Supplementary memorandum by the Department
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
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
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
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
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
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
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
FOR E112 FORMS
E112 FORMS ISSUED
[Though we do not have a full break down, 561 of these were
FOR E112 FORMS
E112 FORMS ISSUED
||Removal of endometric|
||Orthotics, Casting and Fitting of callipers
||Proton Beam Therapy||3
||Preassessment for Proton Radiotherapy||
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
LOCAL COMMISSIONERS THAT RECOMMENDED THAT E112 FORMS BE
ISSUED FOR NON-MATERNITY CARE IN 2007 AND 2008
|Bath and North East Somerset||Lambeth
|Bradford and Airedale||Lewisham
|Calderdale||Lothian NHS Board
|Central Lancashire||Mid Essex
|Cornwall and Isles of Scilly||NHS Greater Glasgow and Clyde
|Croydon||NHS South of Tyne and Wear
|Derbyshire County||North Yorkshire & York
|East and North Hertfordshire||Oldham
|Eastern and Coastal Kent||South Gloucestershire
|Enfield||South of Tyne and Wear
|Fife NHS||South West Essex
|Health Commission Wales||Tameside & Glossop
|Kensington and Chelsea||Warwickshire