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Friday, 31 August, 2001, 13:35 GMT 14:35 UK
Should NHS patients be sent abroad?
Health Secretary Alan Milburn has confirmed that NHS patients will be allowed to go to other European Union countries for treatment in an attempt to cut waiting lists.

Mr Milburn said nobody would be sent abroad against their wishes and added that the government's priority was to cut waiting lists by investing in the NHS.

The move comes after the European Court of Justice ruled that patients facing "undue delay" in their home country could seek treatment elsewhere in the EU where there are spare beds and spare doctors.

This led to growing demand from NHS patients, fed up with waiting for treatment, to be dealt with abroad. But Liberal Democrat health spokesman, Dr Evan Harris, has criticised the initiative, saying it fails to address the real problems of the NHS.

What do you think? Is this a bright idea from a flexible government willing to respond to patients' demands for quick treatment? Or is it an attempt to cut waiting lists without addressing the real problems of the NHS? Would you be willing to travel to another part of Europe to see a doctor?

This Talking Point has now closed. Read a selection of your comments below.

I think it's shameful that we have to do this. How much did we spend on the dome? I can't say we shouldn't consider it though, as I'm not hobbling about with a stick
David Harris, UK

How can money be found to send patients abroad but not for the NHS?
Adrian, UK

From the posts below I've seen comments on low tax and how little the people actually pay towards public services. Is this really true? We have little idea on where each of our taxes (income, national insurance, VAT on bills, fuel tax) and stealth taxes go towards which service. Is none of the above taxes enough to pay for what we expect? Should the government come clean about this? Or is all this money collected from taxes being severely mismanaged, akin to a black hole?
Rod Aries, Scotland

Sending patients to other European countries for treatment can only ever be a short-term remedy

James Cane, UK
Sending patients to other European countries for treatment can only ever be a short-term remedy. In the long term, the people of our country must realise that they can't have something for nothing. It's not really the government's fault that the NHS is in the state it's in - it's the fault of all those ranked masses of individuals who aren't prepared to pay any more towards public services. Government policy is, after all, largely decided by opinion polls.
James Cane, UK

To me it seems like the best short-term solution, and it's a lot more ethical than robbing developing countries of desperately needed doctors. Maybe if this takes some of the load off our own doctors, being a doctor might start to look like an attractive profession again and in a decade or two we can produce enough of our own.
Malcolm McMahon, York, UK

The advent of aeroplanes saw the demise of the British beach holiday. The advent of the European Union will see the decline of the British Health service. In both cases, selfish investment decisions over 40-50 years have meant that the British customer was short-changed. And as a nation we were sullenly compliant. I have little sympathy with NHS crying... my experience of the NHS is of ignorant, arrogant professionals who refuse to give straight answers to straight questions, presumably because they are afraid that I will sue them. I'm sure there are many who are not like that, but I've not seen them. We've brought in foreigners to sort out British sport. Now let's send our patients abroad to sort out our health problems. Then bring in some French and German health czars to continue Arsene Wenger's health revolution...and hopefully give some political medicine to those spouting verbal diaorrhea or suffering from Tony Blair-induced political constipation.
Rhys Jaggar, England

I don't mind paying extra tax, but I expect to see a return on investment

Phil W, UK
Isn't this an admission of failure to deliver by this Government? Increased taxation and National Insurance charges and no NHS improvement show for it. I don't mind paying extra tax, but I expect to see a return on investment.
Phil W, UK

In Belgium, where I live, you can discuss with your doctor the treatment options available to you and often what hospital it would be best for you to go to. In hospital you will share a room with a maximum of two others. My wife had a room to herself for a week at a time when our children were born. In a chemists shop (pharmacy) in Belgium, you speak at the counter to a trained pharmacist, not a shop assistant with no knowledge of pharmacy as you do in England, with the pharmacist lurking somewhere behind a screen out of the sight of customers.

In my experience of the NHS, if you start asking questions you are viewed with suspicion. There is something profoundly wrong with that. The NHS is a government organisation and is run like MI5. Patients are treated as unthinking. The only long-term solution is to open the market up to competition with a mix between compulsory health insurance run by companies, with complementary insurance cover to top it up if you want it.
John, Belgium

Sending patients abroad to treat them is a great idea. It means that pressure can be taken off our overburdened health service, waiting lists will go down dramatically and patients will be treated faster and not left on hospital trolleys unattended. This idea is what being in the EU is all about. If member states couldn't use each others' facilities, then there would be no point in being in Europe! It's time Britain used its position in the EU to the full!
Leon, U.K

In theory a great idea to clear the present backlog. It is a poor reflection on our country that we have allowed to get ourselves into this state. Health Service planning has been atrocious for at least 24 years. If I made such mistakes, I'd be hauled up before the General Medical Council in no time!
Dr Monica Chidgey, Wales

I have just returned from England. My father underwent major surgery. He had to wait 7 months. Here in Belgium he could have had it done within 10 days. Apart from his illness he suffers from stiff upper lip. So he just waited and waited for the operation. I welcome the move to send patients to Europe. I predict that within a few weeks of operations abroad, many English will see just how bad and poorly equipped their hospitals are. Its just another case of rip off Britain. Poor sub standard service, and long delays. Why do you put up with it?
Kevin Ashley, Belgium

Do other European countries have longer waiting lists than us? If so then other Europeans may end up coming over here for their operations and our own waiting lists may get even longer!
A Thompson, UK

As a worker in an operating theatre, I welcome the action taken by the Government. Will there be an exodus of highly trained staff going to countries such as Germany to help look after the British patients, after all don't foreign health services offer higher wages and wouldn't British patients would like to see British staff? Speaking for myself and seeing that I have a family to support I would certainly investigate the possibility of working abroad if the situation arose. With British patients there would be no language barrier and I would be able to travel home or indeed work on the weekends.
Rob, Wales

I can't see any earthly reason why not. We haven't got enough capacity - on the Continent there's excess capacity. We get a fair price and they get to utilize more of an investment that would otherwise be idle. Bingo - everyone's happy! The longer-term problem of over-dependence on an infrastructure that is not under our control won't arise, because this is a short-term measure to tide us over until the additional capacity comes on stream - which will take a couple of years. The most important thing, though, is that patients will see and be amazed at the quality of care and cleanliness over there, and start demanding the same here (maybe they'll even be persuaded to pay for it, although us Brits tend to skimp when it comes to quality of life)
James, UK

I've only support for anything that means the people suffering now whilst they wait get the treatment they need, it might even clear some of the waiting list backlog. What this isn't is a substitute for a NHS that works and can satisfy the needs of the people in this country itself. But the idea of it being "A bright idea by a flexible Government" makes me laugh, surely the Government is reacting to this recent European decision and the initiative taken by people who can't bear to suffer any longer due to governmental incompetance.
Mr Smith, UK

The principle of "free" healthcare for all is admirable but impossible in practice. What we have ended up with is third-rate healthcare for all. A good private insurance system needs to be quickly built up - not on US lines, but like the system in Denmark, which is vastly better than the ramshackle British NHS.
Michael Entill, UK

Surgeons are doctors who operate, not just technicians. Correct preoperative diagnosis, building a rapport with the patient, understanding their expectations and worries and providing individualised aftercare are essential to the success of a surgical procedure. There are often many different surgical as well as non-surgical treatment options for a given condition. As a surgeon, I need to satisfy myself that a procedure chosen by a colleague for me to perform is appropriate before I carry it out. If patients are to be flown abroad for operations, will those who operate on them be acting merely as technicians? If so, this casts doubts on their professionalism and standards, including standards in theatre too. I agree with Margaret Bolan, the NHS will find itself picking up the pieces.
Christopher Mann, UK

This policy has been forced on Milburn and Blair. Labour supporters thought it bad enough for New Labour to be considering introducing private UK hospitals to carry out operations now they are having to bring in private international hospitals. Perhaps they should change the NHS's name to the International Health service(IHS).Meantime this will not resolve the real problems - lack of British trained staff. Bringing migrant workers in for a short time has never and will never work.
Malcolm Hill, England

I think the costs of sending our patients to the continent could be rather invested in improving the NHS local services. I would suggest adding extra lists on weekends. The volunteer hospital staff can be financially rewarded for attending such extra surgical lists.
Dr MS Abdalla, England

If I were slowly dying due to a waiting list in the UK then I certainly would not turn down being treated in another country which can help save my life. However, surely this will just increase the cost of treatment and exacerbate the problems of the NHS in the long term?.
Scott, US

What a God-send the judgment of the European courts is. British patients are finally allowed to receive the treatment they require. This is not a long term solution but it is immediate help for all the patients on waiting lists. It also throws a light on the state of the British health service.
Ralph, UK

I've lived abroad for over 5 years and am very impressed with the health care provision, and very embarassed about the UK's underfunded Health Service. The word among the expats was "if you're going to be sick, be sick here".

When I needed to see a specialist abroad he saw me in one week (with a bank holiday in between), and in the meantime I'd had bloodtests and xrays - all arranged between him, my foreign GP, and the clinics, in a few phone calls. The foreign health care system I know about is privately organised but available to everyone - the state pays the insurance for people on low/no incomes.
Dave, UK Expat in France

Have our health services become so rudimentary that we are on a par with developing nations?

Peter Beales, Thailand
In the developing world countries are obliged to arrange medical evacuations to other countries because their health services are unable to manage the patients. For instance the Pacific Islands send patients to medical facilities in Hawaii, Australia or New Zealand. Have our health services become so rudimentary that we are on a par with developing nations? It is high time that political meddling in our health services stopped and until it does the public will not get a fair deal.
Peter Beales, Thailand

If people in the UK were prepared to pay decent social contributions, as we do here in Belgium and elsewhere on the continent, there might be the funds available for a similar level of service. In Britain, people want things on the cheap. At the end of the day, you get what you pay for. What Britain needs is proper, private medical health care as we have on the continent.

Why should my healthcare be the concern of politicians whose only concern is to get re-elected for another term of office? I have lived abroad for over two decades and know where my family is better treated, but to say you want to abolish the NHS and replace it with private medical care is to say you are going to sacrifice the sacred cow and no party in Britain is prepared to do that because it will not win an election. The NHS has had its day. People take individual initiative for other areas of their lives, why not for health?
John, Belgium

What happens when a NHS patient dies in a foreign hospital? You can imagine the headlines that will generate in the tabloids.
Mac, Scotland

Great! Now all the doctors can go and live in Marbella, and a whole new class of package holidays can be flogged by the travel agents. How about a gallstone operation in Ibiza, or a tummy-tuck in Torremolinos?
Dom, Canada

What is the problem of sending the patients abroad for treatment. I think we should go further and develop a European wide Health Service.
Alun Jones, Wales

This is a really bright idea. The problem facing the NHS at the moment is a chronic staff shortage, who can be blamed for that? Unfortunately our universities do not have the ability to churn out highly trained doctors as soon as they are required (also not every bright student wants to be a doctor these days). Sending patients abroad to countries with over capacity will allow the NHS to dramatically shorten its waiting lists and get on top of the problem.
Niall Duncan, Scotland

The NHS is in a sorry state. The failing is to be borne on the shoulders of the country as a whole. Making politicians scapegoats is a bit nonsensical. The problem started 18 or so years ago when a Tory government introduced an extensive programme of tax cuts in public services. This continued for 15 or so years. Basic economics states that you get what you pay for - i.e. if the population of the UK votes for a party promoting tax cuts then they are implicitly voting for downgrading public services.

The Labour Party has identified that the turnaround in the NHS is going to be a long and painful process. There are 15 lost years to recover. The problem they have is that they won an election on the promise that taxes won't go up (from an unsustainably low level that they inherited). The population of the UK didn't vote for a party that proposed an increase in taxes to fund an increase in public services.
Alistair, UK

I have been living in Germany for 18 months and when I first arrived I was appalled at having to pay 100 pounds a month for my health care. But after having a pregnancy, new baby and kidney illness I don't begrudge a penny of it. The standard of care was more than excellent and very thorough, no waiting around, I saw specialists the same day instead of waiting for an appointment. There is nothing that is as important as our health and maybe the Brits should join other European countries and contribute more financially to a service that the UK health workers would love to provide.
Kim, Germany

I think its shows the Government is not valuing the NHS if its prepared to put money into sending patients to other countries what is the message about our own health service? This doesn't appear to be just about funding, but implies that not only is it cost effective to send people abroad, but that the Government has no faith in its own system! How about investigating the real cause of our collapsing system, where populations are increasing for many reasons, but hospital capacity is not. The consequence of years of under investment, together with lack of real thought on the part of Alan Milburn and his team. However the Government is only as good as the advice they are given from the so called health experts, and maybe this is where a lot of root problems lie.
Mrs Collins, UK

My wife has MS and we had to go abroad for a diagnosis and treatment 3 years ago. In the UK we were given a 3 month min emergency waiting list to see a neurologist. My wife was so bad in that first attack that I had to stop work to look after her and my one year old son. Our family doctor did not take us seriously after many requests for help. In the end he told us we were "not his problem" and he threw us off his list. In France my wife was admitted to Hospital straight away and diagnosed within 5 days. We have now moved to France because of the state of the NHS and the UK, a sad reflection on the state of the country and the attitude of the politicians in the UK
Paul, France(UK origin)

Seems to me that the government can't win. People complain incessantly about waiting lists, but as soon as someone comes up with a suggestion to deal with the problem, they complain about that too! Ideally, of course, we should be able to treat people at home, but after years of under-funding, we cannot expect an ideal NHS. Let's be realistic and look at this as a temporary means of slashing the waiting lists. Once the backlog is cleared, we can concentrate on making the NHS into a health service of which the nation can be proud.
Liz, Japan

I clearly remember Blair announcing to the world that he had "24 hours to save the NHS" when he was elected for the first time. Now nearly five years later we are having to export our sick and elderly to foreign countries for anything like acceptable treatment in a reasonable time. Meanwhile those who choose not to go, or cannot, are left to the scandal of our own hospital corridors. Why oh why is there not a national outcry at this betrayal of our people!
Mike Harvey, England

I await with anticipation their long-term solutions

Louise W, Reading, England
As long as this is in addition to the necessary changes to the health system then I agree with it. The problem that I understand the Government to have is that however much money it may find to throw at the NHS there is still the problem of lack of staff - impossible to solve immediately. Sending people abroad is a useful temporary tool. I await with anticipation their long-term solutions.
Louise W, Reading, England

And my UK friends try to tell me how bad the privatised American medical system is! In Canada, another nation with social medicine, the Vancouver hospitals are so overcrowded right now that they are having to redirect women that are about to give birth to hospitals in Seattle!
John, USA

In the United States we have the same problem due to our health care for profit system. I used to work for the University of New Mexico's Department of Surgery as an Administrative Assistant. The surgeons, and residents in the program spent most of their time trying to get the health insurance companies clerks to okay the payment for the surgery. I found that I ended up speaking to health insurance clerks that had no medical training nor medical education deciding whether or not a patient's surgery was necessary.

Basically most health insurance companies in America want to deny any kind of treatment that will cut into their profits. Right now the United States is facing a health crises in which many Americans are not covered by any health insurance because they can't afford to pay for the high monthly health insurance payments which come out of their pay checks. You are lucky that your system is socialized.
Kay F. Nixon, USA

I think as a short-term solution, this is a good idea, if people need treatment now. However, rebuilding the NHS after years of neglect can be the only long-term solution
Phil, UK

Yes it's a good idea and will not cost much since Europe is generally cheaper than the UK for most items. There should however, be a time limit of 6 to 8 years so that the NHS can get its house in order, and for new doctors to be trained. Stealing doctors from Third World countries where they are needed is not a solution, for the long term.
C Des, UK

The first bright idea on the NHS situation in a long time! Why not send people overseas to countries which have ample beds and doctors who are equally qualified and obviously less stressed than those in the UK. Yes there could be complications, but there is the same risk factor if it is done in the UK. Countries such as Belgium have an excess of qualified doctors, dentists, therapists etc. - the only slight disadvantage is the language barrier. But countries like South Africa also have some wonderful hospitals and the costs, including flights, are still cheaper that the cost to the NHS in the UK! Yes, use outside facilities wherever possible.
Margaret Carre, Belgium

This is just yet another ugly example to the failings of socialised health care. When are we going to scrap this horrible, de-humanising system and go with a system proven to work - privatisation. How bad does the situation have to get before action? Aren't there any lessons to be learned from the USSR and N. Korean failures?
David Rhodes, UK

Oh no. This is ludicrous. Please tell me it's a late April fools jape. A very late one. Of course, this will not cost a penny to send people abroad will it? Are folk expected to pay their own way abroad, or is it all expenses stumped up for by the Government. Really - do we really want to walk down the road of stupendous debt? We're on our way...
Jay Rogers, England, currently residing in the US

What is the European Court doing deciding that patients facing undue delay can seek treatment aboard I presume at the country's expense where the undue delay occurred. Surely this is a matter for the individual nations to negotiate between themselves, but maybe then Parliament is no longer sovereign in this country. Secondly who decides what is an undue delay. Thirdly who are Labour now going to blame for the fact that the NHS is still failing, guess it will still be the Tories - how long can they keep doing that. The Government needs to address the problems in the health service, they need to do it now but I suspect we will still be having the same discussion in five years time when the next election rolls around.
Dave, UK/US

This is not a good idea. Institutionalised racism is the norm in countries like Germany (e.g. daily cases of hassles for UK minorities at German passport checks, frequent far right aggressions...). Equal opportunities laws do not exist in or are not enforced. As a black man I am quite reluctant to be sent for treatment to Germany where doctors/nurses have no respect for ethnic minorities or are likely to openly discriminate against me and fail to understand the basis of equal opportunity laws. In the long term white British citizens will be freely going abroad for the treatment while minorities will have no choice but join the queues. Is this the future of the NHS?
Lino Dedeo, London, UK

The Government will be creating an additional problem for itself by sending patients abroad, for once the lucky few return, they will be wondering why such admirable treatment has been withheld from them for so long. Both my wife and I have been in Continental hospitals and, believe me, they are heaven compared to the meat processing plants that all too often pose as hospitals in this country.
Tom, England

Only the BBC and the Government could pitch this as a "success" and a "flexible" response. In reality isn't it the final indicator that our health system has well and truly disintegrated? This is the same attitude as those who claimed that the Dome was a positive use of resource in re-generating Greenwich, and look where that project is now. Next thing we will hear is that increased deaths in hospitals are a "positive" contribution to shortening waiting lists.
Pete, UK

As one who has waited 2.5 years for a new knee, anything that helps to improve the quality of life for the patient must be to the patients benefit. A healthier patient will cost less in the long run which is to the advantage of the NHS
Terry Margetts, UK

Mr Milburn is now scared of the ruling of the European court, which says that if the Government can't provide the care in a reasonable time they should pay for it to be provided abroad. He thinks patients who have been waiting an unacceptable length of time will take the Government to court. The problem at the moment in the UK, is that hospitals are discharging patients far too early after surgery to meet their targets. These patients need re-admission as emergencies as complications develop, hence creating a vicious circle. Imagine when these post-operative patients will return en masse from abroad and will need to be re-admitted how much pressure that will create on the NHS.
Sabina Ahmed, UK

If the real problem with the NHS is a lack of funding then this initiative will only serve to worsen matters by diluting limited funds still further. Conversely, will the UK be allowed to take patients from other EU countries in order to secure extra funding? This is a nonsense! Fix the problems in our own back yard first!
Malcolm Stayner, New Zealand

It makes sense, given that there is no method of expanding the capacity of the NHS in the short-term. The public want to see tangible improvements in the quality and quantity of care. The Government realises that, instead, there is a perception that since 1997 things have got worse rather than better. A policy of long-term improvements through training more medical staff and investing in capital projects should show dividends in the next few years. Until then, this solution should be welcomed as a practical way of providing speedy treatment for those in need.
Paul Carey, USA (ex UK)

Are they also going to pay for relatives to visit their family members who have been shipped overseas for operations? I have a better idea, lets send our Government overseas and care for our sick at home, where they should be cared for.
Andrew Williams, UK

A private healthcare policy in Britain costs approximately one-third of what it does in Germany

EM, Germany
What I find is strange is that while everybody in Britain is complaining about the NHS they don't complain about its cost. Either they forget, or simply don't realise that health insurance is compulsory in Germany, and its not cheap either - the Government-run healthcare schemes start at 11.2% of gross income, split 50/50 between employer and employee. A private healthcare policy in Britain costs approximately one-third of what it does in Germany.
EM, Germany

I've never heard of French people having to wait as long as in the UK. I have had the same operation done twice for a ligament replacement (it was done in France as the NHS surgeon got it wrong) and I waited 2 weeks instead of 2 months in the UK.
John Hall, France

It's a terrible insult to all the millions of Brits who have been forced to pay their taxes, that this is the result. Incompetent managers and politicians alike, incapable of redressing any situation they have made for themselves. The NHS doesn't need more money. It needs to be managed properly, without the interference of busy body, feeble minded politicians who are only out to score votes at any cost.
Nick Davies, Cardiff, UK

Frankly if you get abroad you should rejoice! I didn't understand how bad the NHS was until I moved to the US and found doctors who have time to talk to you and hospitals with resources to do their job. OK you have to pay insurance or your employer does but it's just the same as paying for private insurance in the UK. The UK HNS system has seen its day and needs dragging into the 21st century.
K. Jackson, USA ex UK

Canada is experiencing severe medical treatment delays, due to staffing shortages and past budgetary constraints. (Private healthcare or two- tier medical care, is prohibited in Canada.) With the number of people, past sixty, increasing steadily, demand on health services are vastly increasing. Many Provinces are now having to send patients into either more cash rich Provinces or to the bordering U.S. states for treatment or diagnosis via MRI.

I think that any Government has to be open to flexible alternatives in providing timely and up to date medical treatment. If it means sending patients to other countries and regions - so be it. Maybe it will shame governments into improving health care services in their own countries.
Pat van der Veer, A Brit in Canada

It is a wallpaper over the cracks solution, but it's no worse than when the NHS used a meat lorry as a morgue.

I don't think Alistair Milburn has thought this through. What if you develop a complication as a result of an operation you've had abroad. You might be too ill to return to France or wherever you have had it done. Then an NHS doctor will still have to pick up the pieces.
Margaret Bolan, UK

See also:

26 Aug 01 | Health
NHS patients to be sent abroad
30 Jul 01 | Health
German hip op plan defended
16 Aug 01 | Health
NHS patients may be sent abroad
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