Barry Ward (Fine Gael)
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I thank the Minister of State for attending the Chamber. This is an issue for many people around the country. As he will be aware, hair loss is not an uncommon thing in men and women. It can be caused by a variety of medical conditions, including cancer treatments that result in hair loss, alopecia and so on. Thankfully, the State has in place measures to help the many people who want to obtain wigs or hairpieces to cover their hair loss, make themselves feel more comfortable or whatever it might be.

We had progress in this area recently when the Minister for Social Protection, Deputy Humphreys, put in place a €500 grant for people suffering alopecia to allow them to obtain hairpieces or wigs. Previously, there was no support for them at all; support was only provided for cancer sufferers. As the Minister of State will be aware, cancer sufferers usually avail of a medical card service. Through that, there is a grant to allow them to purchase a hairpiece or wig.

This issue has been brought to my attention by Mr. Aidan Fitzgerald, a hair salon owner in Blackrock in my area. Mr. Fitzgerald is an award-winning salon owner who has been operating for more than 40 years and has an established business. As part of his work, he specialises in hairpieces and wigs. He brings them into the country and fits them to people to make sure they fit and suit because hair comes in all shapes and sizes. These wigs are not made in Ireland, so they have to be imported. I understand that, generally, they are made in China. They take different forms, in that there are synthetic wigs and wigs made of real hair that have been donated, and there are different types of wig depending on whether someone is European, Asian, African or whatever. The wig has to be specific. Synthetic wigs are slightly cheaper but many people who have been suffering long-term hair loss prefer to have wigs made of natural hair, which have to be imported. No wigs are made in Ireland, although there are charities in Ireland that deal with hair for the construction of wigs.

The difficulty that arises is that, because wigs have to be imported, there is a standard cost. Many of them come through the UK but, either way, VAT and duties have to be paid on them. The grants that are available through the medical card scheme are there to assist people. I understand that the costs range from €650 to €750 for a synthetic wig and from €1,000 to €1,500 for a real wig. Obviously, various factors affect the cost. People can also get bespoke wigs, but those cost approximately €3,000. Generally, such wigs are not chosen by cancer sufferers because their hair will often have grown back by the time the wigs have been made.The medical card scheme, however, puts in place a regime that allows people to claim different sums depending on where they are in the country. In my area, Dublin, for example, the grant under the medical card ranges from €635 to €700, which does not cover the full cost, very often, although it is a substantial contribution to the cost. In Carlow or Kilkenny, by contrast, that grant is €440, while in Tipperary, it is €500. In Cork, it is €450; in Clare, €500; and in the Naas area, for some reason, €767. There seems to be a terrible discrepancy here. Aidan told me that yesterday, he fitted a wig for a lady from Wicklow and she got a grant of €650, whereas a lady from Wexford in the same day only got €440.

There is no good reason for this. The wigs are not made locally and they cannot be bought locally, so they are bought in. There seems to be no good reason there cannot be a standardised grant for people who, in this instance, are mostly cancer sufferers, given that alopecia sufferers do not avail of this grant. Cancer sufferers throughout the country should get the same sum from the medical card scheme. They should all get the same access to wigs and hairpieces. It is an important part of their ability to deal with whatever they are going through during treatment and so on, and it is important they be allowed equal access to the grant.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this important issue and for giving me, on behalf of the Minister for Health, the opportunity to clarify the position on the provision of wigs and hairpieces by the Health Service Executive under community-funded schemes. The HSE provides many aids and appliances through its community services and it endeavours to meet needs in an equitable way within available resources and given the many demands. The provision of wigs and hairpieces by the HSE to patients who are being, or have been, treated for cancer or other illnesses is operated by means of a grant or voucher system administered by the community healthcare organisations. Patients can select their preferred wig or hairpiece and the HSE refunds the service user or the service provider up to the value of the voucher issued.

The HSE established a community-funded schemes service improvement programme to standardise the HSE provision of aids, appliances and related items in order that, irrespective of where someone lives, he or she will have access to the same items as people in other parts of the country. The HSE established an expert group for post-mastectomy products, wigs and hairpieces whose work includes a review of the provision of wigs and hairpieces. The expert group is a sub-group of the aids and appliances work stream of the community-funded schemes service improvement programme. The expert group comprises clinicians and operational staff. It engaged in consultation with service users, including participation in focus groups. It noted significant variations in what is currently provided, including in regard to current allowances for wigs and hairpieces.

The expert group made initial proposals in 2019 for the development of guidelines by the Health Service Executive to standardise the grants paid. The work of the expert group was delayed due to the Covid-19 pandemic because clinical staff were redeployed to deal with the demands of the public health crisis. However, in 2021, the expert group furnished a draft summary of proposed national guidelines for the provision of wigs and hairpieces and of post-mastectomy products. The finalisation and implementation of these guidelines in 2022 should address the inequity of provision on a geographic basis, which has been a problem for many years. In addition, the standardised provision that has been recommended should ensure the approval process and the associated administration will be simpler to operate.

The HSE recognises that the Covid-19 pandemic has created added difficulty for cancer patients, including through the absence of a facility for wig fittings. To address this difficulty, the HSE put in place a temporary measure whereby each patient affected by the absence of wig fittings is provided with additional funding of €80 to facilitate the purchase of up to two items of headwear. I commend the HSE on introducing additional measures to support cancer patients. It is essential that such patients are not subjected to any additional worry or stress at what is a very difficult time for them. I wish to see the implementation of the new national guidelines for the provision of wigs and hairpieces as quickly as possible.

I again thank the Senator for raising the issue. It looks as though much work is ongoing and I hope the issue will be dealt with as quickly as possible.

Barry Ward (Fine Gael)
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I appreciate that the Minister of State acknowledged there is inequity of provision on a geographic basis. To my mind, there should not be. We have made progress in respect of alopecia sufferers, who previously had no relief, but it is important people who are suffering from hair loss for whatever reason have the option to obtain a hairpiece or wig that will help them deal with the issues they have to deal with. I appreciate also what the Minister of State said about the need for the implementation of the new national guidelines as quickly as possible. Those who suffer from hair loss need solutions and we should help them, irrespective of the reason for that hair loss.

I applaud what the Minister of State said and I look forward to the implementation of the guidelines in short course.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Senator for raising this important issue. The HSE is working to standardise the grants available for wigs and hairpieces. Based on the work done to date, an expert group has made a proposal for the development of guidelines by the HSE to standardise the grants paid. The Senator is absolutely correct that it just does not add up that somebody in Wexford would get €200 less than someone in Dublin. As I said, while the finalisation of the guidelines was delayed by the Covid-19 pandemic, much significant work has been done and improvements have been introduced in a number of areas.

In particular, I welcome the interim measures introduced by the HSE whereby each person affected by the absence of wig fittings is to be provided with additional funding of €80 to facilitate the purchase of up to two items of headwear. I hope this measure will be of assistance to patients who have experienced additional difficulties caused by the Covid-19 pandemic. The HSE expects to finalise and implement the new guidelines in mid-2022.