand the ransomware attack in May 2021, which affected many other HSE systems but meant the national vaccination campaign was largely unaffected.
Since that time a national Delivery Director has been in place with her team to accelerate delivery of IT systems in public health. The HPSC system is being replaced and the vaccination system is being developed so that it can cater for all programmes, not just Covid.
Whilst there is still much to be done, the team have a plan, funding and resources are being provided and they are getting on with delivery.
679. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted any assessment since 2020 of infectious disease screening capacity at Ireland’s designated points of entry; the findings of any such assessment; and to explain why reliance is being placed on the EU Public Health Emergency Preparedness Assessment scheduled for 2026 rather than a completed national review. [73506/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
680. Deputy Ken O'Flynn asked the Minister for Health whether any interim actions have been approved by her Department to strengthen infectious disease screening and public health response at ports and airports prior to the 2026 EU preparedness assessment; and to detail those actions. [73507/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
681. Deputy Ken O'Flynn asked the Minister for Health whether her Department holds any internal risk registers, preparedness assessments, or assurance reports relating to infectious disease surge capacity within the HSE; and if so, to outline the main risk categories identified and the mitigation measures in place. [73508/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
682. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted any review since 2018 of the regulatory, quality assurance and clinical governance framework applying to health screening conducted outside the HSE, including screening arranged by employers, universities and occupational health providers, and if not, whether she intends to commission such a review. [73509/25]
Amharc ar fhreagra683. Deputy Ken O'Flynn asked the Minister for Health to outline which statutory bodies hold responsibility for oversight, standards setting or enforcement in respect of non HSE health screening, including any role of HIQA, the Medical Council, CORU or the HPRA, and the policy basis on which those responsibilities are assigned. [73510/25]
Amharc ar fhreagraI propose to take Questions Nos. 682 and 683 together.
As Minister for Health, I am committed to supporting our population screening programmes, which are a valuable part of our health service, enabling early treatment and care for many people, and improving the overall health of our population.
The National Screening Advisory Committee (NSAC) is the independent expert group that considers proposed changes to Ireland’s screening programmes, all of which are delivered by the Health Service Executive (HSE). NSAC assesses the evidence in a robust and transparent manner and against internationally accepted criteria, before making recommendations to myself as Minister.
I would emphasise that screening programmes are for people without symptoms. If anyone becomes aware of symptoms, or if they have concerns or worries, they should contact a medical professional immediately.
As per my reply to PQRef: 69973/25, my Department does not have responsibility for the oversight of health screening or checks organised outside of the HSE. Details on bodies outside the aegis of my Department are operational matters for the bodies concerned and I would encourage the Deputy to contact the relevant Director/CEO/Registrar directly.
684. Deputy Ken O'Flynn asked the Minister for Health to state, for each of the years 2022, 2023, and 2024, the number of compliance checks carried out by or on behalf of the HSE on non-statutory bodies in receipt of HSE funding; and to outline the categories of checks undertaken in each year. [73513/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
685. Deputy Ken O'Flynn asked the Minister for Health to outline, for each of the years 2022, 2023, and 2024, the number of HSE compliance reviews of non-statutory bodies that identified financial or governance non-compliance; and the actions taken in response, including enhanced monitoring, funding conditions, recovery of funds, or suspension of payments. [73514/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
686. Deputy Ken O'Flynn asked the Minister for Health to state whether her Department receives aggregated reports from the HSE on the results of compliance checks carried out on non-statutory bodies, including trends, recurring issues, and risk ratings; and when the most recent such report was received. [73515/25]
Amharc ar fhreagraAs the Deputy is aware the Department operates to high standards of professionalism and effectiveness when dealing with the HSE. Under the Health Act 2004, primary responsibility for funding the Voluntary Hospitals (Section 38s) for the provision of healthcare services on behalf of the HSE, was placed with the HSE. As a result, primary oversight responsibility for the non-statutory bodies including the acute Hospitals is with the HSE and this includes dealing with issues relevant to the delivery of healthcare services as they arise.
Nevertheless, it is prudent for the Department to oversee governance of all aegis bodies including the HSE. The Department in conjunction with the Board of the HSE, conducts a quarterly high-level meeting which involves the CEO of the HSE, the Chair of the HSE Board, the Secretary General of the Department of Health and the Minister for Health.
At the most recent meeting in September 2025, compliance issues relating to the implementation of the new Integrated Financial Management System (IFMS) and other central HSE ICT systems were discussed. The Minister agreed to work with the HSE to resolve the matter. Following this meeting, progress has been achieved and the fifteen (15) larger Section 38 acute hospitals have completed Service Agreements with the HSE to include use of the IFMS and other central ICT systems.
The quarterly Ministerial meeting with HSE top management includes consideration of issues arising from the HSE Statement of Internal Control (SIC) as a standing agenda item. The HSE arrangements for governance of voluntary hospitals is not specifically included on the SIC and arises in the broader context of consideration of issues with potential to impact service delivery.
The Department holds a quarterly Risk Management meeting with the HSE at Officials level to discuss strategic and high-rated risks and the operation of the HSE Risk Register.
By using these meetings, the Department ensures that top level management in the HSE and the HSE Board are accountable to high standards in managing the delivery of healthcare services.
687. Deputy Barry Heneghan asked the Minister for Health the expected timeline for the inclusion of donor assisted fertility treatments within the publicly funded assisted human reproduction scheme; the measures being taken to ensure that same sex couples who undergo fertility treatment abroad are afforded the same legal recognition and parentage as heterosexual couples under Irish law (details supplied); and if she will make a statement on the matter. [73522/25]
Amharc ar fhreagra688. Deputy Barry Heneghan asked the Minister for Health whether she plans to engage with LGBTQ advocacy organisations in the development and implementation of the expanded assisted human reproduction scheme and associated legislation in order to ensure that their specific needs are adequately addressed (details supplied); and if she will make a statement on the matter. [73523/25]
Amharc ar fhreagraI propose to take Questions Nos. 687 and 688 together.
The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
Referrals for publicly-funded, privately-provided assisted human reproduction (AHR) treatment commenced in September 2023, subject to patients meeting the criteria agreed by the Department and the HSE. The access criteria were developed by a multi-disciplinary group, with reproductive medicine expertise and followed consultation with experts in the field along with a review of the international evidence. These criteria are in keeping with those applied in other jurisdictions.
Up to December 5th 2025, over 3,500 couples have been referred by a Reproductive Specialist Consultant for AHR treatment, following extensive investigations and/or secondary level treatment within the Regional Fertility Hubs. Furthermore, the Hubs have successfully and directly managed thousands more patients presenting with fertility-related issues who have been referred by their GP. Not all couples experiencing fertility challenges actually require such advanced and invasive interventions as IVF.
Earlier this year, an important criterion for accessing state-funded AHR treatment was broadened. Couples with one existing child in their relationship, and who meet all the other current access criteria, can now access publicly-funded AHR treatment, including one full cycle of IVF or ICSI, if they are referred for same by a Reproductive Specialist Consultant within one of the Regional Fertility Hubs. Previously, couples with one child in their current relationship were not eligible to access publicly-funded AHR treatment.
There are complex regulatory and clinical issues to be considered in respect of certain categories of AHR treatment. In the case of treatment involving the use of donated gametes – whether by opposite-sex or same-sex couples - there is regulation at European level concerning the quality and safety of procedures involving donated gametes. Furthermore, the Children and Family Relationships Act 2015 deals with matters relating to parentage and the right to identity of donor-conceived children arising from such procedures, there are a number of further clinical and regulatory requirements regarding the donation and use of donated gametes which are being considered.
The access criteria and the terms of the AHR treatment initiative are being kept under ongoing review. Further potential changes to the access criteria or expansion of the initiative requires continued extensive consultation between Department officials, colleagues in the HSE, and also with relevant specialists in the field of reproductive medicine. This will include consideration of additional funding requirements which may ensue from any proposed expansion of the initiative.
There are no plans to introduce public funding of AHR treatment undertaken in pursuance of a surrogacy arrangement.
It should be noted that supports previously available to patients who access IVF, or other AHR treatment, privately, whereby tax relief on the costs involved can be claimed under the tax relief for medical expenses scheme, continues to be provided.
In addition, 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. The annual cost to the State of the financial support for these medicines is far from insignificant.
Regarding the very separate particular query regarding same-sex couples undergoing fertility treatment abroad and the recognition of parentage, the Deputy would be aware that the Health (Assisted Human Reproduction) Act 2024 was signed into law in July 2024. While the legislation was progressing through the Houses of Oireachtas, issues were identified which required further consideration and consultation with the Office of the Attorney General.
These included issues of parentage and citizenship arising from Irish residents undertaking donor-assisted human reproduction (DAHR) procedures abroad or from Irish citizens domiciled abroad undertaking DAHR procedures or surrogacy arrangements.
The Government has approved the drafting of a Bill, the Health (Assisted Human Reproduction) (Amendment) Bill, to legislate for provisions in respect of these issues, as well as making other necessary changes to the AHR Act 2024.
Formal drafting of this supplementary Bill is at an advanced stage, led by the Office of Parliamentary Counsel, in conjunction with officials from my Department, the Department of Justice, Home Affairs and Migration, and the Department of Children, Disability and Equality.
My officials and I have met with relevant stakeholder groups in relation to the AHR legislation.
I want to reassure you that my Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the most effective deployment of finite public resources. Similarly, I can absolutely assure the Deputy that publishing and progressing the AHR Amendment Bill is a priority for Government and for me personally, and we will continue to work to achieve this as soon as practicable.
Finally, it is important to note that all provisions in the Children and Family Relationships Act 2015, the AHR Act 2024, and the forthcoming AHR Amendment Bill in respect of donor-assisted human reproduction and surrogacy apply equally, irrespective of whether the intending parents are a same-sex couple or an opposite-sex couple, or if there is a single intending parent. A similar principle of equal access also underpins the terms of the publicly-funded AHR treatment initiative.
689. Deputy Pádraig Rice asked the Minister for Health to list all legislative changes recommended by the future of healthcare committee in the 2027 Sláintecare report; the status of each; the progress made to date on each; and if she will make a statement on the matter. [73524/25]
Amharc ar fhreagraMy Department is currently collating the information requested and a reply will issue directly to the Deputy as soon as possible.
