Select Committee on Health First Report


47. On 12 July 2001 the European Court of Justice ruled on two joint cases (Geraets-Smits and Peerboms, and Vanbraekel) that some hospital activities might fall within the EC single market rules. The Government then announced that NHS commissioners would be able to commission care for NHS patients from providers in other EU Member States as part of the move to drive down waiting times.[67] The initiative is being led by Mr Peter Huntley, chief executive of the Channel Primary Care Group in Dover. East Surrey and East Kent health authorities have been involved in pilot schemes which seek to establish the value for money of such activity, the extent to which patients would contribute to their travel expenses and other "legal, quality and clinical issues".[68] The Secretary of State told us that use of this route would be confined to patients whose consent had been given and following a full assessment of their clinical needs.[69]

48. Press briefing issued by the Channel Primary Care Group indicated that the pilot schemes would look at the types of procedure which would have the "the greatest impact on waiting times within their local trusts and that fulfil the original criteria of relatively low risk" such as "major joint replacements, cataracts, general surgical procedures such as hernias, varicose veins, haemorrhoidectomies and laparascopic cholecystectomies[70] and possibly tonsillectomies and non-cancerous prostate operations".[71]

49. Mr Huntley told us that he had been given the go-ahead for the pilot projects by ministers in October 2001. At the time of his appearance before us in December 2001, no patients had been treated abroad. Since then, however, the first patients have been treated at La Louviere Hospital Lille for a variety of elective procedures. Hospitals in other countries, including Germany and Greece have also been inspected with a view to extending the scheme.[72] Several European countries, Mr Huntley told us, had excess capacity as a consequence of over-investment.[73]

50. We asked Mr Huntley whether this scheme might be of only marginal relevance to the NHS. He indicated that initial interest in the scheme had been high[74] and that he could envisage as many as 10-20,000 patients being treated abroad annually.[75] Although the initial schemes were based on commissioners in the South East of England, Mr Huntley felt there was no bar to patients elsewhere in the country being treated abroad, pointing out that a flight to Hamburg from the North East of England took less than two hours, which might be quicker than a journey to have an operation out of area in England.[76]

51. Given the paucity of operations carried out to date, and the fact that the Department has cited commercial confidentiality as a reason for not disclosing the cost of individual operations in France, it is hard for us to establish the extent to which operating on NHS patients abroad constitutes good value for money, something which the Secretary of State told us was essential.[77] In written answers, the Government has maintained that the costs of NHS funded operations in Lille are "commercially confidential" but that the prices agreed so far are "in excess of NHS average reference costs but comparable to those in the United Kingdom private sector".[78] General Healthcare Group argued that the private sector would "certainly be competitive" in comparison with Continental suppliers, and that treatment in the private sector in England would be preferable in terms of patient convenience and quality assurance.[79] However, Mr Huntley told us that, even without bulk purchasing discounts that would flow assuming there was sufficient uptake, costs compared "favourably" with the private sector in England and were even below NHS reference costs, though here matters were complicated in that the European option included post-operative follow-up and rehabilitation but excluded travel costs.[80] This last complication may underlie the apparent discrepancies in the statements from the Government, General Healthcare Group and Mr Huntley as to the value for money of this activity. The fact that the figures are confidential, together with the unreliability of the NHS reference costs as a benchmark, makes any assessment of value for money difficult.

52. It is acknowledged both by those involved in the pilots and by the Government that a number of legal and logistical obstacles are posed by this activity. The Secretary of State indicated that legislation might be required to fund free transport for individuals to overseas hospitals.[81] Patients have to have access to English speaking staff. Dealing with complaints will be far from straightforward given the lack of a clear chain of accountability, and liability for adverse clinical incidents will undoubtedly yield problems. In terms of medical complications, Mr Huntley told us that rehabilitation would be included in the initial package: it was general practice in Europe for hip and knee replacements for patients to undertake an acute phase of rehabilitation within the hospital of between eight and 12 days then spend between two to four weeks in a rehabilitation centre undergoing intensive physiotherapy, after which time they are fit to go home.

53. In the short-term at least, we believe that the treatment of NHS patients abroad is likely to prove a fairly marginal activity. Initial patient reactions seem to be encouraging and the excess capacity in continental Europe offers the possibility of the NHS securing good value for money and reducing waiting lists. Clearly it is essential that patients are assured of the quality of the care they receive. So we believe that the Commission for Health Improvement is the appropriate body to inspect standards in hospitals abroad treating NHS patients. It is also essential that robust mechanisms are put in place to ensure that patient follow-up can successfully take place and that the Department sets out clearly the legal implications of adverse clinical incidents.

67   Official Report, 15 October 2001, col. 1042w. Back

68   Official Report, 15 October 2001, col. 1042w. Back

69   Q57. Back

70   The surgical removal of the gallbladder. Back

71   Channel Primary Care Group, Press Briefing No. 2, 19 November 2001. Back

72   The Guardian, 18 January 2002. Back

73   Q896. Back

74   Q887. Back

75   Q898. Back

76   Q890. Back

77   Q57. Back

78   Official Report, House of Lords, 25 February 2002, cols. WA 185-86. Back

79   Ev 215. Back

80   Q901. Back

81   QQ63-65. Back

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