Uro-gynaecological (transvaginal) mesh devices have been widely used for the past two decades for the treatment of stress urinary incontinence and pelvic organ prolapse. While many patients have benefitted from mesh implant procedures, over time it has emerged both nationally and internationally that women have experienced complications associated with these products which have impacted on their health and quality of life.
In July 2018, the Chief Medical Officer (CMO) asked the HSE to pause all vaginal mesh surgical procedures where clinically safe to do so, pending implementation of recommendations as set out in his report on The Use of Uro-Gynaecological Mesh in Surgical Procedures.
While uro-gynaecological mesh procedures are paused in Ireland, the procedure remains available in some European countries. The Department is aware that a small number of women have applied for funding through the Travel Abroad Scheme and Cross-Border Directive to travel to the EU, EEA, and Switzerland for uro-gynaecological mesh implant procedures.
The HSE operates the EU Treatment Abroad Scheme (TAS), for persons entitled under EU Regulation 883/04. The EU Treatment Abroad Scheme (TAS) is a consultant-led scheme that allows an Irish-based public consultant to refer a public patient normally resident in Ireland for treatment in the public healthcare system of another EU member state, the UK or Switzerland. In general, the TAS provides for the cost of approved public treatments, where the treatment is not available in Ireland.
The HSE has advised that as mesh implant treatment is not currently available in Ireland due to the pause on the service, it is possible for patients to use the TAS to access the treatment abroad for Stress Urinary Incontinence. During the period 2024 to 2026 YTD, 8 patients have been approved for TAS funding with an associated cost of €29,063.06 in respect of MESH implants.
The EU Cross Border Directive (2011/24/EU) provides rules for the reimbursements to patients of the cost of receiving treatment abroad, where the patient would be entitled to such treatment in their home Member State, and supplements the rights that patients already have at EU level. The HSE operates the EU Cross Border Directive (CBD) in Ireland. Under the terms of the EU CBD, patients in Ireland can seek to be referred to another EU/EEA country for medical treatment where the Health Service Executive is satisfied that the patient was entitled to the healthcare in question in the public health service in Ireland. The patient may access the overseas service in either the public or private health sector of the country they choose to receive the service in. The patient pays for the treatment and claims reimbursement from the HSE at the cost of that treatment in Ireland or the cost of it abroad, whichever is the lesser. The HSE has advised that HSE data in relation to Mesh treatments that patients access under the CBD is currently unavailable.
The Treatment Abroad Scheme and Cross Border Directive scheme operate within the overall health expenditure framework approved by the Oireachtas through the Estimates process and reflected in the HSE National Service Plan. The HSE is required, under the Performance and Accountability Framework agreed with my Department, to deliver all services, including the Treatment Abroad Scheme and Cross Border Directive scheme, within its overall annual budget allocation and to put in place appropriate governance, monitoring and financial controls.
