Fiona O'Loughlin (Kildare South, Fianna Fail)
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The Minister of State, Deputy Catherine Byrne, is very welcome. I appreciate, as always, her courtesy in attending. Time and again, she is the person who has to come to the House to deal with health issues. While I appreciate that she is a Minister of State within the Department of Health, it should be the senior Minister who takes these issues. It is regrettable that he does not.

I raise the matter of the 511,904 people on outpatient waiting lists.

This is the highest number on record, which is a national disgrace. Of that number, 79,647 have been on the waiting list for more than 18 months. Three years ago, the then Minister for Health - the current Taoiseach - stated that by 2018 nobody would wait for more than 18 months for a procedure. Despite this, the waiting lists are at an all-time high.

The cross-border directive was introduced by the European Parliament to better define the rights of EU citizens when seeking treatment in member states other than their own. Under the directive, Irish residents have the right to avail of medical treatment in any other country in the European Economic Area, EEA, and to be treated on the same basis as they would be treated here. Provided certain criteria are met, EEA residents are entitled to request the treatment and receive reimbursement of the cost.

All Deputies are contacted daily or weekly by constituents who are enduring difficulties that impact on their quality of life. Since I became aware of the directive, I have been advising patients on long waiting lists in my constituency of Kildare to avail of it to access care. Cataract removals, tonsillectomies and joint replacements are the treatments I encounter most frequently. One gentleman, who had been unable to work for three years while waiting for a hip operation, recently thanked my office for pointing him in the right direction. The five-star treatment he received abroad changed his life. It is ridiculous that the Health Service Executive cannot have operations performed here but can pay for them to be done abroad. Given the record number of people on waiting lists, should more people not be encouraged to travel abroad to obtain treatments that cannot be provided in the Irish health system?

The cross-border directive is not advertised well enough. While it is advertised on the Internet, every primary care centre and general practice should have information on the directive because many older people who could avail of it are not Internet savvy and will not be aware of it. None of the people I informed about the directive was aware of it previously. Given our scandalous waiting lists, we should point people in the right direction and help them improve their quality of life.

Catherine Byrne (Dublin South Central, Fine Gael)
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I apologise on behalf of the Minister for Health, Deputy Harris, who cannot attend today. The Minister responded to several Topical Issue matters, including one on cervical cancer, during the week. I do not know where he is but in any case I will respond and the Deputy may contact the Minister's office to relay her concerns about his absence.

I have done exactly what Deputy O'Loughlin suggested in that I have asked general practitioners in my primary care area to ensure information on travelling abroad for treatment is made available to patients. The majority of them indicated they do this in any case.

I thank the Deputy for raising this issue. The vast majority of EU patients receive healthcare in their home country and prefer to do so for many reasons, such as language differences, culture, family support, distance of travel to other countries and, importantly, familiarity with the medical culture of their home state. However, for Irish patients seeking access to health services in another EU-EEA country, the cross-border directive introduced in 2014 has proved to be an important scheme. The Health Service Executive operates the directive in Ireland and, through the national contact point office, provides information for patients on the directive on its website and by telephone, email and post.

The numbers availing of the directive continue to increase since its introduction. According to the latest information from the HSE, 1,422 applications have been processed under the directive so far this year. In 2015, 2016 and 2017, the number of Irish people treated under the directive were 164, 793 and 2,011, respectively. Patients are primarily availing of orthopaedic, ophthalmology and orthodontic services under the scheme, with the majority of these treatments being carried out in Northern Ireland and other parts of the UK.

Noting that the directive states that its implementation should not result in patients being encouraged to receive treatment outside their member state and recognising that any decision to avail of treatment, at home or abroad, is a matter for a patient in consultation with his or her health professional, the HSE has sought to educate health professionals about the directive. Specifically, the HSE has met general practitioner organisations, such as the Irish College of General Practitioners, ICGP, and GP practices as it recognises that general practitioners are on the front line with regard to providing information and referrals to patients on their treatment options, both at home and abroad. Under the directive, general practitioners as well as consultants can refer a patient for overseas treatment.

In addition, the HSE has met and communicated with other professional bodies and organisations, including the Independent Hospital Association of Ireland and various voluntary hospitals and hospital groups, to inform them of how patients can access healthcare under the terms of the directive. The HSE has also held various public meetings on the directive and continues to meet and is available to meet a range of groups regarding the directive.

In summary, the number of people availing of the directive continues to increase, which points to an increased awareness of the directive by both healthcare professionals and the wider general public. In recognition that the decision to seek treatment overseas is one for the patient, in conjunction with his or her health professional, the Health Service Executive plans to continue to engage with healthcare professionals and professional bodies to provide them with information on the operation of the directive.

Fiona O'Loughlin (Kildare South, Fianna Fail)
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I completely agree that the vast majority of EU patients prefer to receive healthcare in their own country for the reasons the Minister of State outlined. It is, therefore, a shocking indictment of the Irish health system that 1,422 applications have been processed under the directive to date in 2018 and it is only 21 June. This figure shows the dire state of the health service.

The cost incurred by the Health Service Executive under the directive to date in 2018 is €2.79 million. Since the directive came into force in October 2014, the HSE has incurred costs of €9.247 million under the directive. As such, almost €10 million has been spent reimbursing the costs of 4,615 procedures. Would this money not be better spent on improving our health system? When people who genuinely need to have procedures done have to travel abroad we still end up paying the costs. It would be far better to invest in improving the health system.

On the issue of doctors referring patients for cross-border services, while I have come across doctors who are aware of the directive, from what I hear, they have no further contact with their patients once they have been referred for treatment abroad. From speaking to constituents, there appears to be a lack of communication between consultants and patients on health services in other countries and following treatment abroad. We are in a catch-22 in that the Government must either commit to providing the healthcare services required in this country or, alternatively, it must actively promote the cross-border directive while we wait for services to be provided here.

Catherine Byrne (Dublin South Central, Fine Gael)
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I have no argument with the Deputy. We all want what is best for the patient.

In light of the concerns the Deputy has raised and the fact that when people are informed by their GP or other professional and they go to a consultant in the hospital, somewhere along the way the message may get lost that there is another way forward. I do not have the specific answer on why the consultants and surgeons are not able to cope with the numbers that need operations and assessments. I do not have anything further to add but I will relay the Deputy's concerns to the Minister and hopefully over the next week he will be able to give the Deputy some insight into why so many people have decided to go abroad because of the lack of theatre space or surgeons to perform the operations in our own country. I will ask the Minister to reply directly to the Deputy.