Written Answers Nos. 799-828
799. Deputy Ken O'Flynn asked the Minister for Health whether any formal expenditure ceiling, cap, or upper limit applies to funding approvals under the treatment abroad scheme; if so, the value of such limits; and if no such ceiling exists, the rationale for the absence of expenditure controls in a publicly funded scheme. [28118/26]
Amharc ar fhreagra800. Deputy Ken O'Flynn asked the Minister for Health whether there is a maximum cost threshold per patient under the treatment abroad scheme; if so, the level at which additional approvals are required; and the approval process triggered when such thresholds are exceeded. [28119/26]
Amharc ar fhreagra801. Deputy Ken O'Flynn asked the Minister for Health the approval hierarchy in place for treatment abroad scheme funding decisions, including the grade or role of officials authorised to approve standard applications and high-cost or complex cases; and whether Ministerial or Departmental sanction is required above specified thresholds. [28120/26]
Amharc ar fhreagra805. Deputy Ken O'Flynn asked the Minister for Health the specific oversight mechanisms exercised by her Department in relation to the treatment abroad scheme, including whether regular reporting, budget monitoring, or performance review processes are in place; and the frequency of such oversight. [28124/26]
Amharc ar fhreagra809. Deputy Ken O'Flynn asked the Minister for Health to identify the specific division within her Department responsible for oversight of treatment abroad scheme expenditure; the grade and title of the official designated as budget holder for the Scheme; and whether that individual has formal responsibility for approving or rejecting expenditure variances. [28128/26]
Amharc ar fhreagra810. Deputy Ken O'Flynn asked the Minister for Health whether a defined annual budget ceiling is set for the treatment abroad scheme; if so, the ceiling in each year from 2020 to 2026; and the process by which expenditure exceeding projections is approved or sanctioned. [28129/26]
Amharc ar fhreagraI propose to take Questions Nos. 799, 800, 801, 805, 809 and 810 together.
The Treatment Abroad Scheme operates 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, within its overall annual budget allocation and to put in place appropriate governance, monitoring and financial controls.
While access to the Treatment Abroad Scheme is determined by individual clinical eligibility rather than fixed activity quotas, it is not exempt from budgetary oversight. Expenditure on the scheme is monitored as part of the HSE’s monthly financial reporting, and pressures arising within the scheme must be managed by the HSE within its overall annual budget allocation.
There are no financial caps applied to referrals under the Treatment Abroad Scheme. Notwithstanding that treatment costs are set by external health systems, the HSE applies statutory eligibility, prior approval, verification and audit controls, with my Department assuring value for money at system level through the budgetary and performance framework within which the HSE operates.
As the detailed operation of the Treatment Abroad Scheme, including the specific control measures in place, is an operational matter for the HSE, I have referred the Deputy’s question to the HSE for direct response.
802. Deputy Ken O'Flynn asked the Minister for Health whether a formal written policy, circular, or governance framework governs approvals under the treatment abroad scheme; if so, to provide the title and date of such policy; and if not, the basis upon which consistent decision-making is ensured. [28121/26]
Amharc ar fhreagra808. Deputy Ken O'Flynn asked the Minister for Health the policy basis upon which ongoing referrals and funding approvals are authorised under the treatment abroad scheme, including whether such approvals are governed by national clinical policy, EU regulation alone, or Departmental guidance. [28127/26]
Amharc ar fhreagra811. Deputy Ken O'Flynn asked the Minister for Health to set out the full approval chain for individual high-cost treatments funded under the treatment abroad scheme, including whether financial approval is distinct from clinical approval and the level at which final sign-off occurs. [28130/26]
Amharc ar fhreagraI propose to take Questions Nos. 802, 808 and 811 together.
As the Deputy will be aware, the HSE operates the Treatment Abroad Scheme (TAS) for persons entitled to treatment in another EU/EEA member state, UK or Switzerland under Regulation (EC) No. 883/2004, as per the procedures set out in Regulation (EC) No. 987/2009. Subject to the EU Regulations and Guidelines, patients may apply to the HSE TAS seeking access to public health care outside the state through the issue of form S2 (IE). The application requires the patient's referring hospital consultant based in Ireland, following clinical assessment, to certify, among other things, that the treatment is medically necessary and will meet the patient’s needs. The treatment must not be available within the State or not available within the time normally necessary for obtaining it in Ireland, taking account of the patient's current state of health and the probable course of the disease. Applications to the TAS are processed and a determination given in accordance with the statutory framework prior to a patient travelling to avail of treatment.
Information and guidelines on the EU Social Security Co-ordination governing legislative framework are available on the European Commission website:
• https://employment-social-affairs.ec.europa.eu/policies-and-activities/moving-working-europe/eu-social-security-coordination/specialised-information/eu-legislation_en
• https://employment-social-affairs.ec.europa.eu/policies-and-activities/moving-working-europe/eu-social-security-coordination/specialised-information/official-documents_en
The HSE is responsible for implementing the Regulations in Ireland and provides further information for patients on the HSE TAS website: https://www2.hse.ie/services/schemes-allowances/treatment-abroad-scheme/
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. As the HSE holds responsibility for the management and operation of the EU Treatment Abroad Scheme (TAS), for persons entitled under EU Regulation 883/04, I have also asked the HSE to respond directly to the Deputy as soon as possible.
803. Deputy Ken O'Flynn asked the Minister for Health whether value-for-money or cost-effectiveness assessments are conducted in respect of treatments funded under the treatment abroad scheme; if so, the methodology used; and if not, the reason no such assessments are required. [28122/26]
Amharc ar fhreagra813. Deputy Ken O'Flynn asked the Minister for Health whether the HSE or her Department has any mechanism to assess, benchmark, or challenge the cost of treatments invoiced by other EU/EEA healthcare systems under the treatment abroad scheme; and if so, the methodology used. [28132/26]
Amharc ar fhreagra814. Deputy Ken O'Flynn asked the Minister for Health whether a formal value-for-money assessment framework applies to treatment abroad scheme expenditure; and whether this has been reviewed or updated since 2020. [28133/26]
Amharc ar fhreagraI propose to take Questions Nos. 803, 813 and 814 together.
As the Deputy will be aware, the HSE operates the EU Treatment Abroad Scheme (TAS), for persons entitled under EU Regulation 883/04. The TAS is a consultant led scheme and allows for a public consultant based in Ireland to refer a public patient who is normally resident in Ireland for treatment in the public healthcare system of another EU member state, the UK or Switzerland. Subject to the EU Regulations and Guidelines, the TAS provides for the cost of approved public treatments in another EU/EEA member state, the UK or Switzerland through the issue of form S2 (IE) where the treatment is:
• among the benefits provided for by Irish legislation;
• not available in Ireland;
• not available within the time normally necessary for obtaining it in Ireland, taking account of the patient's current state of health and the probable course of the disease;
• medically necessary and will meet the patient’s needs;
• a proven form of medical treatment and not experimental or test treatment;
• provided in a recognised public hospital or other institution that will accept EU/EEA form S2 (IE) and;
• is under the control of a registered medical practitioner.
The HSE provides further information for patients on the HSE TAS website: www2.hse.ie/services/schemes-allowances/treatment-abroad-scheme
Under the terms of the EU Regulations on Social Security Co-ordination approved planned treatment, availed of by persons entitled to treatment abroad under EU Regulation 883/2004, is provided in the host Member State's public healthcare system on the same terms and at the same cost that applies to nationals of that State. The governing EU Regulations and framework on the co-ordination of social security systems provide for arrangements, including disputes, regarding reimbursement between institutions in the home Member State and the Member State of treatment.
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. As the HSE holds responsibility for the management and operation of the EU Treatment Abroad Scheme (TAS), for persons entitled under EU Regulation 883/04, I have asked the HSE to respond directly to the Deputy as soon as possible.
804. Deputy Ken O'Flynn asked the Minister for Health the number of internal audits, external audits, or Comptroller and Auditor General reviews conducted in respect of the treatment abroad scheme since 2020; the dates of such audits; and whether any findings or recommendations were made regarding expenditure controls or governance. [28123/26]
Amharc ar fhreagra812. Deputy Ken O'Flynn asked the Minister for Health to provide details of all audits carried out on the treatment abroad scheme since 2020, including dates, scope, findings, and any recommendations made in respect of expenditure control, governance, or value for money. [28131/26]
Amharc ar fhreagraI propose to take Questions Nos. 804 and 812 together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
807. Deputy Ken O'Flynn asked the Minister for Health whether any external body, including HIQA or another regulatory or advisory entity, has reviewed or been requested to review the governance, safety, or cost oversight of the treatment abroad scheme; and if so, to provide details of such reviews. [28126/26]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
816. Deputy Ken O'Flynn asked the Minister for Health whether the suicide crisis assessment nurse service has been operational since the publication of the Model of Care in 2022; and if so, the reason no national data on referrals or activity was collected prior to 2025. [28145/26]
Amharc ar fhreagra817. Deputy Ken O'Flynn asked the Minister for Health whether she accepts that the absence of SCAN data prior to 2025 represents a gap in oversight during the initial rollout phase; and the steps being taken to address this. [28146/26]
Amharc ar fhreagra822. Deputy Ken O'Flynn asked the Minister for Health the key performance indicators used to measure SCAN service effectiveness; and when these will be published. [28151/26]
Amharc ar fhreagra823. Deputy Ken O'Flynn asked the Minister for Health whether any independent evaluation or audit of the SCAN service has been conducted since its integration into the National Clinical Programme; and if not, whether one will be commissioned. [28152/26]
Amharc ar fhreagra826. Deputy Ken O'Flynn asked the Minister for Health whether a national data system is in place to track referral pathways to suicide crisis assessment nurse services, including whether referrals originate from general practitioners, CAMHS, or Community Mental Health Teams, and if not, the timeline for its implementation. [28159/26]
Amharc ar fhreagra827. Deputy Ken O'Flynn asked the Minister for Health the key performance indicators currently used to evaluate the suicide crisis assessment nurse service; and when the full national report referenced will be published. [28160/26]
Amharc ar fhreagraI propose to take Questions Nos. 816, 817, 822, 823, 826 and 827 together.
The Suicide Crisis Assessment Nurse (SCAN) service is critically important safety net for people in suicidal crisis and the Minister fully supports the intention within the second Sharing the Vision implementation plan to expand these services to provide full coverage nationwide. These services provide a timely response to requests for assessment of patients in suicidal crisis from GPs, and the assessments often take place in primary care settings.
Under Budget 2026 I secured funding to expand the SCAN service, adding an additional 6 SCAN teams and bringing the number of teams to 21 with 45 WTEs across 18 counties.
It may be of interest to note that SCAN has been the subject of a [peer-reviewed study]. This study reviewed one SCAN service in a defined catchment area, but found that the majority of presentations were managed in primary care following SCAN intervention.
Your queries relating to the key performance indicators, data collection and evaluation of the SCAN service are operational matters which have been directed to the HSE for direct response to you, as soon as possible.
818. Deputy Ken O'Flynn asked the Minister for Health the number of referrals made specifically by general practitioners to SCAN services in 2025; and if this cannot be disaggregated, the reason such referral pathways are not recorded. [28147/26]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
819. Deputy Ken O'Flynn asked the Minister for Health whether the current SCAN database captures the source of referral, including GP, CAMHS, CMHT or emergency department; and if not, whether this will be introduced. [28148/26]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
820. Deputy Ken O'Flynn asked the Minister for Health the geographic distribution of SCAN services, by county and CHO area; and the timeline for full national coverage. [28149/26]
Amharc ar fhreagra821. Deputy Ken O'Flynn asked the Minister for Health the number of dedicated under-18 SCAN services currently in operation; and whether additional youth-specific services are planned. [28150/26]
Amharc ar fhreagraI propose to take Questions Nos. 820 and 821 together.
The Suicide Crisis Assessment Nurse (SCAN) service is critically important safety net for people in suicidal crisis and the Minister fully supports the intention within the second Sharing the Vision implementation plan to expand these services to provide full coverage nationwide. These services provide a timely response to requests for assessment of patients in suicidal crisis from GPs, and the assessments often take place in primary care settings.
Under Budget 2026 I secured funding to expand the SCAN service, adding an additional 6 SCAN teams and bringing the number of teams to 21 with 45 WTEs across 18 counties. The incremental expansion of this service to provide full nationwide coverage will be progressed through future budgetary cycles in consultation with the HSE.
In July 2025, Donegal Mental Health Services became the first Mental Health Service in Ireland to offer a dedicated suicide crisis nurse service for teenagers (SCAN U) within Primary Care following referral from General Practitioners (GPs) under the National Clinical Care Program for Self Harm and Suicide Related Ideation (NCPSHI). Under SCAN?U, GPs will be able to refer 16 to 18-year-olds who present with suicidal thoughts direct to the Suicide Crisis Assessment Nurses, with a full bio-psychosocial assessment taking place within within 72?hours.
As aspects of your queries relate to service matters, I have asked the HSE to respond to you directly, as soon as possible.
824. Deputy Ken O'Flynn asked the Minister for Health the total number of referrals made by general practitioners to suicide crisis assessment nurse services, including those not accepted for assessment, in each of the years 2023, 2024, 2025 and to date in 2026. [28157/26]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
825. Deputy Ken O'Flynn asked the Minister for Health the number of referrals to suicide crisis assessment nurse services that were not accepted for assessment and the reasons for non-acceptance, in each of the years 2023, 2024, 2025 and to date in 2026. [28158/26]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to the Deputy directly, as soon as possible.
828. Deputy Ken O'Flynn asked the Minister for Health the estimated unmet demand for suicide crisis assessment nurse services, including the number of patients diverted to emergency departments or community mental health teams due to lack of SCAN capacity. [28161/26]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to the Deputy directly, as soon as possible.
