Tuesday, 26 November 2019

Ceisteanna (46)

Brendan Smith


46. Deputy Brendan Smith asked the Minister for Health if additional resources will be provided for the processing of claims under the cross-border directive [48868/19]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)

The cross-border directive scheme has become more and more popular, there is a greater awareness of it and we all know of people who have availed of it. At present, in my reckoning from dealing with constituency cases, there is a three and half month delay in having reimbursement applications processed and approved, and payment made. We know many of the people who avail of the scheme are elderly and they have to borrow in many instances, be it from family or financial institutions, and they worry about the delay in getting reimbursement. There is an obvious need to devote more resources to this scheme to eliminate these delays, which are not acceptable.

I thank the Deputy for raising this question and I know of his particular interest as this is a matter he has raised in this House on a number of occasions. I very much appreciate the importance of the cross-border directive and we have worked very hard, in the context of Brexit, to make sure cross-border healthcare, and healthcare North and South on this island, and east and west, can continue. I am very pleased with the progress that has been made in this regard.

The cross-border directive allows public patients to access necessary healthcare, which they would have been entitled to access in the public healthcare system in Ireland, in another EU or EEA country. The patient pays upfront for the treatment and is reimbursed upon return to Ireland.

The HSE is responsible for the operation of the cross-border directive and has a dedicated cross-border directive office for this purpose. Since being introduced in 2014, awareness of the provisions of the directive has grown steadily. In 2015, the first full year of operation of the scheme, 150 reimbursements were made at a cost of €585,863. In 2018, some 3,886 reimbursement claims were processed, at a value in excess of €12 million. Significant further growth is expected in 2019 as people become more aware of the scheme, and we are seeing this across the EU.

The growth in use of the scheme has placed additional demands on the cross-border directive office and given rise to a build-up of applications. It is important that this service operates in a responsive way, and that both treatment approvals and reimbursement applications are processed within a reasonable timeframe. I, therefore, requested the HSE to examine current resourcing of the cross-border directive office and to identify any necessary actions needed to mitigate waiting times arising from current demands for the scheme. I am pleased to inform the Deputy that I have now been advised by the HSE that additional resources are being allocated and specific initiatives implemented to urgently address the backlog and delays in reimbursement. My Department will continue to engage with the HSE to ensure that the measures being implemented facilitate the efficient ongoing operation of the scheme.

In the next couple of weeks, we will be publishing the HSE service plan for 2020. I expect and, indeed, am aware that the plan will show a very significant increase in the resources being provided to this office to do exactly what the Deputy is suggesting.

I welcome the additional resources being provided. From speaking to constituents throughout Cavan and Monaghan, and from the point of view of a public representative, I know the personnel in that cross-border directive office are exceptionally helpful and courteous to people, and they go beyond the call of duty to try to help people. It is very important, when the office is under pressure, to recognise the good work they are doing under difficult circumstances.

Most of the people availing of the cross-border directive are aged over 60 or even over 70. We are aware that most of the procedures undertaken are either on hips, knees or cataracts, and it is predominantly the older age groups that need to have those procedures. We are aware that most people who avail of the scheme are pensioners and are on limited incomes. In many instances, as I said, they borrow money, perhaps from family or from a credit union, and they are extremely worried about any delay in being able to pay back the person or the institution they borrowed from. To allay the fears of those people, it is particularly important that payments are made in good time.

My understanding was that, at some stage, the HSE proposed that it wanted a turnaround of 20 working days, which is roughly a month, and I believe that is what we should aspire to. Over the years, there were regulations and legislation stating that Departments and statutory agencies should have a minimum time to pay their debts. In this instance, it is a debt to the patient who has gone and paid their own way initially because of the lack of capacity here. It is a win-win for many patients, but we do not want to have the good taken out of those procedures by having that person worry about the payment.

I agree with Deputy Smith, who is correct. My understanding is that, roughly, there is now a waiting time for processing of applications of about two months and the office is processing applications for reimbursement received in September. I agree with the Deputy that the staff in the office, many of them I know and I hear this on a regular basis, are exceptionally helpful and go above and beyond the call of duty. The Deputy will agree, and the facts will show, it is not a financial resource issue but a need to resource the office financially in terms of staffing, and that is exactly what we are doing.

Recognising the issues, officials in my Department have met the HSE to discuss the issue of reimbursement delays. We requested that mitigating measures be identified and put in place. I am pleased to confirm that various steps are now being taken by the HSE to deal with delays in the processing of applications. As a first step to addressing the issue in the short term, the HSE has arranged for the provision of overtime for existing staff and deployed additional staff in the cross-border office.

As for longer-term measures, the HSE is now in the process of recruiting further additional staff and sourcing extra accommodation. I understand that the recruitment of additional staff is imminent and that alternative accommodation has been identified to house the expanded complement of staff for the cross-border directive office. The combined effect of these actions will help address much of the existing backlog and alleviate the ongoing pressure on resources. Officials in my Department will continue to liaise with the HSE in this regard, and I expect the service plan also to reflect this.

My understanding from my constituency work is that the applications made in August are the ones being processed at present, so the turnaround is in excess of three months. We want it back to 20 working days if at all possible. In the most recent exchange the Minister and I had on this issue on Question Time, I pointed to the farce whereby newspapers in Northern Ireland were carrying advertisements from the private hospitals in our State looking for patients to come to avail of the cross-border directive. Similarly, in our provincial and national newspapers here we have advertisements from the private hospital sector in Northern Ireland looking for patients to travel to Northern Ireland's clinics and hospitals to avail of the cross-border directive. There is a good case for more direct funding for the National Treatment Purchase Fund and use of the capacity within our own private hospital sector rather than having people trek from one end of our island to the other. We should maximise the capacity within our own hospital system as much as possible.

I agree with the Deputy. The only slight caveat I will offer - I know he will agree with me on this - is that there is additional capacity in some of our smaller public hospitals as well, including in the Deputy's own constituency. He has spoken to me about this. I refer to Cavan hospital and particularly Monaghan hospital. We should be and indeed we are asking the NTPF and the HSE to identify more that can be done there. I do not want to see any funding leave our State, nor ideally do I want to see any money leave the public health service and go into the private health service if that can be avoided.

My note tells me the HSE is processing applications for reimbursement received in September, but I am open to correction on that. As for ensuring fairness of approach, the cross-border office must process all applications received in chronological order. In short, I reassure the Deputy's constituents that we will fix this through additional staff and the additional office accommodation those staff will require. The recruitment of additional staff is imminent. The locating of additional accommodation, I understand, is well under way. There will be significant extra resourcing of this office in the HSE service plan for 2020 and we will continue to support the office in doing its good work.

Question No. 47 replied to with Written Answers.