Beyond the current discussion on Brexit there are other topics which are making the weather in the UK and featuring regularly in the media headlines. Take healthcare; across the UK we currently have budgetary constraints in place within the NHS, waiting lists for some key surgical procedures, as well as NHS patients travelling abroad under EU law to receive their healthcare, either through rights enshrined in the EU Cross-Border Healthcare Directive (CBHD) or through the EU Health Insurance Card (EHIC).
Whilst the budgetary constraints and waiting lists look set to continue, at least in the short term, there could be change in regards to UK citizens ability to access treatment abroad in the remaining Member States. Today’s agreement between the remaining 27 Member States and the UK guarantees the continuation of the EHIC scheme for all citizens in the UK when travelling abroad, with the detail yet to be agreed. However, concerns remain and this agreement does not cover the CBHD.
The CBHD allows European citizens to access medically necessary healthcare in another Member State and the wider European Economic Area. Paying up front, the patient can then apply for reimbursement from their home health system for the cost of that healthcare treatment.
The logic behind the legislation is that, now that there is a lot more free movement of EU citizens between the Member States, they should be covered for their healthcare whilst abroad. That is, if that same healthcare treatment would have been available back home. Since the passing of the legislation in the European Parliament in 2011 and its effective legal status across the UK in October 2013, it has been used as a document to clarify existing rules under European Court decisions which allow patients to exercise their rights to obtain healthcare services under Article 56 of the Treaty on the Functioning of the EU. In short, it has ‘codified’ patient rights, which was its original aim.
These rights have been widely used in the UK by NHS patients and the legislation has delivered benefits. Figures from 2015 show that more than 600 patients from the UK had surgery overseas in that year, including hip and knee replacements. The cost to the NHS of patients exercising these rights up until the end of 2014 was £833,491 – an average of £1,342 per claim.
So far, it can be said that the benefits of the CBHD have been the ability of patients to access routine surgery more promptly and use up excess capacity and for those people with rare diseases who may not have been able to get the treatment they need at home to travel abroad. The NHS can potentially save money also. For example, recent NHS data shows that the lowest cost for a hip replacement paid for by the organisation under this scheme was £4,153, which was carried out in the Czech Republic. Furthermore, a knee replacement was carried out in France for £2,756. Both these operations would cost around £5,943 and £12,500 to the NHS if carried out in the UK in a private hospital.
However, will the benefits of the CBHD survive in some form post-Brexit as has been the case with the EHIC? Already, it was recently reported that the Republic of Ireland Government has carried out a detailed analysis of the implications of Brexit on the functioning of the CBHD should the UK’s continued participation in it change under a so-called ‘hard Brexit’. This is because under the Directive, Irish patients have been travelling to Northern Ireland for treatment and vice-versa in large numbers; something which could change after March, 2019. This could have significant implications for patients and healthcare providers on both sides of the border.
Lastly, there is also the consideration of how Brexit may affect the health and social care workforce in the UK and regulatory issues which are associated with the smooth running of the CBHD, particularly for networks such as EU Rapid Alert Systems, European Reference Networks on Rare Diseases or the UK’s participation in the European Centre for Disease Prevention and Control (ECDC). The next few months should offer more clarity and hopefully the ongoing Brexit discussions will help push these issues further up the media agenda too, especially as we move towards Phase 2 of the talks on trade.