Malcolm Byrne (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State, Deputy Butler, for coming to the House to address this issue. Over 1,000 people in Ireland require the use of artificial limbs every year. Many people will have heard Saoirse tell her story on the "The Late Late Toy Show" but there was also a piece on "Prime Time" last week with Louise Byrne. A number of stories were told in the programme, one of which was that of Darragh McDonald, a friend of mine from Gorey. He is a gold-medalist Paralympian. He told his story. In his case, because of the limbs he requires, the cost is in the order of €16,000 every two years. The Minister of State will also have heard the story of Darren Kelly, who spoke about his son Éanna, who needs two prosthetic legs, at a cost of €5,000 to €6,000 each per year. If one breaks, the total cost could be €15,000 in a year.

The only way those who require prosthetic limbs can apply for them is by getting a medical card. In many cases, they have to apply for a discretionary medical card. That process can take a long time. I am aware that the Minister of State shares some of my concerns about means testing in the case of permanent disability. Those who require prosthetic limbs need them for their entire lives. There is a problem in that families always have to apply for renewal. Even when this is approved, they have to wait a number of months for the limbs to become available. A growing child, in particular, may not be able to get around. "Prime Time" addressed the issue of the HSE and the postcode lottery that exists. There is a commitment to trying to resolve this but the difficulty is that there has not been an improvement in processing times.

It is a question of determining how we can allow those with a disability to play their full part in society. I am aware that the Minister of State is very committed to this. We must ensure those with a disability can reach or exceed their potential. We achieve this in so many other areas. With regard to getting people into higher education, we have the disability access route to education, DARE, scheme in place. We talk about trying to increase the number of people with a disability in the workplace but, with regard to prostheses, sufficient support is not made available. If we compare our health system with others across Europe, we note that we are clearly behind the curve.

For people like Saoirse, Darragh and Éanna, and thousands of others, I ask that we be innovative and consider putting in place a proper scheme, be it through guaranteed discretionary medical cards or tax deductions, whereby those relying on prostheses do not face a barrier and their families do not have to spend the whole time campaigning or fundraising. I ask the Minister of State to intervene with the HSE to take action on this.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for raising this really important issue. He is quite right in that Saoirse stole all our hearts two weeks ago on the "The Late Late Toy Show". Also, he quite rightly stated that there are so many more affected, including Darragh and Éanna. The issue can be very problematic for parents and children because the latter grow so quickly at a young age. It is an important issue and I am glad the Deputy has raised it.

The term "community-funded schemes" is a collective title for all of the many products, supports, supplies, appliances and aids that are provided through community services. A variety of products and services are provided under the schemes. The HSE provides a wide range of medical and surgical aids and appliances, such as prosthetic limbs, wheelchairs and walking aids, free of charge to medical card holders and people on the long-term illness, LTI, scheme. Assessment by a relevant health professional is required. The products and services play a key role in assisting and supporting service users to maintain everyday functioning and to remain living in their homes and local community. They also avoid the need for a hospital presentation or admission while facilitating early discharge from hospital back into the community.

Under the LTI scheme, patients receive, free of charge, drugs, medicines, and medical and surgical appliances directly related to the treatment of the diseases and disabilities covered by the scheme. People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.

Prosthetic services are currently provided by a range of private providers, and the cost of prostheses for eligible service users is charged to the HSE. Clinical governance arrangements vary depending on the location where services are accessed. Each community healthcare organisation, CHO, operates standard processes for the allocation of funding for medical and surgical aids and appliances.In terms of eligibility criteria, each application for a prosthesis within a CHO is assessed for medical card and long-term illness card patients by the local resource allocation group. A determination is made regarding approval based on priority and funding availability within local budgets.

At times, due to the demand for resources exceeding the available capacity, waiting lists may apply for some categories of items provided through the medical and surgical aids and appliances budget in a particular CHO. CHOs undertake a range of initiatives to ensure optimum use of resources.

As part of the HSE's service improvement programme for community funded schemes, a work stream has been dedicated to standardising provision of aids and appliances at national level. This work includes the establishment of a national approved list of items, national guidance for prioritisation and standardised provision across the entire country to help ensure that the quality and equity of access to the service is improved and that what is sometimes referred to as the postcode lottery becomes a thing of the past. While the availability of sufficient resources will undoubtedly remain a challenge for individual areas in meeting demands for these services, it is expected that there will be a significant reduction in the geographical variation that has previously existed. This does not speak to the issue the Senator raised about those who do not have medical cards and who have to fundraise. I will certainly give this consideration and address it with the HSE and the Minister.

Malcolm Byrne (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State. It is welcome that the postcode lottery will be a thing of the past but it does not solve the bigger question. It is a crazy situation that families have to continue to apply for a discretionary medical card. These are permanent disabilities. As the Minister of State knows, they are not disabilities that will disappear. I ask that once a medical card is granted, it should be allowed to continue so it will give those families and parents certainty.

Where we have somebody who may exceed the income threshold for the medical card, and I am speaking about someone like Darragh who needs to spend €16,000 every two years, it requires a lot of income to be able to do this. We are not providing the incentive for people to go into the workplace if they know they are going to have to come up with this level of funding. We as a society want those with a disability to play their full part and we have to ensure we have a health system that is designed to support it. There needs to be a complete review not just of the postcode lottery but about how we can help each individual child and as they grow into adulthood that we can provide them with the necessary limbs that they are not put out of pocket to the extent they are at present and that they can continue to play a very strong role in our communities.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for the practical and pragmatic way he has raised this matter. It is a serious issue for many families. As he has said, the spotlight in recent weeks on young children with prostheses has shown that it can be very problematic for many families who might not have access to a long-term illness card or a medical card. As Senator Byrne said, if they are trying to raise an extra €16,000 every two years it is a huge amount of money for any one family to come up with.

The HSE states there are many demands on community funded schemes but thousands of products and appliances are provided through the schemes each year and they provide a key role in assisting and supporting service users to live at home and maintain their day-to-day activities. The HSE endeavours to meet needs in an equitable way within available resources and, given the many demands, the HSE prioritises eligible patients with the greatest needs.

I welcome also the programme for the community funded schemes, the work stream that has developed to standardise provision of aids and appliances at national level and the fact we will finally try to move away from the postcode lottery, which is something we are so used to in all services. It is something that has to become a thing of the past. I thank the Senator for raising this matter and I will certainly take back to the HSE the issues he has specifically raised. We know there are supports out there but unfortunately not everyone is able to access them.