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!