Ombudsman investigates HSE scheme complaints

Treatment Abroad Scheme pays for patients to get care abroad

THE Ombudsman is investigating complaints about the HSE’s Treatment Abroad Scheme which pays for patients to be treated in another EU state.

It has also received complaints about the Cross Border Directive on Healthcare, another avenue to get treatment for people stuck on long HSE waiting lists.

So far, around 30 complaints about the TAS have been lodged since 2012, of which only a handful have been upheld, partially resolved or discontinued.

The Irish Daily Mail understands the investigation, which is due to conclude by the end of the year, is believed to be centred around about 12 separate cases.

The HSE said last night: ‘The HSE welcomes all reviews by the Ombudsman into service areas, and will ensure where possible that recommendations (especially Operation: John Harrington those that are in the interest of patients) are implemented as quickly as possible.’

One of the areas of contention is the rejection by the HSE of applications for the Treatment Abroad Scheme, which covers treatments not available here or not available within a reasonable timeframe. According to the latest figures from the HSE, around 16% of applications were rejected last year. This is over double the number of applications rejected in 2012. In addition, the amount of money paid out under this scheme has fallen from a high of €11,113,347 for 574 patients in 2014 to €8,751,653 for 661 patients in 2016.

Ombudsman Peter Tyndall said: ‘Having examined a number of complaints from patients whose applications for approval under the TAS scheme were refused I became concerned that some patients had been adversely affected because of the administrative process.’

A referral for treatment abroad under the TAS must be made by the patient’s consultant and submitted with an application for approval by the TAS scheme administration section of the HSE. Another scheme, the Cross Border Directive in Healthcare covers treatments that are publicly funded and available in Ireland.

But it allows people, who have to pay up front before the HSE reimfour burses them for the cost of their care, to avoid long waiting lists and have their treatment done abroad instead.

All they need is a referral letter from their GP and they do not have to be on a waiting list. One prominent recent recipient of care under the CBD scheme is John Patrick Harrington, 90, who had to endure a 1,000km round trip from his home in Bantry, Co. Cork, to Belfast in order to halt the progression of his blindness.

When his son Jerry tried to get him an appointment at his local hospital, he was warned it would take up to four years for him to be operated on in the HSE.

Knowing he would go totally blind in the meantime, his family found out about the CBD scheme and that the treatment costs incurred would be reimbursed by the HSE within five weeks.

After just three phone calls over days Harringtons had a date for their father’s operation in Belfast for just two weeks later.

The Ombudsman started receiving complaints about the CBD last year.

The complaints he received were from people who ‘were confused about how the scheme operated or who had difficulties when trying to reclaim the money they spent on their treatment’.

He added that they were ‘very often vulnerable people who were seriously ill and who had to travel outside the country to receive much needed medical treatment’.

As the Mail revealed last week, demand for the CBD has shot up more than 500% in just two years and the costs involved have gone up by more than 1000%.

In 2015, just 150 people were reimbursed for treatment on the CBD, totalling €542,106.

But 1,025 people were reimbursed in 2016 at a cost to the State of €1,447,698 and 901 have been reimbursed up until October this year so far, at a cost of €3,210,797.

A 1,000km round trip to Belfast