Written answers

Wednesday, 19 January 2022

Department of Health

Social Welfare Schemes

Photo of Seán CanneySeán Canney (Galway East, Independent)
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1751. To ask the Minister for Health if he will update the long-term illness scheme to include amputees; and if he will make a statement on the matter. [1614/22]

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Long Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. 

Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge. The LTI scheme will be included as part of a review of the current eligibility framework, including the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy. 

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 accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the Health Service Executive (HSE). In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.

Individuals may also be entitled to claim tax relief on the cost of their medical expenses. This includes medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.

The HSE provides a wide range of medical and surgical aids and appliances, including prosthetics, free of charge to eligible persons following assessment by a relevant health professional. These are provided through community services known as Community Funded Schemes and play a key role in assisting and supporting people to maintain everyday functioning, and to remain living in their homes and local community. Applications within Community Health Organisations (CHOs) are assessed by the local Resource Allocation Group and a determination is made regarding approval based on clinical priority and the funding available.  At times, due to the demand for resources exceeding the available capacity, waiting lists may apply for some categories of items but CHOs undertake a range of initiatives to ensure optimum use of resources. 

Amputees, whose amputation arose from either a traumatic or elective event, usually have their primary prosthesis fitted at the hospital where the surgery was undertaken. Subsequent prostheses are provided to eligible clients through the Community Funded Schemes. Rehabilitation services are provided by the National Rehabilitation Hospital (NRH) primarily at their site in Dun Laoghaire and augmented by a number of satellite clinics that they operate throughout the country. There are also a number of smaller services operated at regional level that provide assessment and fitting clinics along with prostheses at a local level. Counselling services for amputees are available through the POLAR service provided by the NRH and through the Irish Association for Counselling and Psychotherapy. 

A HSE Primary Care led National Service Improvement Programme has the aim of improving the equity of access, value for money, and functional processes of the Community Funded Schemes through the establishment of national guidelines for the provision of medical and surgical aids and appliances. While this work was delayed due to the Covid-19 pandemic, as the situation involving the pandemic improves, this Programme will gather pace. 

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