Santé sans (Euro) frontières peut-être?

M-A-C has always backed more service user choice – and we are delighted to see it enshrined in Lord Darzi’s “Next Stage Review” commitment to providing patients with greater access to information and freedom to control their own care. It is therefore perplexing – but not unexpected given previous form – to see the Department of Health speaking for the English NHS decrying what it sees as the likely effects of the new European Directive “On the Application of Patients’ Rights in Cross Border Healthcare” launched earlier this month. Aren’t they in favour of patients having more choice? Only on their terms perhaps.

The EU Directive isn’t very radical and rather watered down compared with earlier drafts, but it is welcome nonetheless to have existing rights (though most people never knew they had them) focused in one document. The sticking point about an NHS patient travelling to another EU member state has always been getting “prior authorisation”. But that is dealt with in the Directive.

About 1 in 5 Luxemburgers regularly receive state-funded care in another member state. But for us Brits, arranging this can turn out to be a “through the looking glass” experience. Some years ago I chaired a complaints panel involving a request to reimburse a patient who had had a stapedectomy (middle ear surgical procedure to improve hearing) done at a well known otology centre in Beziers, France, because the local NHS couldn’t say where or when it would be done here. All the consultants she had seen in the UK agreed the treatment was clinically indicated and the health authority repeatedly insisted that it could be done here in England. But no one was able to tell the patient – whose hearing was deteriorating – who would do it, where and when. Faced with that sort of dithering, the patient did what any sensible person would do and packed her bags for the trip to Languedoc.

When she returned after a successful result and claimed the costs back from the NHS, they refused indignantly to entertain her claim – after all the stapedectomy could have been done here and she did not have prior authorisation. Naturally she complained and that is when the fun really started. When the case finally got to me at the appeal panel stage, I am ashamed to say that I could not have imagined such bureaucratic contortions as my own health authority went through as it struggled to claim that black was white in order to avoid admitting that they had left the patient with no alternative but to travel for her operation unless she wanted to accept deafness in one ear. The panel found for the patient and recommended full cost reimbursement as compensation, which the health authority board to its credit agreed to pay on an ex gratia basis. And they had the sense to agree to a second Beziers trip for the other ear to be seen to when that too caused trouble a while later.

Did we learn anything from this? I never saw another complaint like it and I hope that this particular patient’s experience is not longer typical, but the DH’s latest hand wringing about the evils of two-way “health tourism” isn’t reassuring. The European Court of Justice has made crystal clear in a string of rulings that national health systems cannot refuse to refund costs of overseas treatment if patients have waited longer than clinicians advised, even if waiting list targets were met. The EU sees this as benefitting people with relatively rare or complex conditions and who could say no to that?

Of course, travelling for health care isn’t risk free, and there are costs above that of the treatment itself. Also, I’m not advocating (even if anyone would pay for it) crossing borders for botox, tummy tucks and such like. But I can see a number of very good reasons to encourage people to travel around in Europe for something they cannot get done speedily at home:

1. They will get a better idea of comparative standards in health services in other member states – rather like having the Euro helps compare other things we consume. That’s both good and bad perhaps, but it might put paid to the situation we have now where most people say their own NHS experiences are pretty good, but if asked how things are in the country at large they are convinced that the end if nigh for publicly funded healthcare. Travel broadens the mind in more ways than one and better health literacy back here at home might result;
2. It will encourage partnership and break down paternalism, of which there is still too much about in the NHS despite all the rhetoric to the contrary;
3. It could bring in revenue to the NHS because acute trusts’ capacity will have to be filled somehow as PCT commissioners redirect resources and services outside the hospital gates. If I were a Foundation Trust business director, I’d take this as a serious new business opportunity and get the map out to see which member states had the longest waiting lists for specialities I’d like to sell more of. But before I placed the adverts in the local papers, it would be a good idea to get the hospital’s cuisine up to higher level!

EU member states now have to translate the framework of the Directive for healthcare without frontiers into national law. Let’s hope the UK makes some sensible progress towards that goal and stops moaning about it. And it will be interesting to see if our proto-federal island kingdom can speak with a united voice on this one: what England’s NHS thinks about healthcare without frontiers, may not be the same as the views of Wales, Scotland or Northern Ireland at all. Comments from those jurisdictions would be very welcome on this point.

And a final bit of nannying – if you haven’t got your new European Health Insurance Card yet (replaces the late and un-lamented Form E111) apply for it here http://www.ehic.org.uk now!

A New Song for the NHS – turn me loose and set me free!

“Cause More Trouble”

That was one piece of advice from David Nicolson, Chief Executive of the NHS speaking at a Department of Health conference 8th July to those representing the patient interest. The venue was the cathedral-like space of the Lawrence Hall in the Royal Horticultural Halls before an audience of specialists and enthusiasts working in the area of people participation, involvement, engagement – the vocabulary changed as fast and as frequently as the sky over Wimbledon. Many of them had gathered before in halls to be assured that the future of patient participation was now safe and on a good road only to be disappointed by the reality down the line. Does the NHS this time have a new story and a new song that will not just promise a new dawn but deliver it?

NHS – the New Story and why not? – a Song as well

The speakers assured us that this time it would be different and I was tempted to believe them. What has changed for the better? The NHS now has a draft Constitution which will fix the customer at the centre of the system. That system will be based on World Class Commissioning. The Constitution will define the expectations and service aspirations. The commissioning process and the associated systems will assure compliance. Not a national target in sight and now we have local service designed and commissioned with local people and their needs in mind. Hence the Merle Haggard lyric celebrating the new freedom that will flow from commissioning and delivering for the local community. Going with the show biz flow, we conference attenders did get a playlet that dramatised the present and the future, daring to look 5 years into the future. Alas one thesp running to embrace this vision, fell over Meredith Vivian’s dog. I was cheered by this note of realism that reminded us that there would be obstacles in the road to the future but nevertheless the show went on.

The ducks seem to be all lined up. The juggernaut is rolling. Satisfaction with the NHS as measured by Ipsos MORI has never been higher. PCTs have never had so much money. The presses at the Department of Health have been rolling without pause or interruption – in the period between 9th May and 3rd July the Department pumped out no fewer than 7 publications including the final report by Lord Darzi.

This link will take you to the consultation on the constitution. The closing date is 17th October this year.

Ben Page of Ipsos MORI provided a valuable corrective to the mood of euphoria in the form of some facts about the gap between the promise and the reality. Almost everybody thinks being involved is a great idea – 82% according to his data support the idea of being involved but at the end of the day about 2/100 actually turn up. But everybody likes organisations that offer the chance of getting involved and Ben told us why South Tyneside had been recognised this year as the Best Achieving Council. Their ads showed the engagement process the Council favoured “We Asked, You Told Us, This Is What We Did”. Closing the loop and reporting back on what happened as a result of a consultation or engagement programme is emerging as the key ingredient in sustainable engagement programmes. Ben made the point that the best regarded local authorities were on the whole the best known ones. Information is a vital precursor to engagement.

Keep telling that story or indeed singing that song.

July Newsletter: New Look, Same Passions

Our passions remains the same but we have clothed our mix of news and views in new clothes knitted together with Wordpress which Dan Wardle of Surveylab our adviser in these matters assures us will bring the blog into the world of Web 2.0.

On www.publicinvolvement.org.uk recently…

A MP has asked why we are all so miserable? Are we becoming a nation of miserabilists never happier than when whingeing? We take a look at the latest Annual Report from the Financial Services Ombudsman for some facts and figures on the nation’s complaint behaviour in the markets he covers. The principle of being fair to consumers is all the rage in regulatory circles and we look at the new laws banning unfair practices backed by new OFT research that tells us that ‘consumer detriment’ costs us as consumers over £6billion pounds a year. We join up our learning on complaints with our thinking on user engagement and ask – are they linked?. Can the complainant become the engaged user for the longer term?

Finally just to keep give you a chance to tell us your experience, there is a mini-survey for parents of school age children to complete about what they did when they had a problem with the children’s school.

Have a good summer.