The Ombudsman has said the experience of some patients seeking funding under the HSE’s Treatment Abroad Scheme (TAS) was “extremely stressful and upsetting”.
Peter Tyndall published a report on Wednesday following his investigation into the HSE’s administration of the scheme.
He said he discovered “some shortcomings” which can have “a serious impact on patients”. There were almost 800 approved applications in 2016.
Mr Tyndall also noted that “patient traffic is not just one-way” and that patients in other EU or European Economic Area states travel to Ireland to receive certain specialist treatments not available in their own home countries.
The investigation followed a complaint received by the Ombudsman from a patient who experienced “significant difficulty and delay” in accessing treatment abroad under the scheme.
“This resulted in him having to endure severe pain for several months longer than he should have. This in turn caused deep distress for him and his family,” Mr Tyndall said.
The Treatment Abroad Scheme provides funding to allow Irish public patients access healthcare in other EU countries, the European Economic Area or Switzerland that is not available here.
The vast majority of consultants’ referrals under the scheme are for a surgical intervention, and paediatric patients are among the largest cohorts of patient.
Cancer patient
The report details the case of “Ms F”, a cancer patient who sought specialised lymphedema treatment in Germany. She was told she was not eligible for TAS as the treatment was available in Ireland, despite having received funding for two previous trips abroad for the same treatment.
The Ombudsman learned the treatment Ms F’s consultant had referred her to receive was for “intensive in-patient lymphedema treatment”, which was not available anywhere in Ireland. The application was retrospectively approved on foot of the Ombudsman’s examination.
A separate complaint outlined how “Mr A” was referred for an expert assessment in the UK by his consultant as his symptoms were “severe and worsening” and his treatment was not having the desired effect.
The application was deemed invalid as it did not specify the treatment. Further representations were made to the TAS office on the patient’s behalf by his mother, a local TD and two other consultants.
The application was approved 14 months after the patient’s application and the Ombudsman said this complaint “illustrated a series of shortfalls and failure on the HSE’s part” in processing the application.
The Ombudsman acknowledged the vast majority of applications for the scheme are dealt with appropriately and made a number of recommendations for the HSE.
These include consultants carrying a “pre-referral” check to ensure the application meets the scheme’s criteria, improving the scheme’s appeals system and clearly explaining the reasons applicants are refused, including information on appealing and complaining to the Ombudsman if not satisfied.
