III TREATING NHS PATIENTS ABROAD
47. On 12 July 2001 the European Court of Justice
ruled on two joint cases (Geraets-Smits and Peerboms, and Vanbraekel)
that some hospital activities might fall within the EC single
market rules. The Government then announced that NHS commissioners
would be able to commission care for NHS patients from providers
in other EU Member States as part of the move to drive down waiting
times. The initiative
is being led by Mr Peter Huntley, chief executive of the Channel
Primary Care Group in Dover. East Surrey and East Kent health
authorities have been involved in pilot schemes which seek to
establish the value for money of such activity, the extent to
which patients would contribute to their travel expenses and other
"legal, quality and clinical issues".
The Secretary of State told us that use of this route would be
confined to patients whose consent had been given and following
a full assessment of their clinical needs.
48. Press briefing issued by the Channel Primary
Care Group indicated that the pilot schemes would look at the
types of procedure which would have the "the greatest impact
on waiting times within their local trusts and that fulfil the
original criteria of relatively low risk" such as "major
joint replacements, cataracts, general surgical procedures such
as hernias, varicose veins, haemorrhoidectomies and laparascopic
and possibly tonsillectomies and non-cancerous prostate operations".
49. Mr Huntley told us that he had been given the
go-ahead for the pilot projects by ministers in October 2001.
At the time of his appearance before us in December 2001, no patients
had been treated abroad. Since then, however, the first patients
have been treated at La Louviere Hospital Lille for a variety
of elective procedures. Hospitals in other countries, including
Germany and Greece have also been inspected with a view to extending
the scheme. Several
European countries, Mr Huntley told us, had excess capacity as
a consequence of over-investment.
50. We asked Mr Huntley whether this scheme might
be of only marginal relevance to the NHS. He indicated that initial
interest in the scheme had been high
and that he could envisage as many as 10-20,000 patients being
treated abroad annually.
Although the initial schemes were based on commissioners in the
South East of England, Mr Huntley felt there was no bar to patients
elsewhere in the country being treated abroad, pointing out that
a flight to Hamburg from the North East of England took less than
two hours, which might be quicker than a journey to have an operation
out of area in England.
51. Given the paucity of operations carried out to
date, and the fact that the Department has cited commercial confidentiality
as a reason for not disclosing the cost of individual operations
in France, it is hard for us to establish the extent to which
operating on NHS patients abroad constitutes good value for money,
something which the Secretary of State told us was essential.
In written answers, the Government has maintained that the costs
of NHS funded operations in Lille are "commercially confidential"
but that the prices agreed so far are "in excess of NHS average
reference costs but comparable to those in the United Kingdom
General Healthcare Group argued that the private sector would
"certainly be competitive" in comparison with Continental
suppliers, and that treatment in the private sector in England
would be preferable in terms of patient convenience and quality
Mr Huntley told us that, even without bulk purchasing discounts
that would flow assuming there was sufficient uptake, costs compared
"favourably" with the private sector in England and
were even below NHS reference costs, though here matters were
complicated in that the European option included post-operative
follow-up and rehabilitation but excluded travel costs.
This last complication may underlie the apparent discrepancies
in the statements from the Government, General Healthcare Group
and Mr Huntley as to the value for money of this activity. The
fact that the figures are confidential, together with the unreliability
of the NHS reference costs as a benchmark, makes any assessment
of value for money difficult.
52. It is acknowledged both by those involved in
the pilots and by the Government that a number of legal and logistical
obstacles are posed by this activity. The Secretary of State indicated
that legislation might be required to fund free transport for
individuals to overseas hospitals.
Patients have to have access to English speaking staff. Dealing
with complaints will be far from straightforward given the lack
of a clear chain of accountability, and liability for adverse
clinical incidents will undoubtedly yield problems. In terms of
medical complications, Mr Huntley told us that rehabilitation
would be included in the initial package: it was general practice
in Europe for hip and knee replacements for patients to undertake
an acute phase of rehabilitation within the hospital of between
eight and 12 days then spend between two to four weeks in a rehabilitation
centre undergoing intensive physiotherapy, after which time they
are fit to go home.
53. In the short-term at least, we believe that
the treatment of NHS patients abroad is likely to prove a fairly
marginal activity. Initial patient reactions seem to be encouraging
and the excess capacity in continental Europe offers the possibility
of the NHS securing good value for money and reducing waiting
lists. Clearly it is essential that patients are assured of the
quality of the care they receive. So we believe that the Commission
for Health Improvement is the appropriate body to inspect standards
in hospitals abroad treating NHS patients. It is also essential
that robust mechanisms are put in place to ensure that
patient follow-up can successfully take place and that the Department
sets out clearly the legal implications of adverse clinical incidents.
67 Official Report, 15 October 2001, col. 1042w. Back
Official Report, 15 October 2001, col. 1042w. Back
The surgical removal of the gallbladder. Back
Channel Primary Care Group, Press Briefing No. 2, 19 November
The Guardian, 18 January 2002. Back
Official Report, House of Lords, 25 February 2002, cols.
WA 185-86. Back
Ev 215. Back