NHS may face health tourism bill after Euro ruling


By Geoff Meade, PA Europe Editor, in Brussels
Published: 16 May 2006
NHS patients must be reimbursed for medical treatment abroad if they
face an "undue delay" for surgery at home, European Court judges ruled
today.

The verdict came in a case brought by 74-year-old grandmother Yvonne
Watts, who defied the NHS to have a £4,000 hip operation in France
despite being warned that Bedford Primary Care Trust would not
authorise payment.

Today, the European Court of Justice confirmed that, under EU rules on
free movement to provide services, one EU healthcare system must pay
the bill if a patient is obliged to look elsewhere in Europe for
treatment because of hold-ups.

But the judges did not award Mrs Watts her £4,000 back - they said it
was up to the domestic courts to decide if, in her case, she had faced
an "undue delay".

The case is the first of its kind involving the NHS to be challenged
under EU law.

Mrs Watts went to court after returning from her hip operation in
France to face the refusal of Bedford Primary Care Trust to cover her
costs.

The Trust had insisted the three- to four-month wait for an NHS hip
replacement did not amount to the "undue delay" which would warrant
reimbursement of her foreign costs.

But today the European judges said the decision on what amounted to an
"undue delay" should not be based on either National Health Service
waiting lists or Government NHS targets.

The decision was to be based entirely on the individual patient's
medical condition and circumstances.

Now it will be up to British courts to reconsider the situation of Mrs
Watts and decide if she gets her £4,000 back.

Mrs Watts had originally been told she faced a waiting time of one year
for a hip operation. She then saw a French consultant who advised her
the need for treatment was becoming more urgent due to her declining
health.

A few weeks later she saw a British consultant, who recommended that
she be moved up the NHS waiting list to receive surgery within three or
four months.

But Mrs Watts wanted even swifter treatment abroad and asked the Trust
to authorise such treatment.

When authorisation was refused she went to France anyway, receiving the
necessary surgery in Abbeville just one month later.

The Department of Health had argued in court that if all NHS patients
were guaranteed reimbursement of their medical costs when they opted
for treatment abroad, it would seriously undermine the NHS system of
administering medical priorities through waiting lists.

The result, claimed the Government, would be the diverting of NHS
resources to pay for less urgent treatment for those willing to travel
abroad, and discrimination against others not willing or unable to go
to another EU country for surgery.

Mrs Watts, who has avoided publicity since launching her legal
campaign, would not be drawn on a comment about her landmark court
victory this morning.

When told of the court ruling, she said from her home in the Queens
Park area of Bedford that it was "wonderful" news after such a lengthy
legal struggle.

She said: "It is wonderful, after such a long time."

Katherine Murphy, director of communications at the Patients
Association, said the case raised important questions about why people
felt they needed to travel abroad.

There needed to be less focus on targets and more consideration of a
patient's clinical need and their quality of life, she added.

"We must ask ourselves why are people opting to go abroad? Why don't
they want to stay with the NHS in this country?

"Things such as deficits really concern patients who are waiting for
operations or any form of treatment.

"What this case highlights is that we should be looking at improving
our NHS here and making it a service that patients are proud of and
want to use.

"I don't think we should always be focused on meeting targets. Mrs
Watts was obviously in a lot of pain and her quality of life was
obviously affected.

"In this case, her GP should have researched and seen if there was
anywhere else in the UK that would have performed this without her
having to wait."

She said there were several worries about patients going abroad for
treatment, including the cost and the possibility of feeling isolated
from friends and family.

She continued: "There are also questions about the after-treatment.
What if things go wrong? If somebody has an operation abroad but then
needs things like physio, X-rays or other investigations, do they have
that treatment here or do they stay abroad?"

Today's judgment said: "The obligation to reimburse the cost of
hospital treatment provided in another member state also applies to a
national health service which provides such treatment free of charge."

It went on: "In order to be entitled to refuse a patient authorisation
to receive treatment abroad on the ground of waiting time for hospital
treatment in the State of residence, the NHS must show that waiting
time does not exceed a medically-acceptable period having regard to the
patient's condition and clinical needs."

The judges said that under EU law, an "E112" scheme allowed a patient
to apply for authorisation to travel elsewhere in the EU for treatment.


"That authorisation cannot be refused where the treatment in question
is normally available in the member state of residence but cannot be
provided there in the individual case without undue delay. The health
insurance fund is then required to reimburse the cost of treating the
patient."

In Mrs Watts' case, the original diagnosis was that her case was
"routine" - meaning a one-year wait for surgery.

Bedford Primary Health Care Trust refused to issue Mrs Watts with an
E112 form because they said her treatment could be provided "within the
Government's NHS Plan targets", and, therefore "without undue delay".

That timetable was revised to 3-4 months as her health deteriorated,
and the Trust repeated its refusal to authorise even swifter treatment
available in France.

The judges said that to be entitled to refuse authorisation, the Trust
had to establish that the NHS waiting time - based on "planning and
management" objectives in the supply of hospital care - did not exceed
a period acceptable in the light of the patient's medical condition and
"the history and probable course of his illness, the degree of pain he
is in and/or the nature of his disability at the time when the
authorisation is sought".

The judges added: "In the present case, it is for the referring court
to determine whether the waiting time invoked by the competent body of
the NHS exceeded a medically acceptable period in the light of the
patient's particular condition and clinical needs."

NHS patients must be reimbursed for medical treatment abroad if they
face an "undue delay" for surgery at home, European Court judges ruled
today.

The verdict came in a case brought by 74-year-old grandmother Yvonne
Watts, who defied the NHS to have a £4,000 hip operation in France
despite being warned that Bedford Primary Care Trust would not
authorise payment.

Today, the European Court of Justice confirmed that, under EU rules on
free movement to provide services, one EU healthcare system must pay
the bill if a patient is obliged to look elsewhere in Europe for
treatment because of hold-ups.

But the judges did not award Mrs Watts her £4,000 back - they said it
was up to the domestic courts to decide if, in her case, she had faced
an "undue delay".

The case is the first of its kind involving the NHS to be challenged
under EU law.

Mrs Watts went to court after returning from her hip operation in
France to face the refusal of Bedford Primary Care Trust to cover her
costs.

The Trust had insisted the three- to four-month wait for an NHS hip
replacement did not amount to the "undue delay" which would warrant
reimbursement of her foreign costs.

But today the European judges said the decision on what amounted to an
"undue delay" should not be based on either National Health Service
waiting lists or Government NHS targets.

The decision was to be based entirely on the individual patient's
medical condition and circumstances.

Now it will be up to British courts to reconsider the situation of Mrs
Watts and decide if she gets her £4,000 back.

Mrs Watts had originally been told she faced a waiting time of one year
for a hip operation. She then saw a French consultant who advised her
the need for treatment was becoming more urgent due to her declining
health.

A few weeks later she saw a British consultant, who recommended that
she be moved up the NHS waiting list to receive surgery within three or
four months.

But Mrs Watts wanted even swifter treatment abroad and asked the Trust
to authorise such treatment.

When authorisation was refused she went to France anyway, receiving the
necessary surgery in Abbeville just one month later.

The Department of Health had argued in court that if all NHS patients
were guaranteed reimbursement of their medical costs when they opted
for treatment abroad, it would seriously undermine the NHS system of
administering medical priorities through waiting lists.

The result, claimed the Government, would be the diverting of NHS
resources to pay for less urgent treatment for those willing to travel
abroad, and discrimination against others not willing or unable to go
to another EU country for surgery.

Mrs Watts, who has avoided publicity since launching her legal
campaign, would not be drawn on a comment about her landmark court
victory this morning.

When told of the court ruling, she said from her home in the Queens
Park area of Bedford that it was "wonderful" news after such a lengthy
legal struggle.

She said: "It is wonderful, after such a long time."

Katherine Murphy, director of communications at the Patients
Association, said the case raised important questions about why people
felt they needed to travel abroad.
There needed to be less focus on targets and more consideration of a
patient's clinical need and their quality of life, she added.

"We must ask ourselves why are people opting to go abroad? Why don't
they want to stay with the NHS in this country?

"Things such as deficits really concern patients who are waiting for
operations or any form of treatment.

"What this case highlights is that we should be looking at improving
our NHS here and making it a service that patients are proud of and
want to use.

"I don't think we should always be focused on meeting targets. Mrs
Watts was obviously in a lot of pain and her quality of life was
obviously affected.

"In this case, her GP should have researched and seen if there was
anywhere else in the UK that would have performed this without her
having to wait."

She said there were several worries about patients going abroad for
treatment, including the cost and the possibility of feeling isolated
from friends and family.

She continued: "There are also questions about the after-treatment.
What if things go wrong? If somebody has an operation abroad but then
needs things like physio, X-rays or other investigations, do they have
that treatment here or do they stay abroad?"

Today's judgment said: "The obligation to reimburse the cost of
hospital treatment provided in another member state also applies to a
national health service which provides such treatment free of charge."

It went on: "In order to be entitled to refuse a patient authorisation
to receive treatment abroad on the ground of waiting time for hospital
treatment in the State of residence, the NHS must show that waiting
time does not exceed a medically-acceptable period having regard to the
patient's condition and clinical needs."

The judges said that under EU law, an "E112" scheme allowed a patient
to apply for authorisation to travel elsewhere in the EU for treatment.


"That authorisation cannot be refused where the treatment in question
is normally available in the member state of residence but cannot be
provided there in the individual case without undue delay. The health
insurance fund is then required to reimburse the cost of treating the
patient."

In Mrs Watts' case, the original diagnosis was that her case was
"routine" - meaning a one-year wait for surgery.

Bedford Primary Health Care Trust refused to issue Mrs Watts with an
E112 form because they said her treatment could be provided "within the
Government's NHS Plan targets", and, therefore "without undue delay".

That timetable was revised to 3-4 months as her health deteriorated,
and the Trust repeated its refusal to authorise even swifter treatment
available in France.

The judges said that to be entitled to refuse authorisation, the Trust
had to establish that the NHS waiting time - based on "planning and
management" objectives in the supply of hospital care - did not exceed
a period acceptable in the light of the patient's medical condition and
"the history and probable course of his illness, the degree of pain he
is in and/or the nature of his disability at the time when the
authorisation is sought".

The judges added: "In the present case, it is for the referring court
to determine whether the waiting time invoked by the competent body of
the NHS exceeded a medically acceptable period in the light of the
patient's particular condition and clinical needs."

.

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