Phil Hogan (Carlow-Kilkenny, Fine Gael) | Oireachtas source

I thank Senator Healy Eames for raising this matter. The notice of the matter received did not refer to a specific individual case. If that had happened I would have expected to have been briefed on the individual case. She asked about the criteria which the Department of Health and the HSE use to determine the eligibility of such children as Lily Mae who have rare life-threatening cancers. The Health Service Executive operates a treatment abroad scheme, TAS, for persons entitled to treatment in another EU or EEA member state or Switzerland under EU Regulation 1408/71, as per the procedures set out in EU Regulation 574/72, and 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 or EEA member state or Switzerland through the issue of form El12 (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 member state or Switzerland, where the treatment in question meets the following criteria: First, the application to refer a patient abroad has been assessed and a determination given before that patient goes abroad. Second, following clinical assessment, the referring consultant certifies a recommendation that the patient be treated in another EU-EEA country or Switzerland; the treatment is medically necessary and will meet the patient's needs; the treatment is a proven form of medical treatment and is not experimental or test treatment; the treatment is in a recognised hospital or other institution and is under the control of a registered medical practitioner; and the hospital outside the State will accept EU-EEA form El12 (IE).

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.

The response sets out the criteria in terms of who is eligible under such a scheme. Perhaps the person the Senator has brought to the attention of the House is eligible under the scheme outlined, but I am not in a position to determine that as I have not been given the necessary briefing. The Senator might wish to bring the details to the attention of the family involved and explain to them the precise procedure to be followed. No applications to the scheme have been accepted for referral for inclusion in clinical trial and current practice is that costs associated in participation in a clinical trial are borne by the providers of the trial. Applications to the scheme are only accepted where the patient, adult or child, are being referred outside the State for proven treatment that cannot be obtained within the State.