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

Examination of Witnesses (Questions 280-299)

Ms Jo Webber, Ms Susan Williams and Mr Tim Curry


  Q280  Baroness Perry of Southwark: I suppose at the heart of all the questions we have been asking is the issue of how we can ensure quality of care for patients if they do cross borders for their care. My question relates, first of all, to what the Royal College of Nursing said in their written evidence, that you thought the responsibility for ensuring quality should be in the Member State of treatment and not the home country. Could you expand on that. We hear what you believe is necessary in the light of the complex pathways of care that may arise and how we can guarantee the quality. Are there any lessons that we can learn from the London Patient Choice project, covering patients who were sent to five hospitals in Belgium in 2003-04?

  Ms Williams: In terms of what we want to see in the overarching Directive, the reason it is important to clarify who is responsible for safety, quality, and redress—that is, the country of treatment—is that we have had previous proposals from the EU, notably the Services Directive, where the opposite proposals were given, particularly with the free movement of services, where a service provider would be able to set up in a country and not be necessarily subject to the quality and safety regime of that country. It is quite important, therefore, that if somebody is being treated in the UK they should expect to be treated under the regulatory frameworks that operate within that country, and, equally, if somebody is being treated in another country, under that regulatory framework. From the practical point of view, there may well be issues—and we have talked about this already—about the kinds of discussions that an individual patient may have before they leave their own country and discussions around continuity of care, but, in terms of the framework, it is important that if you are being provided care in a particular country where, for example, those health professionals are registered and where those providers operate, that you should be subject to the regime in that country. In terms of the London Patient Choice Project, we flagged that up because it was part of a very useful wider study that has been done about cross-border care and quality. There is generally very little evidence around, which is why it is such a welcome piece of work. The London Patient Choice Project may have some lessons for us, however it was a very specific pilot. It had funding put into it so that things like travel costs were covered. It had a lot of intense work done on patient liaison and information so that patients making choices either to go elsewhere in the UK or to go abroad had an awful lot of information available to them—quite a tailored service. I think the other issue to raise is that quite detailed contracts were agreed which would be unrealistic in the context that we are talking about, unless we are again expecting there to be commissioning of care abroad in a cross-border context. It was also done at a time when there were very long waiting lists, so that was one of the reasons for it being set up. Realistically, the parameters are unlikely to be the same. However, it did flag up issues about the fact that patients did find having that information very useful and that they would have wanted to be more aware of the wider costs associated with treatment abroad—so the psychological costs or the costs for relatives, et cetera, if they were seeking a treatment where they would want to be accompanied. It also flagged up the fact that they had mixed experiences of referral from the UK and aftercare when they returned. That is partly why we also flagged up the issue of information and education of health professionals.

  Q281  Baroness Perry of Southwark: Is there not a slight contradiction, that you understandably emphasise the need for information and the information to be given in this country? Let us talk about people going from here into another country. If I get what I think is good advice from my GP, via the centre of information or whatever, that I can have an absolutely super operation in Northern Italy or somewhere, and I go there and it is a disaster, am I not going to be just as likely to feel I have been cheated by the information givers in my own country as by the treatment givers in the other country?

  Ms Webber: I think you probably are in that situation. Part of the reason for going with prior authorisation is the ability to have that time period when you can have a very fair, honest, and open discussion about what the issues are. The other thing to note which probably did not come across was that the London Patient Choice Project was a contracted thing, contracts were laid. In terms of somebody seeking cross-border care, the contract is between the patient and the provider, and that means that the patient, if you like, has the onus on them to have gone into the issues around quality and safety for the provider that they are going to elsewhere. This is where I think getting the information right and giving people a really clear understanding of what the issues are is important, because some of the quality standards that we have are going to be different in different countries and in different systems. One way that could be overcome would be for European providers to sign up, to almost have the NHS terms and conditions placed on our choice menu, but there is an issue about liability for care delivered under another regulatory system in a different system. We are not clear what the legal implications of that would be, but there is a very great difference between the contractual thing that went on within the London Patient Choice and what we are dealing with here, which is individual contracts.

  Chairman: We do have to finish there, which is a great pity, because had there been time I would have asked you the question that swept up Lord Wade and Lord Lea's point in terms of proportionality, we know we have to do something because of the Watts European Union finding. In terms of proportionality and understanding different systems, having enough information to answer Lord Lea's question which is how do you know where anything is, getting commissioners to have that information, seems to us a huge task. We are really asking if you agree that although this has to be tackled it could quite overwhelm resources in relation to the size of the issue that it is dealing with. I think that is what Lord Wade was asking right at the beginning and Lord Lea is trying to get at by asking you specific questions. You are nodding.

  Lord Lea of Crondall: If we could have a supplementary note on that, I would be grateful.

  Chairman: We would be very grateful to have a note on that because it is what is beginning to concern the Committee, I think, that things have to happen but the size of the bureaucracy could be greater than the answer to the question. Thank you very much. As you can see, the Committee have valued your evidence greatly and we are sorry we have run over.

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