The Ombudsman, Mr Ger Deering, speaks about his investigation into the HSE’s Treatment Abroad schemes

"In April 2023 my Office published ‘In Sickness and In Debt’ - a report on our investigation into the administration by the Health Service Executive of schemes that fund necessary medical treatment in the EU/EEA or UK (primarily the Cross Border Directive and the Northern Ireland Planned Healthcare Scheme). Our investigation found an unreasonable and inflexible approach by the HSE in administering some aspects of the schemes.

The schemes fund treatment abroad for healthcare which the State is either unable to provide, or unable to provide in a timely manner in Ireland. The schemes are designed to allow patients who cannot access necessary healthcare at home, either due to the cost or the waiting period, to travel abroad to receive that healthcare. The patient then seeks reimbursement of the cost of the treatment from the HSE. The investigation was triggered by a number of complaints my Office received from patients who had accessed the necessary healthcare abroad but had then been unable to access reimbursement under the schemes. Although the number of complaints to my Office had been low in the context of the overall schemes, I was struck by the impact on the physical, mental, and financial well-being that the process had on certain patients.

The report made 21 recommendations which focused on improving the administration of the schemes, both moving forward and in the investigation of complaints that remained with my Office. I am pleased to say that the HSE accepted all of the report’s recommendations and it put together a team to deal with their implementation. That team is also reviewing cases at either the request of my Office or at the request of the patient themselves. To date there have been over 200 cases identified for review and the HSE is continuing to work through those.

Already my Office has seen patients receive reimbursements who were previously denied payment due to minor or administrative issues with referral letters. We have seen patients who disputed the level of reimbursement provided access to a meaningful appeals process and, in many cases, a full re-evaluation of the cost has led to an increased reimbursement for those patients. We have also seen patients receive reimbursement who borrowed from family members to pay for the treatment but were denied reimbursement due to the HSE’s onerous ‘proof of payments’ requirement.

My Office has continued to liaise with the HSE since the report was published last April and I welcome the progress being made by the HSE in implementing the recommendations in the report. I am confident that the full implementation of the recommendations will have a positive effect for patients seeking reimbursements under any of the treatment abroad schemes and will put those patients at the centre of all future decisions."

The report, ‘In Sickness and In Debt’, is available on the Ombudsman’s website: www.ombudsman.ie