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

Supplementary memorandum by the Royal College of Nursing

  During the oral evidence session from the RCN to EU Sub-Committee G Inquiry on cross border care we were asked to provide supplementary evidence.

  At the end of the oral evidence session Lady Howarth raised the issue of proportionality and understanding the different systems in place across the EU.

  The RCN believes that the government in this country needs to ensure that patients can be advised on how to access cross border care whilst meeting the requirements of the directive. Given that any decision to seek treatment in another country cannot be isolated from considerations about options for treatment in the home member state (most patients preference), wherever possible it is sensible to integrate information and advice on treatment outside the UK, with processes in place to advise on options locally/nationally.

  Consideration should also be given to ensuring that information provided to facilitate choice and cross border mobility is to a consistently high standard and that Member States demonstrate that they are taking steps to address the needs of population groups who traditionally have difficulty in accessing information.

  The overriding concern of any government should be to prevent rising inequality of outcomes in respect of health and social care. The Directive should provide guidance to member states and emphasis the importance of cohesive health and social care services which improve the health and opportunities for citizens of the EU. In particular, the Commission may wish to consider what happens where member states costs are significantly lower than neighbouring states costs who may find it impossible to fund "greater" choice or mobility as reimbursement is only the level it would cost to provide the care in question within the host member state.

  In terms of proportionality the Commission should be aware that this Directive will pose more of a challenge for some member states than others. The health care systems in some of the wealthier member states are already set up along lines which facilitate choice and provide a decent level of information for commissioners, providers and users of services. For example in England, the government has already invested significant resources in Choose and Book which attempts to provide greater choice and flexibility for planned care. Even with this investment, take up rates are still very low.

  In poorer or less well resourced member states, there may need to be significant investment in staff training, public education and infrastructure to address the aims of the Directive. The impact of this Directive in terms of the sustainability of services and patient flows across borders should be closely monitored.

  If you require further information please do not hesitate to contact me. Once again thank you for allowing the RCN to contribute to this important investigation.

15 December 2008

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