Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 638, 640, 641 and 642 together.

The Community Ophthalmic Services Scheme (COSS) is a national fee-per-item scheme which was introduced in 1979. Under the COSS, medical card holders aged over 16 years can be seen by ophthalmologists, community ophthalmic physicians, optometrists or dispensing opticians.

Eligible patients can receive an eye examination and be provided with prescribed optical appliances in accordance with a national schedule of approved optical appliances.

The Health Professionals (Reduction of Payments to Ophthalmologists, Optometrists and Dispensing Opticians) Regulations 2013 (SI 274 of 2013) sets the fees for optometrists and dispensing opticians under the Community Optometric Services, Community Spectacle Dispensing Services and Health Amendment Act Card Schemes.

Increasing the fee payable to contractors for a standard eye examination under the COSS (to ensure parity with that payable for the same exam under the Department of Social Protection’s Treatment Benefit Scheme) is a priority for my Department, and work with stakeholders is ongoing in this regard.

All children, including those not covered by a medical card, receive a vision screen while in national school from a Public Health Nurse. The Health Service Executive (HSE) provides optical services free of charge to pre-school children and national school children referred from child health service and school health service examinations who are discovered to have sight problems. These children are referred to the appropriate consultant for treatment. In such circumstances, these services will continue to be provided until the child has reached the age of 16.

The HSE Primary Care Eye Services Review Group Report, published in June 2017, highlighted the limitations of the current model of service delivery and set out the way forward for a significant amount of eye services to be delivered in a primary care setting. The Report estimated that 60% of existing outpatient activity could be moved to primary care thus enabling hospital services to focus on patients who require more specialist diagnostics or treatments.

The National Clinical Programme for Ophthalmology has developed a model of care which details how the realignment of eye services from the acute hospitals to the community will be undertaken. Included in current priorities is transferring the care of children aged 8+ years to the care of local private optometrists.

A project team with a wide-ranging membership was established in late 2019 / early 2020 to progress this initiative. The work of the team was paused due to the requirement to focus resources on the COVID 19 pandemic. However, the project team has been reconvened and is progressing matters in relation to this initiative. Recently, I asked the HSE to prepare a detailed implementation plan in regard to this matter.

The number of optometrists providing care to medical card holders under the COSS in the years 2018 through 2023 was as follows:

There will be engagement between my Department and the Department of Public Expenditure, National Development Plan Delivery and Reform during the Estimates 2025 process. It is in the context of that process, that funding needed will be agreed.

Stephen Donnelly (Wicklow, Fianna Fail)
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Sight testing, eye examinations and optical appliances are provided to medical card holders by ophthalmologists, optometrists and dispensing opticians through the Community Ophthalmic Services Schemes (COSS), administered by the Health Service Executive (HSE).

The number of optometrists providing care to medical card holders under the COSS in the years 2018 through 2023 was as follows:

The Department of Social Protection would have information regarding the number of optometrists contracted to provide services under the Optical Benefit Scheme, access to which is based on PRSI contributions.

Stephen Donnelly (Wicklow, Fianna Fail)
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As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.