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Last Updated: Tuesday, 16 May 2006, 11:29 GMT 12:29 UK
Q&A: NHS treatment abroad
Yvonne Watts
Yvonne Watts needed a double hip operation

The case of a 75-year-old grandmother who travelled to France for a hip replacement has prompted the European Court of Justice to tell the NHS it must fund treatment abroad in cases where patients face unacceptable waits.

But what does this mean for the NHS and its patients?

What was the situation before the ruling?

Patients facing an "undue delay" for treatment on the NHS already have a right to seek treatment abroad and ask their local primary care trust to refund the money.

In the past the Department of Health has argued that anyone being offered treatment within its own waiting time target is not facing an unacceptable delay. They therefore cannot get a refund.

How has the ruling changed things?

The court said health officials will now have to pay heed to the precise clinical needs of the patients in question as assessed objectively by an expert.

This means it is not acceptable to simply say the person is being seen within the target time and therefore is not facing an unacceptable delay.

Instead the degree of pain the patient is in, his medical condition, and the history and probable course of his illness must be considered.

Futhermore, the Department of Health has been told that the setting of waiting times should be done "flexibly and dynamically", and should be changed if the patient's condition alters.

Does this open the floodgates for treatment abroad?

Obviously more people will be entitled to go abroad for treatment, and seek reimbursement of their costs.

However, the Department of Health argues that as less people are waiting longer for treatment the ruling really relates to a small number of people - at the moment at least.

But as cash-strapped NHS trusts seek to balance their books and postpone operations, that situation may change.

What is likely to reduce the numbers is the fact that patients have to find the funds to pay for the treatment themselves.

They will also have to organise and pay for all their own travel and subsistence costs.

Also legal experts say that where these powers have been exercised in other European countries, very few patients have taken advantage of them.

But it does mean that those who decide whether to authorise the refund of treatment costs abroad - the primary care trusts - will have to make ensure they apply a wider set of rules.

What does the medical profession think?

Consultants from doctors' group the British Medical Association have welcomed the fact that clinical needs should be prioritised over waiting time targets.

They have been arguing for years that inelastic government targets should take a back step to the opinion of clinical experts.

The Department of Health says it needs time to digest the implications of the complex ruling but maintains its impact will be limited.

Will the effect of the ruling cost the NHS more money?

It is unlikely to increase costs because the patient can only reclaim up to the equivalent cost of the operation or procedure on the NHS.

But if the cost of the operation in the specific EU country is cheaper, they will be reimbursed for that lower cost rather than the full NHS cost.

The extra costs of travel and subsistence will be borne by the patient unless they are entitled to them at home.

However, some health analysts have warned that the fact that some patients could opt for treatment abroad may upset local healthcare systems by opening them up even more fully to market forces.




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