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Health Services

Dáil Éireann Debate, Wednesday - 28 April 2021

Wednesday, 28 April 2021

Questions (915)

David Cullinane


915. Deputy David Cullinane asked the Minister for Health the entitlements of persons with endometriosis to medical treatment here and abroad; the extent to which this is covered by the public system; the extent to which this is covered by private health insurance and rights to treatment under same; and if he will make a statement on the matter. [21390/21]

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Written answers (Question to Health)

The commitment to promoting women's health is highlighted within the Programme for Government. This includes a specific commitment to supporting "the work of the Women’s Health Taskforce, including the development of a Women’s Health Action Plan, to tackle a wide range of issues impacting women’s health outcomes in Ireland". A number of initial priority areas for action were determined by the Taskforce, with the issue of endometriosis recognised and included as part of a priority workstream on improving gynaecological health for women and girls.

The endometriosis workstream identified a number of potential actions in this area, including enhanced services and supports such as the establishment of a centre of excellence for endometriosis surgery and optional access to psychologists in women’s health settings, and enhanced information including a clear patient flow for period/pelvic pain and excessive bleeding and a communications and education strategy to raise awareness of endometriosis and the supports and treatments available.

Budget 2021 has provided a dedicated €5million ‘Women’s Health Fund’ to progress a programme of actions arising from the work of the Women’s Health Taskforce. On 21 April I announced the first two areas to be funded from the Fund: two community-based Ambulatory Gynaecology Services in Tallaght and Limerick/Nenagh and the expansion of the endometriosis service at Tallaght University Hospital.

The expansion of the endometriosis service at Tallaght University Hospital, with an associated cost of €641k, will deliver a specialist endometriosis centre for the management and treatment of all forms of endometriosis, with particular focus on advanced and complex cases for which there is no ready access in Ireland. Endometriosis is estimated to affect 1 in 10 women and represents one of the top four categories of symptoms that comprise approximately 80% of gynaecology referrals. The provision of a secure, supported, expanded and specialist service in Tallaght University Hospital will help to improve both clinical outcomes and overall care experience for women suffering from this debilitating condition.

In addition, the Deputy may wish to note that the  HSE’s National Women & Infants Health Programme has advised that the best way to help the majority of patients with endometriosis is to improve access to gynaecology services.  As such, the Programme has developed a plan to increase capacity and reduce waiting times for women awaiting general gynaecology, which includes patients with endometriosis. The plan aims to re-orient general gynaecology services to an ambulatory, or see and treat, model, rather than the traditional outpatient referral model.  An ambulatory care model is a more efficient and effective use of resources.  It is also better for the patient as it reduces the requirement for multiple outpatient appointments.

The roll out of Phase One of the new Model of Care commenced in 2020, and the first three clinics were established under the governance of the Rotunda Hospital, Cork University Maternity Hospital, and University Hospital Galway and are providing services. Development funding has been provided in 2021, which will accelerate the implementation of the Model of Care, through the establishment of additional ambulatory gynaecology clinics this year.  Subject to available resources, it is envisaged that up to 19 such clinics will be rolled out in the coming years.

The Deputy has also asked about treatment abroad for endometriosis. The HSE operates a Treatment Abroad Scheme (TAS), for persons entitled under EU Regulation 883/04.  The TAS is a consultant lead scheme and allows for an Ireland-based public consultant to refer a public patient who is normally resident in Ireland for treatment in the public healthcare system of another EU member state, the UK or Switzerland. Subject to the EU Regulations and Guidelines, the TAS provides for the cost of approved public treatments in another EU/EEA member state, the UK or Switzerland through the issue of form S2 (IE) where the treatment is:

- Among the benefits provided for by Irish legislation,

- Not available in Ireland,

- Not available within the time normally necessary for obtaining it in Ireland, taking account of the patient's current state of health and the probable course of the disease. medically necessary and will meet the patient’s needs;

- a proven form of medical treatment and not experimental or test treatment;

- provided in a recognised public hospital or other institution that will accept EU/EEA form S2 (IE) and;

- is under the control of a registered medical practitioner.

As Minister for Health I do not have a role in directing insurers to provide coverage for treatments beyond those prescribed in the minimum benefit regulations. The minimum benefit regulations provide that all health insurance contracts must provide cover for a broad range of in-patient hospital services, and these include laparoscopy for diagnosis and/or treatment of endometriosis. I would advise any health insurance customer seeking treatment for endometriosis to consult their table of benefits and contact their insurer to determine what treatments their health insurance contract covers.

When it comes to treatment abroad via health insurance for endometriosis, again this differs depending on the health insurance contract in question. The minimum benefit regulations do not provide that health insurers must provide cover for treatment abroad, but many plans do where a treatment is medically necessary and the required procedure is not available in Ireland. Again, I would advise a health insurance customer seeking treatment abroad for endometriosis or any other condition to consult the table of benefits for their health insurance contract and to contact their insurer when planning treatment abroad.