Dáil Éireann Debate, Thursday - 16 June 2022
548. Deputy Holly Cairns asked the Minister for Health the steps that he is taking in response to issues raised concerning access to prosthetics by an organisation (details supplied) including the cost that persons have to pay. [31734/22]
Amharc ar fhreagraThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines and medical items, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
The HSE provides a wide range of medical and surgical aids and appliances, including prosthetics, free of charge to eligible persons (such as medical card holders and people on the Long-Term Illness scheme) following assessment by a relevant health professional. These are provided through community services known as Community Funded Schemes and play a key role in assisting and supporting people to maintain everyday functioning, and to remain living in their homes and local community.
Applications for such appliances made within Community Health Organisations (CHOs) are assessed by the local Resource Allocation Group and a determination is made regarding approval based on clinical priority and the funding available. At times, due to the demand for resources exceeding the available capacity, waiting lists may apply for some categories of items but CHOs undertake a range of initiatives to ensure optimum use of resources.
Amputees, whose amputation arose from either a traumatic or elective event, usually have their primary prosthesis fitted at the hospital where the surgery was undertaken. Subsequent prostheses are provided to eligible clients through the Community Funded Schemes. Rehabilitation services are provided by the National Rehabilitation Hospital (NRH) primarily at their site in Dun Laoghaire and augmented by a number of satellite clinics that they operate throughout the country. There are also a number of smaller services operated at regional level that provide assessment and fitting clinics along with prostheses at a local level.
A HSE Primary Care led National Service Improvement Programme has the aim of improving the equity of access, value for money, and functional processes of the Community Funded Schemes through the establishment of national guidelines for the provision of medical and surgical aids and appliances. While this work was delayed due to the Covid-19 pandemic, the Programme has recommenced. A review of the current prosthetics service is underway and is due to be completed by early 2023.
The Long Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.
