The HSE operates a Treatment Abroad Scheme (TAS), for persons entitled to treatment in another EU/EEA member state or Switzerland under EU Regulation 1408/71, as per the procedures set out in EU Regulation 574/72, and in accordance with Department of Health Guidelines. Within these governing EU Regulations and the Department of Health and Children's Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE).
The TAS allows for an Irish based consultant to refer a patient that is normally resident in Ireland for treatment in another EU member state or Switzerland, where the treatment in question meets the following criteria:
(a) The application to refer a patient abroad has been assessed and a determination given before that patient goes abroad.
(b) Following clinical assessment, the referring consultant certifies the following:
- They recommend the patient be treated in another EU/EEA country or Switzerland;
- 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 other institution and is under the control of a registered medical practitioner;
- The hospital outside the state will accept EU/EEA form E112 (IE).
In recent past months the TAS has had a number of applications for the Selective Dorsal Rhizotomy procedure for which there is an emerging evidence base. The British National Health Service (NHS), which provides the treatment for patients that have received approval under the TAS, has published guidance for the provision of same. This guidance states:
Current evidence on selective dorsal rhizotomy for spasticity in cerebral palsy shows that there is a risk of serious but well-recognised complications. The evidence on efficacy is adequate.....During the consent process parents or carers should be informed that selective dorsal rhizotomy....is irreversible...
All applications to the TAS are independently assessed by the HSE Health Intelligence Unit. In consideration of the NHS guidelines for referral for this procedure, the HSE worked with leading paediatric consultants to establish an assessment procedure in Ireland for patients seeking referral for the procedure, prior to the patients' applications being submitted to the TAS to ensure the patient is a suitable candidate for the procedure and to ensure the parent(s) or carer fully understands the procedure and the implications of same.
The HSE’s Treatment Abroad Scheme and Health Intelligence Unit met with relevant consultants in May 2012 to review the matter of referrals for selective dorsal rhizotomy (SDR) and agreed on the need for a rigorous assessment procedure in Ireland and that patients seeking this treatment must attend the assessment team in order to have recourse to the TAS for the treatment. Subsequently, an assessment team was established in the Central Remedial Clinic (CRC) and all applications for SDR are now independently reviewed by the CRC team who therefore act as the independent medical advisors to the TAS on SDR applications. The team follow strict assessment criteria for the approval or otherwise of applications for SDR procedures.
The procedure abroad includes three weeks of inpatient physiotherapy and parents are trained in providing the subsequent required physio for the post op period in the home. Aftercare services in Ireland are provided in line with the clinical management of the patient by the referring consultant upon the patient's return to Ireland.