Gerald Nash (Louth, Labour)
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I wish to question why current guidelines for the HSE treatment abroad scheme do not cover the costs of accommodation, baggage or travel agent fees for the travel companion of a patient who is unable to travel alone. I find it very perplexing that under current structures an individual who is unable to travel alone cannot receive financial support for the baggage, accommodation or travel agent costs of a person travelling with him or her.

We must remember we are not just dealing with guidelines or facts and figures, but real people who are actively and adversely affected by these decisions. The financial burden of their illness, as well as the emotional burden, is very real and distressing. In my constituency I have been dealing with the case of an individual who is not, and never will be, in a position to travel independently to receive his annual treatment in the United Kingdom. Thus through necessity his wife is required to travel with him, but under the scheme she must bear the financial burden of her accommodation, baggage and travel agent fees. To be honest I am bewildered as to why the treatment abroad scheme does not allow for the travel expenses of this woman. As far as the HSE is concerned, she should have to worry about paying these expenses as well as worry about her ill husband. The couple is in receipt of an invalidity pension and a half rate carer's allowance. They have to borrow money to cover these critical expenses.

This is unacceptable. We are dealing with individuals who, by virtue of the fact that they are covered by the scheme, are by definition unwell and vulnerable. We are not dealing with an extravagant request. In his instance the person has simply asked that as her husband is unable to receive the treatment he needs within the State, the HSE should cover the reasonable cost of somewhere for her to sleep. It is clear that the TAS do not cover these expenses but I feel strongly that this decision on the structure of the scheme must be revisited, in so far as is practicable.

These people are not looking for much. All they want to do is travel with a loved one who cannot travel alone, without the worry of putting themselves in debt. I think this is a reasonable request and I fail to see how anyone would find this situation tenable or sustainable for individuals in such circumstances.

Kathleen Lynch (Cork North Central, Labour)
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I would like to thank the Deputy for raising this matter. The HSE operates a treatment abroad scheme, TAS, for persons entitled to treatment in another EU/EEA member state, or Switzerland, under EU Regulation 883/04 and Implementing Regulation 987/09 in accordance with Department of Health guidelines. Within these governing EU regulations and the Department of Health's guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state, or Switzerland, through the issue of form E112 (IE).

A decision is made on each application in accordance with this legislation and guidelines, and on the basis of a review by clinical experts. The cost of the treatment is not a deciding factor when approving an application. The treatment must not be available within the State or not available within a time normally necessary for obtaining it. The TAS allows for an Irish-based consultant to refer a patient that is normally resident in Ireland for treatment in another EU-EEA member state or Switzerland, where the treatment in question meets certain criteria.

The application to refer a patient abroad must be assessed and a determination given prior to the patient availing of the treatment abroad. Valid applications will be processed within 15 to 20 working days and a decision will be issued via letter. Appointments should not be scheduled prior to a decision being reached on an application. Appointments that are made prior to a decision will have no bearing on the review process or its expedition.

Following clinical assessment, the Irish-based referring hospital consultant must provide details of the patient's condition, the specific treatment being applied for and the provider of the treatment abroad. Under the regulations, there are no provisions obliging the State to make payments towards accommodation and baggage costs of people availing of treatment under the TAS. Nevertheless, in exceptional circumstances and despite budgetary pressures generally on the budget of the Health Service Executive, some discretionary assistance is made available on a case by case basis.

The treatment abroad scheme does not include a provision for travel and or subsistence expenses for patients or their relatives travelling abroad to avail of approved treatments. However, the HSE and specifically the TAS may provide assistance towards reasonable, economic air or sea travel fares for patients and a travelling companion where appropriate.

In an effort to standardise and provide equity of access and entitlements to approved applicants for transport costs associated with travelling outside the State for treatment, this policy is executed as national policy. The HSE treatment abroad scheme will implement this policy on travel expenses for such patients and in certain circumstances an accompanying family member or another travelling companion, as follows: the full cost of air or sea transport from Ireland to the relevant EU-EEA country, or Switzerland, will be provided for the patient availing of approved TAS medical treatment, subject to available funding; where the patient is under the age of 18, the full air or sea transport costs of one accompanying adult will also be provided, subject to available funding; in the circumstances that a patient over the age of 18 requires accompaniment on the basis of medical health or incapacitation, consideration can be given for the funding of such an escort's sea or air transport costs where the referring consultant certifies such a need, subject to available funding.

Once the patient has availed of an approved treatment abroad, the care of the patient reverts immediately to the referring Irish consultant. I hope this clarifies the issues for the Deputy.

Gerald Nash (Louth, Labour)
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I thank the Minister of State for her comprehensive remarks on the structure of the scheme. I understand the regulation under which the scheme operates and that there are certain restrictions. It is a good, necessary scheme which has worked very well in recent years. The Minister of State said that some discretionary assistance is made available on a case by case basis but that should be made clear to applicants. They should be aware that discretion is applied, particularly to people in difficult financial circumstances because they are exclusively dependent on social welfare payments.

In the case I am dealing with, we have a set of circumstances whereby an individual is required to be accompanied by his wife. By definition, he has a chronic condition and will never be able to travel alone. The people concerned will be travelling for a week. It is not possible to survive with one small suitcase for a week, particularly if a person does not have any washing facilities. Therefore the treatment abroad scheme should take account of the real situation facing those applying for it. It is necessary to provide some resources for relatively small amounts of baggage fees which may not be a challenge for the Minister of State or myself, but may be very difficult for a person in vulnerable circumstances. The scheme helps people to get well but it should not put people into debt when they are already in a very difficult situation.

Kathleen Lynch (Cork North Central, Labour)
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There is a key piece concerning the discretionary element of the scheme, which is that the consultant should state that the person needs to be accompanied. People probably do not know about that, but they need to.

A discretionary scheme has flexibility that does not apply to other schemes, which is helpful. Nonetheless, that discretion is not often applied evenly across the country. Therefore, while it is a good thing to have such discretion and flexibility, it often does not have the result one would expect. It is an issue of communication both for people exercising the discretion and those applying for the scheme. That type of information needs to be available to applicants for the treatment abroad scheme. It would be helpful if the relevant data were part and parcel of the information leaflet on the scheme.