Wednesday, 6 February 2013

Is Europe good for the NHS or is the NHS good for Europe?

I took part in a fascinating event yesterday, a Balance of Competencies Review meeting. In true tradition of government speak – as the invitation popped into my inbox my first question was ‘what?’  But actually the aim of the review is pretty straightforward – to gather evidence to submit to a health report required by the Foreign Secretary with the following brief: To undertake an audit of what the EU does and its impact on the UK – what this means for UK national interest.

I was immediately impressed with the diversity and calibre of the audience – representatives from the Royal colleges, NHS departments running overseas visitor services, the pharmaceutical industry, charities, the food industry and independent commentators and service providers. We had limited time available to brainstorm the positives and negatives of EU membership from the perspective of public health, the NHS, and medical devices and medicines.
I joined the NHS workshop and although I suspect the organisers didn’t learn anything new from the gathered ‘experts’ it was interesting to note the polarity of views. Despite a request to keep things ‘high level’ the group understandably kept slipping towards minutiae and local specifics. We discussed the report, ‘Patient choice beyond borders’ issued by the NHS European office in May 2011. The EU directive confirming the right of patients to receive healthcare in another EU member state will become law in October 2013. In simple terms, patients can travel to any member state to receive care that would be available in their home country and the cost (excluding travel and accommodation) must be reimbursed by the home country. The treatment tariff from the home country will apply. There have already been some test cases where the European Court of Justice decided in favour of the claimants, and ruled that a PCT should reimburse UK patients for their elective overseas treatment. Pre-authorisation is desirable but not essential. There is already a steady flow or European patients attending the NHS for treatment. But is this free movement of patients and staff good or bad for the NHS and the UK in general? Cue a heated discussion….

It was agreed that most of the negatives and pitfalls of accepting European patients into the NHS are not due to EU law, but down to the fact that our healthcare is a ‘residency based system’ so if someone is ‘residing’ in the UK – they are likely to be treated. It is the way we police this treatment of ‘visitors’ in hospitals that leads to a significant number of patients receiving care for which the UK is not reimbursed. But is this the EU’s fault? No it’s not. The point was made that UK citizens travelling to Europe for treatment remove themselves from the duty of the care of the NHS for that treatment so they are at the mercy of their chosen facility. This highlights the need for some sort of central information service to report on standards and clinical governance – a bit like Tripadvisor for health!

The pluses of an open European market for health are exciting and manifold and as the discussion continued, I found myself becoming increasingly Europhile! Shared data, research, the creation of world renowned centres of excellence are all tangible opportunities to bring much needed income into the NHS. The way that Great Ormond Street Hospital has become a global brand is a good example of how we could promote specialist services throughout Europe. Another sensitive issue is cross border employment. The risk of losing doctors and nurses to overseas competitors is offset by a significant number of European clinicians choosing to work in the UK. Language is a major hurdle to be overcome, but again this is down to local management – if an EU migrant worker does not have sufficient language skills to do their job properly then a hospital is under no obligation to employ them.

This blog only scratches the surface of what was discussed at the review and the scope of evidence to be collected is mind blowing. But I was left with a new insight on the European Union and the potential it can offer. So many of our negatives against this free market are down to local interpretation, the generous way the NHS is set up,  poor reimbursement collection systems and dare I say, narrow minds.

What about the elephant in the room? David Cameron’s referendum that could potentially exclude us from the EU? It wasn’t mentioned..


Rob Dickman said...

Glad you enjoyed it! I think we could have done with slightly longer and had a better focus for discussions but it was encouraging to hear people contribute so readily - and not all negatively!

Although the focus of the BoC review is necessarily wider, Directive 2011/24 EU (on patients' rights in cross-border healthcare) covers a lot of the issues you refer to above - reimbursement of EU medical costs, prior authorisation, pricing and charging, obligations on Member State of treatment, set up of National Contact Points, mutual recognition of prescriptions, European Reference Networks & centres of excellence, eHealth, sharing of information, etc etc....

I would describe the Directive as complex, wide-ranging and potentially controversial (when understood properly). It is required to be implemented into national laws by 25 October this year and I'm just finalising the consultation process, which looks likely to start towards the end of February - so look out for that and a couple of consultation events that you (and others) might like to attend...

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