I want to read to the Taoiseach a letter from Nikita Clarke, who is from Dublin and who I met recently. She suffers from suspected endometriosis:

Thank you for taking time out of your day to read this letter. Please listen carefully, this is not easy to talk or write about. I am 18-years-old and instead of getting my driver's licence, picking out a Debs dress, studying for my leaving cert, going out with friends or getting a job, I spend my days sitting bed in horrific amounts of pain. My days just roll in all together. I barely get any sleep because of pain. Everything I do isn't without a high level of pain. Walking hurts. I have to use a walker and a wheelchair to get around. I need help getting dressed, having a shower, doing my hair, going to the toilet. It's humiliating. Being a young woman once full of hopes and dreams, now completely numb. I don't allow myself to feel because if I do, I won't be able to stop. I have to watch my friends move on with life, going to parties, graduating, getting their licences and so much more, while I hate weekends because it means a doctor won't call to set up my surgery. How sad. An 18-year-old who hates weekends. I need the surgery to see if I have endometriosis. It has been three and half years. I have been patient. I have done everything the doctor told me to do. I am fully dependent on my mam. I get headaches that blur my vision. I have pain peeing, stomach pain. I’ve had bleeding constantly with breaks only of a few days. How am I meant to stay happy and hopeful when no one is listening to me or helping. I once dreamt of being a lawyer, a doctor or nurse, having a family of my own. Now, I am a young woman alive but not living. Please help me live again.

Endometriosis is a crisis in women's health. It is a chronic, inflammatory and whole-body disease that affects the pelvic region, uterus, fallopian tubes and cervix. It affects one in ten women in Ireland and yet it takes nine years for a woman to get a diagnosis here. Often, by the time an endometriosis diagnosis is received, the disease has spread beyond the reproductive system. It can travel to the bladder, bowels, diaphragm and even the lungs. Instead of receiving excision surgery here in Ireland, many women and girls are forced to travel abroad to have the specialised surgery and to receive an official diagnosis. The lack of understanding and awareness often sees the suffering of women and girls dismissed, their pain often put down to bad periods. Instead of getting proper care, they receive outdated treatment that prolongs pain and trauma.

Tá géarchéim inmheatróise i gcúram sláinte na mban in Éirinn. Cuirtear iachall ar mhná diagnóis agus cúram a lorg thar lear. Bíonn ar a lán ban fulaingt go ciúin. Caithfidh an Rialtas gníomhú chun deireadh a chur leis an gcrá croí seo.

This scandal has impacted thousands of women, with very few families left unaffected and it has gone on for far too long. Will the Taoiseach commit to delivering a long overdue specialised centre for the treatment of endometriosis, and will he ensure the provision of excision surgery in Ireland is available so women are not forced to seek care abroad?

Hear, hear.

First, I thank Deputy McDonald for raising the issue and for reading out Nikita's letter to her, which clearly illustrates the very debilitating impact endometriosis can have on women. It is extremely debilitating, painful and the span of impacts are very wide. Regarding a phased response, this can be at GP, gynaecology or indeed specialist centre level.

There has been progress for endometriosis. Approximately €5 million in additional funding has been spent and €2.1 million has been allocated for this year. If it is allowable, I ask Deputy McDonald to forward the correspondence to us because Nikita mentioned it has been three and half years. We have two supra-regional hubs established in Tallaght and Cork, with the latter opened recently. The estimates are saying, and they are conservative estimates, that there are 350 severe cases - and Nikita is clearly in the severe category - per year that will require a referral to the specialist endometriosis clinics and services that are located in Tallaght and Cork. In addition to those, there are five other hubs across the country in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. There were approximately 760 women on a specific waiting list for treatment at the end of last year and the agenda is to get through the backlog as quick as possible. There are discussions under way and hopefully the national framework in respect of endometriosis will be concluded but there is engagement with GPs and between GPs and the HSE regarding the precise role of primary care versus gynaecological care and then obviously the specialist hubs.

As the Deputy said, one in ten women will have this condition. There is the development of a national endometriosis framework and the Minister is keen to bring this to a conclusion. This was discussed in the House previously and all questions have been asked in respect of that. The model of care has been outlined and there is a clear framework there. Investment is happening and will continue. This is on top of significant investment in women's health in recent years which has been quite transformative compared to what was there before. There has been specific investment into a whole range of areas pertaining to women's health. This is one area that needs further investment but it also needs the national framework to be concluded.

The two supra-regional hubs are there for the specialist and severe cases and the referral should be sent there in the context of Nikita's letter, although I do not have the full background to it. We fully acknowledge it is a very real issue for women involving very severe pain that impacts on one's personal and working life. It is something Government is very committed to addressing.

Nikita is 18-years-old. I am more than happy to forward the correspondence to the Taoiseach and the Minister. Nikita will travel to Romania to get the care she requires. Despite the assertions in his response, the fact is that the level of care here is simply unacceptable.

Hear, hear.

I know of a woman who lost a kidney to endometriosis. I know a 27-year-old who went through a radical hysterectomy because the disease, in her case, had eaten away at her pelvic organs and bowel. The services are not available to women and there should not be any attempt to dismiss or downplay the real experiences of women and girls.

They are asking now for proper investment. Have a framework by all means but we need a specialised centre that offers the care that is required.

Experts have been telling the Government for a decade that excision surgeries are the only way to go.

I thank the Deputy.

The Government knows this. Yet, that treatment and service are not available.

I ask the Deputy to conclude.

Why is the Government instead offering treatments that the experts have told it will fall short and will fail? I appeal to the Taoiseach to listen to the voice of this young woman and those of the other women whose lives have been devastated by the failure to provide them with the care they need here in Ireland.

I thank Deputy McDonald.

So many of them are now travelling. That is the most damning evidence of the Government's failure.

There has been significant progress in this area. That has to be acknowledged. More than 200 new patients were seen in Cork's endometriosis service from May to December last year. About 94% of women on the waiting list in that region are now seen within six months. As I said, more generally we are seeing improvement in terms of the Tallaght centre also. The Government is listening. In terms of the State, the Government, the HSE and everybody involved in this area have been engaging to get the national framework concluded so that there will be a comprehensive range of services covering the entire span of symptoms or manifestation of the condition, in other words, from primary care to the hubs to the super-regional hubs. Specifically, specialist care is available. There is ongoing recruitment. Additional posts are being recruited as we speak, specifically for this area. Admhaím go bhfuil géarghá le níos mó infheistíochta. Tá sé sin á chur ar fáil againn faoi láthair. Is é sin an aidhm atá againn.

When we look at all the other developments in women's health over the past two to three years, it is clear we can and will do this. There have been some very significant developments. I am not going to list them all but they are there. In terms of endometriosis, it will be manifest as well. It already is in that two super-regional hubs and the five other hubs are there.

I do not know who the Taoiseach is listening to.

It is important to get the framework.