Guidance published by the Department of Health (DH) to accompany implementation of the EU Directive on patients’ rights in cross-border healthcare sets out to provide a practical guide to the obligations placed on NHS England, Clinical Commissioning Groups (CCGs) and healthcare providers by the new Regulations and Directions.
The guidance provides information in relation to:
- Claims for reimbursement of treatment costs;
- Applications from patients seeking prior authorisation for the receipt of healthcare in another EU state; and
- NHS providers who may receive requests from overseas patients for treatment in the UK under the provisions of the directive.
The Regulations provide that EU citizens who choose to obtain a health service (including private and unplanned care) in another Member State can seek reimbursement of the costs they will have paid up front, provided that the service is the same as or equivalent to a service that would have been provided to the patient within the NHS. The right to claim a reimbursement is limited to the cost to the NHS of the same or equivalent treatment or the actual amount paid by the patient, where this is less. Where the treatment would be commissioned by the patient’s CCG, NHS England will reimburse the patient and then, itself, seek reimbursement from the patient’s CCG.
Unlike the S2 route to EU healthcare, which does not cover private sector treatment, the Regulations permit access to treatment in both the state and private sector. As a general rule, unless they are seeking highly specialised complex and costly treatment, patients may obtain treatment under the Regulations without prior authorisation from NHS England. Authorisation, where it is required, may be refused only where there is an unacceptable risk to patient safety, travel poses a substantial safety hazard to the general public, the provider’s standards raise serious and specific concerns or the NHS can provide the same or equivalent treatment within a medically appropriate timescale.
Ironically, when a patient requests prior authorisation under the Regulations, NHS England will first, according to the guidance, decide whether the patient meets the requirements of the S2 route. If they do, they will be granted authorisation under that process instead.
Where treatment is sought under the Regulations, the law of the country of treatment applies: it is the patient’s responsibility to assure themselves about who will be accountable for assuring their safety. The role of NHS England is to facilitate the patient’s choice to seek treatment abroad instead of at home. As such, the National Contact Point (NCP), sitting within NHS England, will make information publicly available and readily accessible and should be able to provide assistance with anything from advice on entitlements to translation of receipts.