'Overly complex’ HSE scheme caused 'unnecessary distress', says Ombudsman

A man with a rare, painful, and debilitating disease was denied HSE funding for specialist treatment abroad due to shortcomings in the scheme designed to finance such requests, an Ombudsman investigation has found.

Ombudsman Peter Tyndall has today published a report following his investigation into the HSE’s administration of the Treatment Abroad Scheme following a number of complaints the scheme is overly complex: there were delays in approving applications, the process lacks transparency, and some applicants were being given incorrect information.

The Treatment Abroad Scheme (TAS) provides funding to allow Irish public patients access healthcare in other EU countries, the European Economic Area or Switzerland that is not available here.

Fewer than 800 patients apply for TAS yearly and the expenditure averaged approximately €9 million for the last four years.

The report states that the examination of a specific man’s complaint “identified significant shortfalls and weaknesses in the TAS application process, which resulted in unnecessary distress and delay for the patient and his family”.

“A wider-ranging investigation of the TAS application and assessment process identified administrative weaknesses, which left unchecked, have the potential to cause similar delay and distress for others,” the report said.

Speaking ahead of the report’s publication, Mr Tyndall said some people had difficulties with their applications under the scheme.

“These are people who are waiting for treatment or surgery so the impact on them can be particularly severe.

“I am glad to say that the HSE has co-operated with my investigation and has fully accepted my recommendations which are aimed at improving the operation of the scheme,” he said.

Another complaint concerned a woman who sought treatment in Germany but only to be told that she was not eligible for TAS as the treatment was available in Ireland - despite that not being the case.

The woman had received funding for two previous trips abroad for the same treatment, and her complaint prompted an Ombudsman investigation which established the treatment was not available in Ireland.

The report makes a number of recommendations, including improvements in the appeals’ process for refused applicants, and the establishment of a ‘pre-referral’ check to ensure a patient’s application meets the TAS criteria, rather than refusing them at the end of a lengthy application process.