The Health Service Executive is proposing to suspend issuing new long-term illness cards to children with attention deficit hyperactivity disorder (ADHD) pending policy clarification from the Department of Health on whether this condition falls within the scope of the scheme.
The HSE has warned the Department of Health that should ADHD be considered a mental illness, and therefore allowing patients to qualify for long- term illness cards, it could cost the health service millions of euro.
Official documents also show that the department has been reviewing the long-term illness scheme and has been in consultation with the Attorney General’s office.
The long-term illness scheme allows people with specific eligible conditions to receive drugs, medicines as well as appliances related to the treatment of their illness free of charge irrespective of their income level.
Public health doctors working for the HSE locally determine the eligibility of an applicant under the scheme. The scheme, which has been in operation since the 1970s, considers mental illness in persons under 16 to be an eligible condition.
Disagreement
However, there has been disagreement between medical officers in different parts of the country as to whether the disorder should be classified as a mental illness under the terms of the scheme.
While long-term illness cards have been approved for children in Dublin North East, Dublin Mid-Leinster, the North West, the South and parts of the midlands, in other regions similar applications have been turned down.
A draft report drawn up by Ombudsman Emily O’Reilly and given to the HSE in March found that the health authority had “failed in its responsibility to ensure a uniform approach to the administration of the long-term illness scheme and failed to provide HSE administrators of the scheme with adequate and clear guidance in relation to the scheme and that these failures were contrary to fair or sound administration”.
The ombudsman's draft report came on foot of a complaint made by a woman in the southeast who had was refused a long-term illness card for her son and who spent about €3,000 on medication before one was ultimately awarded nearly three years later.
Policy guidance
In March the director general -designate of the HSE, Tony O'Brien, wrote to the secretary general of the department, Ambrose McLoughlin, seeking policy guidance on whether, under the terms of the long-term illness scheme, ADHD should be considered as a mental illness. "Alternatively, it would be helpful to receive clarification on any early plans there are to modify or change the scheme, which would render this particular issue no longer relevant."
Mr O’Brien said that when the scheme was established in the 1970s, ADHD would not have been a recognised condition at the time. He said a senior HSE official, the national lead for child and adolescent mental health, was currently consulting with a wider cohort of child and adult psychiatrists, “with a view to establishing the broader clinical view on this question”.
