Healthcare across EU borders: a safe framework - European Union Committee Contents


Supplementary memorandum by the Department of Health

  Thank you to the Committee for an interesting session on the 30 of October. As part of the session, I undertook to write to you and the Committee with further detail on four points:

  Firstly, on the issue of the Department's understanding of what the Commission have in mind regarding a "standard format" for the provision of information to patients.

  This "standard format" is referred to in Article 10 of the draft Directive, which states,

    "(1)  The Member States of affiliation shall ensure that there are mechanisms in place to provide patients on request with information on receiving healthcare in another Member State, and the terms and conditions that would apply, inter alia, whenever harm is caused as a result of healthcare received in another Member State.

    (3)  The Commission may, in accordance with the procedure referred to in Article 19(2), develop a standard Community format for the prior information referred to in paragraph 1."

  The Government's response to the suggestion of a Community format for the provision of information is that we feel that this might only work for the very basic and common details shared by Member States. Health provision and services differ from country to country and to try and capture all these on the one form could prove very difficult and be unusable for patients.

  Secondly, on the issue of the Department's view on national contact points, as raised by Lord Kirkwood, in our consultation document we have asked for views on where national contact points could be located and how they could make best use of existing resources.

  However, our initial thoughts around the establishment of dedicated "national contact points" is that they should be focused on providing general information only as well as providing links to the National Contact points in other Member States. We do not believe it would be appropriate for National Contact points to be under any expectation that they could provide specific information about service providers in other Member States.

  Already, there is information on the EHIC, E112 and Article 49 for patients who may consider or require health treatment in another Member State on Department of Health, NHS Choices and NHS Direct websites.

  However, we expect that it would be the role of the local commissioner to provide more detailed information for the patient during assessment, ensuring that they fully understand the difference between E112 and Article 49 when reaching an informed decision. I do not think the national contact point could replace this.

  The issue was also raised of how the NHS would deal with issues around the recognition of, and reimbursement by the NHS for, prescriptions issued in another Member State and brought back to the UK by a UK patient to be dispensed for drugs not licensed for use in the UK and/or not recommended by NICE.

  Firstly, regarding drugs that are not licensed for use in the UK. Dispensers in the UK cannot dispense a prescription for a drug that is not licensed for use in the UK. We think that Article 14 in the draft Directive ensures dispensers in Member States do not have to recognise prescriptions for medicines that are not licensed in their territory. Since the patient will be unable to get the prescription for an unlicensed product dispense in the UK, the issue of whether they are reimbursed by the NHS does not arise.

  Similarly if a patient presents a prescription for an item that is listed in Schedule 1 of the NHS (General Medical Services Contracts) (Prescription of Drugs etc) Regulations 2004 as a substance not to be prescribed in primary care at NHS expense, it is unlikely that the PCT will think it appropriate to reimburse for the prescription.

  Secondly, covering prescriptions from another Member State for a drug that would not normally be funded by their local Primary Care Trust (PCT) for example a drug that receives a negative NICE appraisal. Decisions on whether patients are entitled to such drugs at NHS expense would be for their local PCT to make. If a UK patient seeks an NHS reimbursement for a prescription item that would not normally be funded by their PCT, then their case is open to the normal PCT procedures for exceptional circumstances.

  If the PCT decides not to fund the drug, (and assuming the drug is licensed and it is a valid prescription), the patient is entitled to have the medication dispensed as a private prescription under the Medicines for Human Use (Prescribing by EEA Practitioners) Regulations 2008.

  In terms of the relationship with "top up" payments, if the EEA prescription is paid for by the NHS, then clearly losing entitlement is not an issue. If the EEA prescription is not paid for by the NHS, in his report, Improving Access to Medicines for NHS Patients, Professor Mike Richards recommended that patients should not lose their entitlement to NHS care if they choose to buy additional care privately, as long as the private element of care is delivered separately from NHS care. The Government published alongside the report, on 4 November, draft guidance for the NHS for consultation that makes this principle clear.

  The final set of information I undertook to provide is the detailed information on the current data I have available on who is accessing cross-border healthcare under the E112 scheme. I attach this as an annex to this letter.

  I hope that these answers are useful to you. I am sure we will meet again in the coming months on this matter and thank you again for an opportunity to discuss these issues with you.

  I await the Committee's Report with interest, and will be writing to update you following the meeting of the Council of the European Union on the 15/16 December.

12 November 2008

COUNTRIES OF TREATMENT AND IF MATERNITY/NON-MATERNITY FOR E112 FORMS ISSUED IN 2007
MaternitySpecific Treatment Total
Austria45 9
Belgium1510 25
Bulgaria10 1
Cyprus02 2
Czech Republic210 21
Estonia10 1
Finland215 17
France12854 182
Germany5112 63
Greece22 4
Hungary40 4
Italy178 25
Lithuania10 1
Malta10 1
Netherlands80 8
Norway01 1
Poland1051 106
Portugal10 1
Romania10 1
Slovakia100 10
Spain2512 37
Sweden311 14
Switzerland315 18
Total404148 552


Annex 1

COUNTRIES OF TREATMENT FOR E112 FORMS ISSUED BETWEEN JAN-SEPT 2008
Austria11
Belgium26
Czech Republic18
Finland8
France108
Germany42
Greece4
Hungary5
Ireland1
Italy13
Latvia1
Lithuania1
Luxembourg2
Malta1
Netherlands5
Norway2
Poland294
Portugal1
Slovakia21
Spain17
Sweden8
Total596


  [Though we do not have a full break down, 561 of these were maternity cases.]

COUNTRIES OF TREATMENT AND IF MATERNITY/NON-MATERNITY FOR E112 FORMS ISSUED IN 2007
MaternitySpecific
Treatment
Total
Austria45 9
Belgium1510 25
Bulgaria10 1
Cyprus02 2
Czech Republic210 21
Estonia10 1
Finland215 17
France12854 182
Germany5112 63
Greece22 4
Hungary40 4
Italy178 25
Lithuania10 1
Malta10 1
Netherlands80 8
Norway01 1
Poland1051 106
Portugal10 1
Romania10 1
Slovakia100 10
Spain2512 37
Sweden311 14
Switzerland315 18
Total404148 552

COUNTRIES OF TREATMENT AND SPECIFIC TREATMENT GIVEN FOR E112 FORMS ISSUED IN APRIL-JUN 2008
MaternitySpecific
Treatment
ReasonTotals
Austria6 6
Belgium43 Ictal SPECT7
Ictal SPECT
Hysterectomy
Czech Republic7 7
Finland5 5
France614 Chemotherapy65
Proton Treatment
PVI Ablation
Brachytherapy
Germany16 16
Greece21 Chemotherapy3
Hungary4 4
Italy51 Illizarov Treatment6
Netherlands2 2
Removal of endometric
Poland1311 lesion132
Slovakia8 8
Spain6 6
Sweden52 Lymphoedema7
Orthotics, Casting and Fitting of callipers
Switzerland03 Proton Beam Therapy3
Proton radiotherapy
Preassessment for Proton Radiotherapy
Total26215 277


Further supplementary memorandum by Department of Health

  Many thanks for your letter dated 16 December. I am glad that you found the information provided helpful and look forward to reading your final report.

  With regard to your query on who in the NHS is commissioning E112 referrals, please see the attached table below. This lists which PCTs (or local commissioner in Wales or Scotland) recommended authorisation of an E112 form for a patient to travel to another Member State. However, it is important to note that the NHS does not commission E112 referrals. Each E112 request from a patient is examined on a case-by-case basis.

  This data covers non-maternity cases in 2007 and 2008. However, it is not possible to provide information around how many requests each local commissioner handled. The GP or midwife who recommends the authorisation of a maternity E112, is not currently captured.

  On the issue of the responses to our consultation, we are still analysing and preparing our response to the consultation in advance of publishing the Government response to the consultation.

  However, we believe that many of the points made to us in consultation responses will have been made to you via written and oral evidence.

  We will of course ensure that you have copies of our response to the consultation as soon as is possible.

22 January 2009

Annex 1

LOCAL COMMISSIONERS THAT RECOMMENDED THAT E112 FORMS BE ISSUED FOR NON-MATERNITY CARE IN 2007 AND 2008
Bath and North East SomersetLambeth
Berkshire EastLeeds
Bradford and AiredaleLewisham
BuryLiverpool
CalderdaleLothian NHS Board
CambridgeshireLuton
CamdenMedway
Central LancashireMid Essex
Cornwall and Isles of ScillyNHS Greater Glasgow and Clyde
CroydonNHS South of Tyne and Wear
CumbriaNorfolk
Derbyshire CountyNorth Yorkshire & York
DevonNorthamptonshire
East and North HertfordshireOldham
East LancashireSomerset
Eastern and Coastal KentSouth Gloucestershire
EnfieldSouth of Tyne and Wear
Fife NHSSouth West Essex
GloucestershireSouthwark
GreenwichStockport
HaringeySurrey
HaveringSwindon
Health Commission WalesTameside & Glossop
HounslowWakefield District
HullWaltham Forest
Kensington and ChelseaWarwickshire
KnowsleyWorcestershire


 
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