Brendan Smith demands faster Cross-Border Directive reimbursements

Thank you very much. As all of us in this House know, the Crossbow, the Directive Scheme has become more and more popular. There's a greater awareness of it. We all know of people who have availed of it. Minister, at the moment, in my reckoning, indeed, in constituency cases, there's about a three and a half month delay in having reimbursements, applications, processed and approved and payment made. We know that many of the people who are availing of the scheme are elderly people. They have to borrow, in many instances, be it from family or from financial institutions, they worry about the delay in pay in getting the reimbursement. So, Minister, there's an obvious need to devote more resources to this scheme to eliminate these delays that are not acceptable. Thank you, Deputy. On that. Thank you, Smith, for raising this question. I know she's of particular interest in this. This is a matter he's raised in this House on a number of occasions. I very much appreciate the importance of the Cross-Border Directive. We worked very hard in the context of Brexit, also, to make sure that cross-border health care, and indeed health care north and south on this island and east and west, can continue, and I'm very pleased with the progress that has been made in this regard. The Cross-Border Directive allows public patients to access necessary health care, which they would have been entitled to access in the public health care system in Ireland in another EU or EEA country, and the patient pays up front for their treatment but is then 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, 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 and more aware. We are seeing this indeed right across the European Union. The growth in the use of this scheme has placed additional demands on the Cross-Border Directive office and has 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 the 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 this backlog, delays and 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. What I can say to the Deputy is that in the next couple of weeks we will be publishing the HSE service plan for 2020. I expect and indeed I am aware that that plan will show a very significant increase in the resources being provided to this office to do exactly what the Deputy is suggesting. I will welcome additional resources being provided. I am going to just say at the outset as well Minister, that speaking to constituents right throughout Cavan Monaghan and from the point of view as a public representative as well, the personnel in that Cross-Border Directive scheme, they are exceptionally helpful, courteous to people and they go beyond the call of duty to try to help people. And I think that is very important where an office is under pressure to recognise the good work that they are doing under difficult times. Minister, most of the people availing of the Cross-Border Directive are people aged 60 plus or 70 plus. Because we are aware that most of the procedures that are undertaken are either hips, knees and cataracts. And predominantly it is the older age groups who have to have those procedures. We are well aware that most of the people who are availing of the scheme, they are pensioners. They are on limited income. In many instances, as I said earlier, they borrow money maybe from family or from a credit union or whatever. They are extremely worried then about the delay in being able to pay back the person or the institution that they borrowed from. So Minister, it is particularly important to allay the fears of those people that payments are made in good time. My understanding was at some stage at the HSE were proposing that they wanted a turnaround of 20 working days. That is roughly a month. And I think, Minister, that is what we should be aspiring to. And, of course, over the years there were regulations and legislation that departments and statutory agencies should have a minimum time to pay their debts. In this instance, Minister, it is a debt to the patient who had gone and paid their own way initially because of that lack of capacity here. So it is a win-win situation for many patients. But we do not want to have the good taken out of those procedures by that person worrying about the payment. I agree with Deputy Smith. I think he is correct. My understanding is that, roughly speaking, the waiting time for processing of applications now is about two months. I think they are processing applications for reimbursement now received in September. I want to agree with the Deputy that the staff in the office, and I know many of them and I indeed hear this on a regular basis, are exceptionally helpful, do go above and beyond the call of duty. And I think the Deputy would agree and indeed the facts will show it is not a financial resourcing issue, it is a need to resource the office financially in terms of staffing. And that is exactly what we are doing now and recognising the issues. Officials in my department have met with the HSE to discuss the issue of reimbursement delays. And we did request that mitigating measures be identified and put in place. And I can confirm, and 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 address 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 well. In terms of 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. So I do believe the combined effect of these actions will help address much of the existing backlog and alleviate the ongoing pressure on the resources. And officials in my own department will continue to liaise with the HSE in this regard. And I expect the service plan also to reflect this. Mr Prime Minister, my understanding, and this is for my own constituency work, is that it is that applications that were made in August, that they are the ones being processed at the present time. So it is in excess of three months at the moment. But what we want it back is 20 working days if at all possible. Minister, in the last exchange we had in this House at Quest Time on this issue, I pointed to the farcical situation where we would have newspapers in Northern Ireland advertising or 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 newspapers and our national newspapers here, we have advertisements from the private hospital sector in Northern Ireland looking for patients to travel to their clinics and hospitals to avail of the Cross Border Directive. Minister, there is a good case for more funding to be put directly to the National Treatment Purchase Fund and use the capacity within our own private hospital sector, not having people to trek from one end of our island to the other. I think we should maximise and use the capacity within our own hospital system as much as is possible. The only slight caveat I place, and I know he would agree with me on this as well, is I do believe there is actual additional capacity in some of our smaller public hospitals as well, and indeed in the deputy's own constituency, and I know he has spoken to me about this, but in Cavan and perhaps particularly in Monaghan Hospital, we should be asking and indeed are asking the NTBF and the HSE to identify more that can be done there. I do not want to see any funding leave our state and I also ideally do not want to see any money leave the public health service and go to the private health service if it can be avoided. My own note tells me that the HSE is processing applications for reimbursement received in September, but I am open to correction on that. And I suppose in terms of ensuring fairness of approach, the cross-border office obviously has to process all applications received in chronological order. But in short, I would say to the deputy and reassure his constituents, we are going to fix this. We are going to fix it through additional staff and indeed the additional office accommodation that those staff will require. The recruitment of additional staff is imminent. The location of additional accommodation, I understand, is well underway. There will be significant extra resourcing of this office in the HSE service plan for 2020, and we will continue to support this office in doing its good work. Thank you Minister.