Denis Naughten (Longford-Roscommon, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue. Earlier this year the policy in the Health Service Executive western region towards patient transport was as follows. Those without access to private family transport or public transport and who were on a medical card were eligible for the service. There was flexibility if such transport put an undue financial burden on a family, and patients in receipt of kidney dialysis, oncology treatment or organ transplant patients were also provided with a transport service.

While the service was not ideal, there was an element of flexibility to it. However, the HSE western region issued a directive earlier this year that only those with a full medical card in receipt of dialysis or oncology treatment, or such patients with organ transplants or an acute lower limb injury, were eligible for the patient transport scheme. This significantly restricted the service throughout the HSE western region. Subsequently, following lobbying, the Department of Health and Children and the HSE have extended the patient transport service to all dialysis patients, regardless of means.

While I welcome this step, I question why the Department and the HSE are stopping at that point. Why are oncology patients and organ transplant patients not being considered in a similar manner? Let us examine, for example, the case of a young mother with breast cancer or cervical cancer which may not have been diagnosed at an early stage because screening for cervical cancer has been withdrawn and breast screening has not yet arrived in the region. Not only will such a mother with a young family suffer a loss of income because she will no longer be able to work, she will also incur substantial overheads. Surely a person in those circumstances has enough to worry about without having to take into account the cost of transport to and from Galway for cancer treatment.

Under the revised regulations introduced by the HSE in the western region, a patient within ten miles of University College Hospital, Galway, UCHG, with an income of more than €100,000 can get transport, but a young mother who is a cancer patient in County Roscommon or an elderly patient in somewhere like Arigna, which is more than 90 miles from UCHG, cannot. A patient with whom I am acquainted with no public transport facilities must travel two and a half hours to get to hospital in Galway and must fork out more than €200 to pay for a taxi to attend outpatient services. There is no equity in that.

In another case, an 81 year old patient who has recently had a heart attack and must travel 75 miles to Galway for an appointment once a month and who must also travel twice a month for an appointment in Roscommon, which is 25 miles away, must pay over €250 in taxi fares. Another patient must travel more than 130 miles to the Mater Hospital in Dublin at a cost of €260 for outpatient services. In another case, a 67-year old patient must travel 65 miles to UCHG three times a month at a cost of €330. That patient is wheelchair-bound owing to a Parkinson syndrome disease but is not entitled to a travel service.

This policy will cost lives. Patients are missing critical outpatient appointments because they cannot afford to fork out up to €260 for taxis. They cannot get on the waiting list for transport because they cannot make their outpatient appointments.

People in this country now need health insurance to pay for taxis to get them to their hospital appointments only to receive no treatment. That is a disgraceful situation and the decision on the hospital transport service must be rescinded. It is a damning indictment of the current service that affordability is not a consideration. The HSE has made clear that if patients cannot afford to travel to hospital for an appointment by taxi and do not have an alternative means of transport available to them, they are ineligible under the current rules. A person with a long-term mobility problem who is wheelchair-bound or who has a long-term disability is not eligible under the current scheme but someone who has a broken leg is eligible. This is an appalling situation that cannot be tolerated. It is inequitable. I plead with the Minister of State, Deputy Tim O'Malley, to rescind the decision and reinstate the previous service.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Naughten for raising this matter. I am replying on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

Under the Health Act 2004, the Health Service Executive has responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of ambulance services.

The HSE provides emergency and patient transport ambulance services to a population of more than 380,000 people in the former Western Health Board region. The Department is advised that the emergency ambulance service is provided from ten stations across the catchment area. There has been a significant expansion of this service in recent years. Ten additional crews have been put in place and the number of 24-hour bases has increased from three to nine, while the overall hours of operation across all bases have increased significantly.

In 2004-05, 13 new high specification ambulances were provided. In addition, two new rapid response vehicles have been introduced as back-up to the fleet. Facilities at ambulance stations in Ballina, Boyle, Clifden and Roscommon have also been improved.

The HSE has advised that all dialysis patients in the region are entitled to ambulance transport services. It has further advised that ambulance transport services are provided to medical card holders who are oncology patients, kidney transplant patients for up to one year after the transplant, and patients with acute lower limb injuries. In addition, the HSE examines all requests for patient transport services in the region case by case and determines the requirement for transport support based on each patient's medical needs.

I understand that the National Hospitals Office intends to conduct a comprehensive review of patient transport arrangements as an element of its 2006 service plan. It is envisaged that this review will examine the service delivered nationally and make recommendations for its future development.