Niall Collins (Limerick County, Fianna Fail)
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The issue I have sought permission to raise is a very important one for women who are survivors of breast cancer and find themselves seeking support from the HSE after a mastectomy. The backdrop is that breast cancer is the second leading cause of cancer death in women in Ireland, second only to lung cancer. It affects a significant number of women nationally. Statistics show that approximately 2,500 women per annum are treated for or are at least diagnosed as having breast cancer. It affects them directly and also their families.

It was brought to my attention late last week that the HSE had decided off its own bat to introduce a policy on the provision of post-mastectomy products. I will quote several lines from an email that was sent to me. It claims that, after surgery, a lady is currently supplied and fitted with a breast prosthesis and two surgical bras to hold it in place. If this lady has a medical card, she may then be fitted and supplied with two surgical bras every year and a new breast prosthesis every two years, if required. Yesterday, the person who sent me the email received an email from the HSE stating that, from 1 July, there has been a new allowance in place and that ladies will now only be provided with an allowance of €68.50 for one breast prosthesis every two years and will no longer be provided with surgical bras other than those supplied when leaving hospital. The cost of a breast prosthesis, the email states, is between €150 and over €200, depending on the specification. The concern was considerable.

The Minister of State's colleague, the Minister, Deputy Harris, moved quite quickly to postpone the implementation of this new policy. What we want is certainty from the Minister of State and the Government on this policy because it appears nobody was consulted apart from the Irish Cancer Society. No survivors of breast cancer or clients of the HSE were canvassed or consulted directly.

With regard to public policy, I am not aware of any public representatives having been consulted through the HSE forums that now exist around the country. Given the impact on those who have had a mastectomy and who are dealing with the physical and emotional fallout from a cancer condition, it is unacceptable that the support the HSE was providing was suddenly halved overnight. The sums of money I have quoted in the context of the overall HSE budget seem tiny. Could the Minister of State shed a little light on this in her reply? There is a pause until August, as we now know. What will happen after August? Will the Minister of State also address the inconsistency or lack of uniformity in the application of the policy throughout the country? Will the same supports be available to medical card holders and non-medical card holders?

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, Deputy Harris, I thank the Deputy for the opportunity to address the issue of supports provided to breast cancer survivors. The provision of wigs and hairpieces by the HSE to patients who are being or have been treated for cancer and other illnesses is operated by means of a grant voucher system administered by the community healthcare organisations, CHOs. Patients can select their preferred wig or hairpiece, and the HSE refunds the service user or service provider up to the value of the voucher issued. The Minister became aware, through media reports on 30 June, of the HSE's intention to introduce revised arrangements for the provision of supports to the patients in question. I understand that the HSE's objective was to develop more equitable arrangements for the provision of such products and to extend these supports to a broader cohort of patients. The HSE established a working group to undertake a full review of the operation of this service and develop national guidelines to ensure uniformity of approach in the provision of these products at local CHO level. This was part of a wider community-funded schemes service-improvement programme. The guidelines were developed by the HSE on an overall cost-neutral basis. This would have meant gains in some areas and reductions in others.

While the Minister understands that the health service is working with a range of stakeholders, most importantly patients, to try to improve the supports throughout the country, this cannot take place before plans are put in place to ensure there is no hardship or reduction of supports for patients who are already receiving a particular level of service. Neither the Department nor the Minister for Health were involved or consulted in the course of this process. At the Minister's request, the HSE has deferred the introduction of the proposed changes. He has asked the HSE to re-examine the matter with a view to devising a plan that will achieve an equitable outcome but not lessen the level of provision for patients who are already coping with a very serious illness. The HSE has confirmed to the Department of Health that it has deferred changes to its guidelines pending further review and a consultation process, which will include engagement with the Department of Health, suppliers, patient groups and other stakeholders.

I assure patients and Deputies that anyone receiving post-mastectomy products, or wigs or hairpieces, will continue to receive the same level of support. It is essential that such patients not be subjected to any additional worry or stress at what is a very difficult time for them and their families. I cannot give the Deputy any details on what will emerge from the review but I will ensure that the Deputy receives a full reply from the Minister as soon as I speak to him, which will be tomorrow.

Everything has been put back where it was. Nothing is happening and everything has been deferred until a proper system and plan can be put in place. As a woman, I was very concerned when I heard what had happened. I know that other Deputies were too. Deputy Tom Neville and others on this side of the House were really struck by the fact that that this had gone on and been broadcast and that people had been sent letters. It caused huge strain for patients who were already in difficult circumstances, for which we apologise. It was terrible that it happened.

Niall Collins (Limerick County, Fianna Fail)
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I thank the Minister of State for her reply. I do not think anybody blames her or the Minister for Health, Deputy Simon Harris, for the decision that was taken which completely blindsided him as head of the health service and everybody around the country. I was very heartened by his robust reaction when he was challenged and it was put to him. It has been reassuring for breast cancer survivors and those dealing with the fallout.

I have been lobbied by a group in Limerick and can only speak for my part of the country, as Deputy Tom Neville can. About 200 clients attend the breast cancer clinic at University Hospital Limerick. They have formed a group and will be seeking to meet the Minister shortly. The Minister of State might convey that message to him. They would like him to hear about their experiences and how these supports are critical. Part of what came out in the past few days through a discussion on our local radio station, Limerick's Live 95FM, was that women would need ongoing support after a mastectomy. The policy was to provide initial support and leave women on their own after that. That is not acceptable. I ask the Minister of State to impress on the Minister the need to clear up the anomaly. Will it be just medical card holders or will non-medical card holders be able to avail of the supports available on an equal basis? We obviously need to standardise the service across the country. Will those engaged in the consultation process please consult the survivors of breast cancer? Will the Minister of State tell the Minister that there will be a communication on its way to him shortly requesting him to meet a group which represents breast cancer survivors?

Catherine Byrne (Dublin South Central, Fine Gael)
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As I said, the consultation process will include engagement with the Department of Health's suppliers, patient groups and other stakeholders. I firmly believe the group about which the Deputy is speaking must be part of it also. What happened should not have happened which, as a woman, I can perfectly understand. I have family members and friends who had a breast removed. It is a very difficult time for everybody. What we want to do is make sure everybody receives a decent service at a time when they are very seriously ill. What happened in the last couple of weeks should not have happened. and I cannot relate to the Deputy on a basis such as this why it happened. However, when I spoke to the Minister about it, as others did, action was taken rapidly to put things right aside, as the Deputy said. The consultation process will have to involve all those patients who are suffering, as well as stakeholders. Only then will those who, unfortunately, will end up being so ill that they will have to have a breast removed believe the service available meets their needs. That has to be the case for medical card holders and for others also. I will relay a very strong message to the Minister because it is something that cuts to the core of every person in the country, not just women but also family members, including husbands and partners. What happened was shocking and should never have happened.