Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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445. To ask the Minister for Health further to the reply in parliamentary Question No. 626 of 12 July 2016, if a person (details supplied) is eligible for the treatment purchase fund; and if he will make a statement on the matter. [23486/16]

Simon Harris (Wicklow, Fine Gael)
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A key challenge for our health system is ensuring timely access to health services. Every year there are 3.2m outpatient attendances at our hospitals. 100,000 patients have an elective inpatient procedure and 800,000 have a planned day case procedure. Up to the end of May 2016, there has been an increase of over 19,000 scheduled inpatient / daycase procedures, in comparison to the same period in 2015.

The key issue for patients is how long they have to wait. It is important to note that approximately 60% of patients wait less than 6 months for their required outpatient appointment or inpatient/daycase procedure. The HSE seeks to ensure that those whose clinical needs are most urgent are prioritised accordingly, while managing the needs of those who have been waiting longest for routine treatment in chronological order.

The Minister for Health met with the HSE National Director for Acute Hospitals on Friday, 15 July, regarding proposed measures to tackle waiting lists. The Minister for Health requested that the HSE prepare an action plan, setting out specific measures that the HSE will implement, in conjunction with hospitals, between now and the end of 2016 in order to tackle waiting lists.

This Government recognises that a sustained commitment to improving waiting times is required, with a particular focus on those waiting longest. Consequently, the Programme for a Partnership Government commits to €15m funding to the NTPF to address waiting lists in 2017, as part of the Programme’s commitment to a continued investment of €50m per year to reduce waiting lists. This commitment seeks to utilise the expertise of the NTPF to further assist the HSE in addressing specific waiting list pressures. The Department will engage with the National Treatment Purchase Fund and the HSE to deliver on this commitment. As outlined in the Programme, this initiative will commence in 2017 and focus on those patients waiting longest.

With regard to access to cross border healthcare, the EU Directive 2011/24/EU on Patients’ Rights in Cross Border Healthcare aims to ensure EU citizens may access safe and good quality healthcare services across EU borders. The Directive establishes a framework for cross border healthcare between EU/EEA states to facilitate patients to access care in another Member State in accordance with their entitlements in their own country. Under the Directive, known as the Cross Border Healthcare Directive (CBD), insured patients are entitled to have the costs of cross-border healthcare services reimbursed if the healthcare service in question is among the benefits to which they are entitled in their Member State of affiliation. As such, it allows Irish residents to avail of healthcare in other EU or EEA (excluding Switzerland) Member States that they would be entitled to within the public health system in Ireland, which is not contrary to Irish legislation.

Public patients may access the healthcare they require in either the public or private healthcare system of the country abroad under CBD. Access to healthcare abroad is based on patients following public patient pathways - i.e. patients must demonstrate they have followed the equivalent public patient pathways that a patient would follow if accessing public healthcare in Ireland. Referral for care under the CBD may be made by a GP, a hospital consultant and certain other HSE clinicians. The CBD excludes certain health services, e.g. services of public health, long term care, organ transplantation, etc. All persons on public waiting lists, other than for such exempt health services, are eligible for the Scheme.

The Health Service Executive (HSE) operates the CBD in Ireland. The HSE, through the National Contact Point (NCP) office, provides information for patients on the Cross-Border Directive on its website - - and also by phone. The principal function of the NCP is to facilitate exchange of information for patients concerning their rights and entitlements relating to receiving healthcare in another Member State, in particular the terms and conditions for reimbursement of cost and the procedures for accessing and determining those entitlements.

Potential users of the CBD Scheme should note that reimbursement will be at the cost of the treatment availed of abroad or the cost of providing the healthcare in Ireland whichever is the lesser. The NCP is able to inform patients what the cost of their treatments would be in Ireland to allow them make a comparison with the costs they are being quoted for comparable treatment in another Member State. The HSE also advises where a patient is in any doubt as to the need to seek prior authorisation before availing of a consultation or treatment abroad to contact the NCP. The NCP is happy at that stage to advise patients of the reimbursement rate that will apply to the assessment/treatment being accessed.

The HSE endeavours to reimburse the cost of treatment incurred or the cost of providing such healthcare in the State, whichever is the lesser, to the applicant within 30 days of receipt of a claim for reimbursement, in line with Prompt Payment Legislation.

The NCP also has a responsibility to ensure that all enquirers are informed of the right to healthcare, if any, that they may have through the European legislation on the coordination of social security schemes (EU Regulation 883/04) and which may be more beneficial to them.