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Seanad Éireann debate -
Thursday, 16 May 2013

Vol. 223 No. 6

Adjournment Matters

National Disability Strategy Implementation Plan Issues

Tá fáilte roimh an Aire agus táim buíoch de as ucht teacht isteach. Is cuairteoir rialta é sa Teach agus táimid thar a bheith buíoch de faoi sin.

I am grateful the Minister is back in the House and acknowledge that he is here on a regular basis.

To put matters in context, we in Sinn Féin have proposed the establishment of a national disability strategy implementation and monitoring unit, which would set annual targets in order to ensure full delivery of such a strategy. We believe that taking a rights-based approach to policy implementation and change should not be disregarded during a recession. We are committed to protecting income supports and necessary public and social services for people with disabilities.

The gains made in previous years for people with disabilities have been under attack from the Government through its programme of cutbacks. These vulnerable persons are paying for the disastrous policies and practices of the Government, banks and big business which led to the economic collapse. People with disabilities have had their incomes cut. Services are under increasing strain and funding for the voluntary organisations providing services and advocacy services for people with disabilities has also been cut.

The Government should lead by example. The number of public servants has been reduced significantly. My question could be asked of a number of Ministers because it seeks to discover how many people with disabilities work in each Department. What is the Government target for an increase in the level of representation of people with disabilities? Nice policy documents are all very well, but the Government and Departments should be proactive in employing people with disabilities to ensure they are given a chance to be gainfully employed. This would set a good example for other employers. I ask the Minister to provide an indication of the Government's policy on this issue, state the number of people with disabilities employed in each Department and a timescale for improving on that number.

I thank the Senator for raising this issue. I will relieve him of any mystery by saying my good friend and colleague, the Minister of State, Deputy Kathleen Lynch, is primarily responsible as the co-ordinating Minister across Departments. I am replying to this debate because she is abroad on Government business. I know this is an area in which she has substantial commitment. I will deal with some of the issues raised by the Senator who may take some added value from this information.

The national disability strategy was launched in September 2004 and its implementation continues to be the focus of Government policy for the sector. Key elements of the strategy include the Disability Act 2005, the Education for Persons with Special Educational Needs Act 2004, the Citizens Information Act 2007 and the sectoral plans of key Departments which set out how they will deliver services for people with disabilities. However, a specific implementation plan for the strategy had not previously been developed, but this issue is now being addressed by the Government. The programme for Government states:

The Government will publish, following wide consultation, a realistic implementation plan for the National Disability Strategy, including sectoral plans with achievable timescales and targets within available resources, and ensure whole of government involvement and monitoring of the Strategy, in partnership with the disability sector.

The Minister of State with responsibility for disability, equality, mental health and older people, Deputy Kathleen Lynch, has established and is chairing a new group to develop an implementation plan for progressing the strategy in line with the commitment in the programme for Government. The new group has replaced the national disability strategy stakeholder monitoring group while maintaining the cross-departmental focus and collaboration with stakeholders.

The implementation plan is developing well, with the identification by Departments of actions, time lines and key performance indicators, KPIs. Discussions are ongoing between the disability stakeholders' group and Departments in an effort to reach agreement on the suite of actions contained in the plan. Once all parties are agreed on the plan, it will be published as soon as possible thereafter.

The aim of the implementation plan is, through engaging with the disability sector and building on the traditional problem solving and constructive approach of the community and voluntary sector, to make progress to achieve our common interests. More targeted, innovative and flexible services, designed and delivered on the basis of the evidence drawn from systematic evaluation, will help to ensure available resources are used to deliver services that meet the needs of the community as efficiently and effectively as possible. Acknowledging the current economic climate and diminished resources available across government, the implementation plan will seek to ensure available resources are used to the best effect in ensuring the living standards and access to essential services for people with disabilities are maintained.

The implementation group comprises the senior officials group on disability which represents all relevant Departments and agencies across government. A broad representation of disability organisations and the National Disability Authority has also been appointed to the group, as have a number of individuals with disabilities who have been appointed in a personal capacity to bring their lived experience to the group.

In order to achieve further consultation with people with disabilities who are the users of the services provided by public bodies, the Minister of State has also set up a disability forum under the stewardship of the National Disability Authority. The first meeting of the disability forum was held on 19 June 2012. A report on the views expressed forms part of the considerations of the implementation group on the actions included in the implementation plan. As before, the National Disability Authority is helping Departments in setting performance indicators and outcomes for the plan's targets. One-on-one meetings with Departments were held during 2012 to assist them in identifying actions to be included in the implementation plan. Work by the authority on disability indicators has been signed off on by the senior officials group on disability and the disability stakeholder group.

With regard to employment in Departments, the Disability Act 2005 provides that public bodies shall, as far as practicable, take all reasonable steps to promote and support the employment of people with disabilities. It also provides a framework for monitoring the employment target, currently set at 3% in all public bodies, through departmental monitoring committees. The role of the monitoring committees is to monitor and, in consultation with the National Disability Authority, encourage compliance with the Act by all of the public bodies within the remits of the relevant Ministers. The authority has an overall monitoring and reporting role under the Act. The Minister for Public Expenditure and Reform has overall responsibility under the Act for setting and monitoring the targets for Departments and other bodies staffed by civil servants. Other Ministers are responsible for public bodies accountable to them. Each Department and public body is accountable for its own performance under the Act in promoting and supporting the employment of people with disabilities and meeting the target.

The National Disability Authority publishes an annual report in compliance with Part 5 of the Disability Act since this became a legal obligation in 2006. The most recent report, published in 2012, is based on data provided for 2011. It shows that for the first time the proportion of staff with disabilities reported across the public service as a whole reached 3.1%. Departments averaged an employment figure of 4.2%. For a number of years all Departments had successfully achieved or surpassed the 3% target. However, in 2011 the Department of Children and Youth Affairs, the newly established Department with a very small complement of staff, was just below the target at 2.4%. It was the only Department not to achieve the target in 2011; all other Departments achieved compliance, with percentages ranging from 3.2% to 6.6%.

The Deputy will appreciate that with the significant number of civil servants leaving through early retirement schemes and the current recruitment embargo, it is a significant achievement for Departments to reach and maintain the target for the employment of people with disabilities in recent years. The data for the numbers of employees in Departments for 2012 are being collated and will not be available until the autumn. However, the percentages achieved by individual Departments, according to the report on 2011 data, are as follows: Department of Agriculture, Food and the Marine, 3.2%; Department of Arts, Heritage and the Gaeltacht, 3.2%; Department of Children and Youth Affairs, 2.4%; Department of Communications, Energy and Natural Resources, 5%. One of the two Departments at which I am Minister, the Department of Defence, has a figure of 4%, with the figure for civilian employees at 5.4%. The figures for the Department of Education and Skills is 3.4%; the Department of Finance, 3.9%; the Department of Foreign Affairs and Trade, 3.5%; the Department of Health, 6%; and the Department of Jobs, Enterprise and Innovation, 6.6%. The other Department at which I am Minister, the Department of Justice and Equality, has a figure of 5.4%. The figure for the Department of Public Expenditure and Reform is 6.5%; the Department of Social Protection, 4.2%; the Department of the Environment, Community and Local Government, 4.1%; the Department of the Taoiseach, 4.7%; and the Department of Transport, Tourism and Sport, 5.1%. The total average figure is 4.2%. I am very pleased that the two Departments in which I have the privilege to be Minister have rightly and substantially exceeded the 3% target and it is my objective that we will continue to do so.

That was an extremely long and comprehensive reply, with which I am sure the Senator is very pleased.

I am and, for a change, I will not give out to the Minister.

As the Senator rarely gives out to me, I must be doing something right on occasion.

It was a very encouraging reply and the figures are very encouraging. A review will take place of the numbers who have left the public service and we look forward to getting the figures in the autumn. Does the Minister believe the Government will relax the embargo in cases where it is important to increase the percentage, for example, in the Department of Children and Youth Affairs where it is below the average figure? Will he ask the Government to relax the embargo in certain cases to ensure we reach the target of 3%?

I do not want to give my good friend and colleague, the Minister for Public Expenditure and Reform, Deputy Brendon Howlin, apoplexy by suggesting the embargo be relaxed. Obviously, we must stick to the strict financial parameters within which we are operating, but within these parameters, as the Senator kindly acknowledged, the overall objective is being achieved. There are some Departments, including the Department of Children and Youth Affairs which I mentioned where it has not been fully achieved. Let us wait to see the figures for 2012 and if all Departments have managed to achieve that objective. Obviously, I am conscious that staff are retiring and of the need to keep an eye on this area to ensure we meet our objectives.

Employment Equality Training

I welcome the Minister. The fact that he is here to address this matter is very telling and I suspect there might be some good news. I actually raised this matter on the Adjournment this time last year because the Equality Authority provided what I would describe as extremely cost-effective and successful equality training for small and medium-sized businesses. Many of the businesses which availed of the training provided now have very strong equality statements in place and some of the things about which my good friend and colleague, Senator Trevor Ó Clochartaigh, spoke are in place and people from myriad backgrounds, whether they are from different countries or ethnic groups or people with different disabilities, are working very successfully in the private sector, as the O2 ability awards have acknowledged. The training was funded primarily by the European Union and the Equality Authority through the Minister's Department, but, unfortunately, the programme was shelved a couple of years ago. The reply I received on the last occasion from a Minister speaking on the Minister's behalf outlined the fact that another panel would be established which would provide this service. The exact title of the panel was that it was a panel of equality experts for equality mainstreaming support to the SME sector. Expressions of interest were sought and a shortlist was drawn up, but the process has stalled.

I understand the funding being provided by the European Union will come to an end at the end of 2013. As we are now in May, we really only have seven or eight months in which to facilitate companies in providing training through this very good initiative. I do not know what the reason for the blockage is. Perhaps the Minister is not even aware that there is a blockage, but I respectfully suggest to all parties concerned that it is a no-brainer; there is a need to establish the panel and get on with it because it is primarily being paid for by the European Union as part of its obligations under various UN conventions. We are on the cusp of ratifying the UN Convention on the Rights of Persons with Disabilities and making ground-breaking changes in amalgamating the Equality Authority and the Irish Human Rights Commission which will be the benchmark for equality services in this country for decades. It will establish very strong and powerful foundations which will help us to meet our international obligations. The problem is the enormous economic recession which has affected the SME sector very badly and, unfortunately, equality training and equality principles can be on the first line of attack when it comes to making cutbacks. Without funding from the European Union, companies will not be in a position to afford this training and it is incumbent on us to ensure it is provided.

I look forward to the Minister's reply which I hope will be as positive and comprehensive as that given to Senator Trevor Ó Clochartaigh.

I thank the Senator for raising this issue and very much appreciate his long-standing interest in this area. I am not sure I will be able to give him as full a reply as he seeks, but in so far as there is any information missing, I assure him I will revert to him in that regard.

I take the opportunity to emphasise my continued commitment and that of the Government to promoting good employment and equality practices by all employers in Ireland, including those in the SME sector. As we have highlighted on a number of occasions, there is a body of evidence that, in addition to improving the welfare of workers, such practices have advantages for firms in improving competitiveness and stimulating innovation.

The panel to which the Senator refers relates to activities undertaken by the Equality Authority under an overall equality mainstreaming approach programme. This programme was set up under the 2007-13 human capital investment operational programme in Ireland. The equality mainstreaming activity is jointly funded by the European Social Fund and from the Equality Authority's grant-in-aid provision to a maximum of €4 million over the period of the ESF programme. In this context, expenditure incurred in 2014 is also covered.

Overall, the programme aims to contribute to improving access to the labour market for specific groups experiencing barriers to employment. It does this by supporting small and medium enterprises, providers of vocational education and training and providers of labour market programmes to make institutional changes to combat discrimination, promote equality and accommodate diversity. The selection of individual projects for funding is a matter for the project management within the criteria set out and agreed with the ESF for the overall programme. There are a number of distinct strands to the programme.

Support packages are provided for vocational education providers, training providers and labour market programme providers and trade union and employer networks. Research is funded to support the knowledge base on groups vulnerable to discrimination across the nine grounds protected under equality legislation. The development of resource materials is funded, supporting good practice in combating discrimination, promoting equality and accommodating diversity. For example, an employer's guide to equality in the workplace was developed with the Irish Small and Medium Enterprises Association and is actively disseminated within the SME sector by that body. A fourth strand involves the provision of consultancy support benefiting enterprises in the form of projects undertaken on a sectoral basis with groups of enterprises and other stakeholders and such support is ongoing.

In the first four years of the programme equality expertise was also made available to enterprises on an individual basis under a grants scheme for SMEs. Under this scheme small businesses have been offered from one to four days consultancy support by expert equality trainers and facilitators to put in place equality policies and practices. This support was paid for directly by the Equality Authority. Some 282 individual SMEs benefited from direct interventions of this nature, with spending on the SME grants scheme amounting to €759,000.

As I explained, the Equality Authority, in its role of project manager, has responsibility for the selection of individual projects for funding. In preparing its work plans, the authority is advised by a national framework committee comprising the social partners, the Department of Justice and Equality, the Department of Finance and other stakeholders. The Senator will be aware that this committee took a decision in early 2011 that it would not be prudent to operationalise the SME grants scheme in that year. In the current difficult economic environment it proposed that a sectoral project approach, through which equality expertise could be made available to enterprises, might be an effective mechanism for engagement with the SME sector.

Accordingly, the SME grants scheme did not operate in 2011 or 2012 and it is not planned to operate it in 2013.

I support the decision that was made by the authority, which is a valid one, in the very difficult economic budgetary context we face. While the Equality Authority has made no announcement regarding its priorities, under this programme for 2014, I am advised that the authority has not closed the door on re-instating an SME grant in the future, if and when the budgetary outlook is more favourable. I thank the Senator for raising the important topic of the mainstreaming of equality.

I thank the Minister for his reply. I hope that some provision will be made in the 2014 budget for the scheme because a demand exists. A set of companies which had tried to access equality training when it was available would benefit enormously. We will keep an eye on the matter.

Hospital Services

Senator Mary Moran has kindly agreed to allow Senator Byrne to table his Adjournment matter on a health issue.

I am grateful to the Senator. I must attend an engagement so I owe her a favour. I also thank the Leas-Chathaoirleach for his stewardship of the Seanad this week and for allowing me to speak twice during the Adjournment debate. I appreciate his efforts.

In County Meath there are significant issues that need a response from the Government this evening or this week. My issue relates to the future provision of services at Our Lady's Hospital, Navan. The matter is urgent, particularly in light of the recent proposal to group hospitals. The Navan hospital is now part of the miscellaneous group that includes hospitals as far away as Wexford and Kilkenny.

Yesterday the report entitled Securing the Future of Smaller Hospitals: A Framework for Development was published. What services will be provided in Navan in the future? Paragraph 3.2, overview of services at a Model 2 hospital, clearly states: "The hospital will have a daytime Urgent Care Centre comprising a Medical Assessment Unit and Local Injuries Unit which will be open where feasible 7 days a week." With regard to an intensive care at Navan hospital, paragraph 3.3, medical and critical care services for a model 2 hospital, states: "This hospital will not have an ICU."

I am also concerned about the provision of orthopaedic services. The Navan hospital has been grouped with a number of hospitals, including Cappagh Orthopaedic Hospital. Does that mean that services will be moved out of Navan hospital? I am aware of one Meath person who is due to undergo an operation this week at the orthopaedic unit of the Navan hospital and will need an ICU bed post-operation. I understand from the report that such a person, even if orthopaedic services remained at Navan, would not be treated there due to the closure of the ICU unit, as per the smaller hospitals report.

Contrary to the contents of the smaller hospitals report, local Fine Gael Deputies have been out and about and stated in the media that the report was wrong about the services and that they will not close. I seek clarity from the Minister on the future provision of services at Our Lady's Hospital, Navan. The provision of hospital services is a huge issue in County Meath and 15,000 people protested in October 2010. At the time the Minister for Health and Children gave an assurance that services in Navan would not be downgraded. The new report suggests a change of mind and that he broke his promise.

In the weeks approaching the 2011 general election the Fine Gael team in Meath gave a commitment to provide a regional hospital for the north east in Navan. At the time they said that they were working on the initiative with a number of investors who could participate in a public private partnership. Today's Adjournment is a good forum to debate the matter. Yesterday the hospital report was published but there was no Topical Issues debate on it in the Dáil. I do not know if there will be a Topical Issues debate today on the subject. The Seanad is a good forum to seek a clear answer from the Government on the future of Our Lady's Hospital, Navan.

I thank the Senator for raising the matter on the Adjournment. I am not aware that it was debated in Dáil yesterday. I do not think that it was.

That is what I said.

I am taking the Adjournment matter on behalf of my colleague, Deputy James Reilly, the Minister for Health. I thank the Senator for raising the matter and for the opportunity to discuss the reports that were launched on Tuesday. They signal a fundamental modernisation of the health system in line with best practice.

We know that the traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. The formation of acute hospitals into a small number of groups, each with its own governance and management, will provide an optimum configuration for hospital services to deliver high quality, safe patient care in a cost-effective manner. In the longer term, each group's viability and future prosperity will be realised by its ability to deliver a comprehensive range of services across the group.

The establishment of hospital groups will see small and larger hospitals working together as one. This is a key foundation stone for the eventual abolition of the HSE and the introduction of universal health insurance for the people. These huge reforms will take time but the establishment of hospital groups is a significant milestone in achieving the vision set out in the Future Health initiative.

Securing the Future of Smaller Hospitals: A Framework for Development, which the Minister also published on Tuesday, offers clear information about the role of our smaller hospitals and what they will do in the future. The framework focuses, in particular, on the role of nine smaller hospitals, including Our Lady's Hospital, Navan.

The hospital has the potential to carry out more complex surgery than most of the other smaller hospitals. More patients will be treated in Navan as part of the new hospital group. The hospital will do more work in a large number of areas including day surgery, diagnostics, rehabilitation and chronic disease management. Accident and emergency services will continue on a 24-7 basis as capacity issues within the group remain unresolved. Endoscopy services will be enhanced. Elective endoscopy and day surgery services will be further developed, including general surgery, gynaecology and urology to maximise utilisation of resources and reduce waiting times. Outpatient services will also be expanded. Discussions will commence immediately within the group to draw up a plan to address the issue in the context of the strategic plan which the group must develop within a year of its formation.

All hospital groups are required to submit a strategic plan in which to outline plans for future services within the group area. Consultation will be a key component of this planning, including consultation with local communities. Smaller hospitals will play a crucial role in the delivery of services. The framework for smaller hospitals commits to the expansion of services delivered in smaller hospitals, especially in services such as day surgery, ambulatory care, medical services and diagnostics. In this regard, a new emergency department-minor injury unit is being constructed in Our Lady's Hospital, Navan.

When groups are established services can be exchanged between sites. This will result in the maintenance of activity in smaller hospitals. It will allow them to focus on the provision of high volume less complex care that is safe and appropriate. The measure is intended to lead to significant increases in overall activity in these hospitals providing care as close as possible to the local people's home.

The people of Meath will greet the Government's statement with great disappointment. Today is the first time that I have heard the new emergency department in Navan referred to as the "new minor injury unit". That is its formal description in the Government's reply. I am not making a personal attack on the Minister of State. He simply read the statement on behalf of the Minister who did not attend. We have been told that a new accident and emergency department is being constructed but today it was described as an "emergency department-minor injury unit". That would accord with the smaller hospitals framework document.

The Minister and the Government have stated:

Accident and emergency services will continue on a 24-7 basis as capacity issues remain unresolved. Discussions will commence immediately within the group to draw up a plan to address the issue in the context of the strategic plan which the group must develop within a year of its formation.

As I see it, services in Navan, particularly the accident and emergency department and the intensive care unit, are on death row. They are continuing for now but plans are afoot to get into the detail of how they will be stopped. That is completely wrong and unfair, particularly in light of the fact that the regional hospital has been taken out of the picture and that Navan is outside of the group containing the other hospitals in the north east, which I find astonishing. Now we have to wait to see what the capacity issues in the Mater Hospital are before anything happens in Navan. There will be huge disappointment in County Meath in this regard and I will pursue the matter with the Minister for Health himself in due course.

While I note the Senator's comments, it is only fair to point out that Deputy McGinley is only the bearer of the message.

As I have said, the Senator's message will be conveyed to the Department and in the absence of the Minister, I must say that I believe the Senator is being overly pessimistic about Navan. Construction work is going on there at the moment and units will be built. However, we all know that if there is major trauma involved, patients will have to be transferred to one of the larger hospitals. In Donegal, such patients must go to Beaumont Hospital in Dublin. With all due respect, patients in Navan would not have to travel the same distances. The short response I have just read contains a list of guarantees which should reassure the people of Navan that their hospital will continue to operate as a vital cog in the wheel of health services provision for the people in the eastern region.

Treatment Abroad Scheme

I welcome the Minister of State to the House and hope he can provide me with some good news on the matter I am raising on the Adjournment. I wish to draw attention to the plight of a young man I met recently, a 22 year old constituent of mine suffering from a rare, debilitating condition called Ehlers-Danlos syndrome, hypermobility type. This young man is severely disabled as a result of this condition and displays marked, widespread joint hypermobility. Basically, he is constantly suffering dislocations, up to 18 times per day. As he is prone to recurrent dislocations he frequently requires hospital accident and emergency admissions, particularly for his left shoulder. This is the only joint, according to his mother, that he cannot replace himself. It is pitiful to see such a young man in this condition. While he can put his fingers back into place, he cannot put his shoulder back and every seven to ten days, he is admitted to Our Lady of Lourdes Hospital, where he has to be completely anaesthetised so that his shoulder can be put back into place. This has been ongoing since he was diagnosed with this rare condition. It has interfered with his schooling and prevented him from taking part in the normal, everyday activities that most young people engage in.

After a case conference of consultants in 2012, it was accepted by the consultants that there was no one in Ireland who could treat this young man and he was referred by a consultant orthopaedic surgeon to Britain for treatment. I have all of the documentation relating to this referral. His travel was approved by the treatment abroad scheme and he went to Britain. It seemed that a solution had been found and that he could undergo a rehabilitation programme which was due to commence in September 2012. He went to England and was assessed by an orthopaedic team there. However, on 14 September last, the day before he was due to travel for his treatment, he was informed that his costs would not be covered by the scheme because the scheme did not cover second opinions. Every time I have raised this matter, I have been told that the scheme does not cover a second opinion. However, I have a letter from the orthopaedic consultant concerned who wrote to the HSE and said that he was puzzled by the HSE's decision. He went on to point out that there is much correspondence in regard to this young man's problem and his application for treatment abroad. The consultant confirmed that the young man has been seen by every specialist upper limb surgeon in Ireland, that his case was discussed at a shoulder conference and on foot of that case conference, his treatment in Britain was arranged. The consultant argued that, in view of the fact the young man has already been seen by every upper limb specialist in Ireland, the decision and comments of the HSE were difficult to understand.

I have read through all of the correspondence and I met the young man in person when I received extremely distressed correspondence from his mother. It is dreadful that a 22 year old is frequently confined to a wheelchair when the dislocations become too much. I am at a total loss as to why this case cannot be examined again. He received a letter telling him to reapply for the scheme or to return to Cappagh Hospital or the orthopaedic surgeons he has already seen. However, it is acknowledged, in writing, that he has been seen by every orthopaedic surgeon in the country.

I hope the Minister of State can provide some new insight into this case and, more importantly, some good news for this young man who is suffering terribly. As I have already said, his condition has interfered with his life in a physical way but lately it has begun to affect him mentally. In fact, there has been a danger to his life in recent months. He feels at a total loss and that nobody can help him. I do not know if this is a question of finance but one must ask how much it is costing the HSE to bring this man through accident and emergency and into theatre every week, with all of the associated expenses, including anaesthesia? I would be really grateful if some solution could be found so that this young man can lead the active life to which he is entitled and which he could lead, if given the correct treatment.

I thank Senator Moran for raising this matter and for giving such a comprehensive description of this young man's situation.

The HSE operates the treatment abroad scheme, TAS, for persons entitled to treatment in another EU or EEA member state or Switzerland under EU Regulation 883/04, as per the procedures set out in EU Regulation 987/09 and in accordance with the Department of Health guidelines. Within these governing EU regulations and the Department of Health guidelines, the TAS provides for the cost of approved treatments in another EU or EEA member state or Switzerland through the issue of form S2, formally known as an El12.

The TAS allows for an Irish-based medical consultant to refer a patient who is normally resident in Ireland for treatment in another EU or EEA member state or Switzerland, where the treatment in question meets certain criteria, is not available within the State or is not available within a time normally necessary for obtaining it. Following clinical assessment, the referring consultant certifies the following: the treatment is medically necessary and will meet the patient's needs; the treatment is a proven form of medical treatment and is not experimental or test treatment; the treatment is in a recognised hospital or institution and is under the control of a registered medical practitioner; and the hospital outside the State will accept EU or EEA form S2. The application to refer a patient abroad has to be assessed by the HSE normally within 15 to 20 working days and a determination given before that patient goes abroad. Appointments should not be scheduled prior to a decision being reached on an application.

The situation with this particular case is that the TAS of the HSE received an application from the person involved and issued a letter informing him that, in line with the governing EU regulations and Department of Health guidelines, his application did not meet the criteria for the scheme. This decision was confirmed in a review of the case by the general manager of the TAS. In order to advance this case, a letter was issued by the TAS to the person concerned following the review.

The letter recommended that he seek a referral to the tertiary services in Ireland in the first instance and confirmed that should his consultant identify a treatment, as opposed to a request for a second opinion, then he is free to re-apply accordingly. The HSE is not permitted to transfer a patient's care abroad without recourse to the EU regulations referred to above. Until the HSE receives a valid application from the person it is not possible to progress the matter any further at this stage.

I am decidedly disappointed with this response. It is certainly not clear. The Minister of State said he must go back to look for tertiary services, but he has done that and we have the letter to prove it. The surgeon has stated that he has seen everyone in Ireland. The treatment sought is in one of the most well-known hospitals in England. Two consultant orthopaedic physicians, one a professor, have signed letters stating that he is in need of this treatment. I am at a loss to understand the response to a request for something that is obviously minor, although perhaps I should not say minor. I cannot fathom why it cannot be considered. I strongly call on the Minister of State to take this back to the Minister for Health and perhaps open up correspondence with the family involved to encourage them. They are not going to accept this. They have given all the details. I call on the Minister to enter into a correspondence to help this young man achieve the best of his ability rather than subject him to a life of pain. He is experiencing excruciating pain on an ongoing basis and yet this treatment could help him and his family. I have met his mother, who is totally distraught at this stage, as I or the Minister of State would be if one of my children or his children were in the same situation.

I understand the Senator's concern. I realise the Senator has met this young person and is aware of the trauma he is experiencing. I believe the door is not firmly shut and there is an opening as far as I can see. As I have stated, until the HSE receives a valid application from the person it is not possible to progress the matter any further. This means if a further, valid application is submitted it will be considered by the HSE. All I can say at this stage is that Senator Moran's concerns and the points made will be brought to the attention of those whose responsibility it is to decide on the matter.

I appreciate that.

The Seanad adjourned at 2.15 p.m. until 10.30 a.m. on Wednesday, 22 May 2013.
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