Imelda Munster (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

In recent weeks a letter has been sent out by the HSE to haemochromatosis patients throughout County Louth informing them of a new charge to attend appointments in the venesection clinic. As and from 1 September, an €80 charge per visit will apply, up to a maximum of €800 per year, for visits to the clinic. I believe the Minister of State will accept that the imposition of this charge will deter patients who do not have the financial means from attending the clinic. It puts an unfair financial burden on people. While medical card patients are covered, for those who may be just slightly over the medical card limit, €800 is both an exorbitant and disgraceful amount to ask patients to pay.

As the Minister of State knows, haemochromatosis is a lifelong illness. Iron overload is not curable. If patients have genetic haemochromatosis, they will need to be monitored and treated for the rest of their lives. It is very serious illness if it is not monitored regularly and treated accordingly. For example, if it goes untreated, it can affect major organs such as the heart, the liver and the pancreas, and it can eventually be fatal. Therefore, the importance of regular monitoring of patients with haemochromatosis is crucial. To impose a charge of €80 per visit to the clinic without taking into account the financial means of a patient is reckless. Will the Government include haemochromatosis on the long-term illness scheme?

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am taking this matter on behalf of the Minister, Deputy Simon Harris. I wish to thank Deputy Munster for raising this issue. I will address the charges for patients for venesections first. The Health Act 1970, as amended, provides that all people ordinarily resident in Ireland are entitled, subject to certain charges, to public inpatient hospital services, including consultant services, and to public outpatient hospital services. Under the Health (Amendment) Act 2013, a person who has been referred to a hospital for an inpatient service, including that provided on a day-case basis, is required to pay the statutory daily charge, currently €80 per day, up to a maximum of €800 per year. On this basis, where venesection for haemochromatosis is classed as a day-case procedure and is not carried out in an outpatient setting, the public inpatient charge applies. However, it is a matter for a treating clinician to decide how venesection for haemochromatosis is provided. It should be noted there are a number of exemptions to the public inpatient charge, including exemptions for medical card holders.

The Deputy may also be aware of the ongoing review of the GMS and other publicly-funded contracts involving GPs, and that the next phase of discussions to progress this work is under way. The aim is to develop a contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. It is expected that the issue of venesection services for patients with haemochromatosis will be considered in the context of the overall GP contract review process.

In addition, the Irish Blood Transfusion Service, IBTS, has been running a haemochromatosis clinic in the Stillorgan blood donation clinic since 2007 and sees approximately 600 patients annually. In this clinic the IBTS only accepts hereditary haemochromatosis patients who are eligible to donate blood. In 2013 and 2014 the IBTS also commenced provision of a programme for hereditary haemochromatosis patients in its clinics at D’Olier Street in Dublin and St. Finbarr's Hospital in Cork, respectively. The clinics provide venesection at no cost to patients with a prescription from their treating clinician. The venesection would be performed, regardless of whether patients wanted to have their unit converted to a blood donation.

In regard to the inclusion of haemochromatosis on the long-term illness scheme, the scheme was established under section 59(3) of the Health Act 1970, as amended. There are 16 conditions covered by the long-term illness scheme but haemochromatosis is not included. Under the long-term illness scheme, patients receive drugs, medicines and medical and surgical appliances directly related to the treatment of their illness, free of charge. There are no plans to extend the list of conditions covered by the scheme.

Imelda Munster (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

It is very disappointing there are no plans to include patients with haemochromatosis on the long-term illness scheme, particularly given it is a lifelong illness, is not curable and needs regular monitoring and treatment, and given the fact it can lead to failure of vital organs and can be fatal if not regularly monitored. The response given is from the Minister and the Department. What the Government is saying is that it is fully happy to put a financial obstacle in the way of patients in regard to ongoing treatment for a serious illness and that it does not see the need to include this in the long-term illness scheme. It is happy with the fact patients may not have the financial means to attend a clinic with €80 stuffed in their pocket for the privilege. The Government is saying that is okay; it is acceptable.

The procedure itself takes a maximum of 30 minutes for the blood to be drawn down. The blood pressure is then checked and if it is okay, the patient is told to come back in a month. This means the patient is less than an hour in a bed but is being charged €80 for that privilege. It is grossly unfair. What the hell are we paying PRSI for if we have to pay every time we access a health service in hospital? Where is it going if it is not going towards patient care, preventive measures and medicines? What are we paying it for? Where has it gone?

I ask the Minister for Health to reconsider this given it is a lifelong condition.

Iron overload is not a curable condition and this new measure of imposing this charge will put a financial burden on people and will deter them. The objective of any health service should be about preventative measures and not deterring people because of their financial means.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

As I have explained in the reply from the Minister's office, there is no intention at present to provide the service free of charge for those patients. The service is provided, however, under the medical card to many other people with different long-term illnesses. According to the Minister for Health and the Department, there is no intention at present to include it on the list in to the future. I will bring back the Deputy's reasons and concerns regarding this issue, on which she has spoken so well, to the Minister and I will explain in detail the Deputy's response. I will ask the Minister to revert to Deputy Munster.