Coronation Street hip op plot highlights pitfalls for medical tourists
Fans of TV's Coronation Street have been following soap favourite Blanche's exploits as she attempts to beat NHS waiting lists by going abroad for surgical treatment.
The Corrie character, who in the latest storyline requires a hip operation, has decided that rather than wait for an NHS appointment she will go privately instead, selling her house to meet medical costs. In the most recent episode she has discovered that she could save money by obtaining treatment abroad and TV viewers have watched as she surfs the Internet in search of cut price hip op offers.
According to legal health expert, Lisa Jordan, Partner with Irwin Mitchell Solicitors, the latest Coronation Street plot mirrors the recent explosion in the phenomenon known as 'medical tourism.'
She says: "In the past two years we have seen a dramatic increase in the number of people seeking medical and surgical procedures abroad. Whilst on the surface this route may seem to offer a cost effective and speedy solution, patients need to be aware of the possible pitfalls so that they can minimise the risks, both medical and fiscal.
In particular, people should be wary about following Blanche's example by 'going it alone'. Before travelling abroad for treatment they should consider whether they may be eligible to have all or part of their treatment abroad funded by the NHS. This way they may not be left with the financial struggle that Blanche now faces".
At present there are two main schemes under which UK residents can have treatment abroad at the expense of the NHS, these are:
- Direct referral for treatment in the EU from the patient's NHS Trust or Primary Care Trust through a scheme known as NHS Overseas Commissioning and;
- Prior approval under the E112 scheme.
The Commissioning Scheme is being run as part of the Government's policy to reduce waiting times for hospital treatment. The NHS locally has responsibility for identifying suitable patients who are willing to undergo treatment abroad and are fit enough to travel. Before going abroad, patients are invited to attend a clinic in the UK for assessment. They then travel to the foreign country about three to five weeks later, accompanied by a multi-lingual 'Euro-PAL'. After the treatment the patient recuperates in the host country for about two to three weeks before returning home, with post-operative care then being provided by their local hospital and GP.
Lead commissioners, who are responsible for monitoring the quality of the service and who contract with the foreign hospitals or agencies involved, oversee the scheme. Whilst liability for clinical negligence under the scheme remains somewhat unclear, Government policy anticipates that patients may be able to seek redress in the UK courts by suing the appropriate NHS body, which in turn could recover the costs under the contract it holds with the foreign provider. This may mean that patients are not left with the difficulty of trying to pursue a claim abroad.
The second way in which costs can be obtained for treatment abroad is through the E112 scheme. British tourists will already be familiar with the E111 scheme, which provides reimbursement for emergency treatment if they fall ill whilst visiting an EU country. The E112 works in a similar way but prior authorisation must be obtained from the patient's Primary Care Trust and the Department of Health before travelling. Patients wishing to apply for authorisation under the scheme should first obtain a letter recommending the treatment from their Consultant.
Generally, authorisation cannot be refused where the patient is unable to obtain treatment in the UK within the time normally necessary, bearing in mind the patient's condition and whether they are likely to deteriorate.
The question of how to assess normal waiting time has therefore arisen. In the recent case of Mrs Watts, a patient who travelled abroad for a hip replacement, the High Court found that the original wait of one year she faced for the surgery could be considered to be undue delay, despite being within the Government's target waiting time for such a procedure. As such, Government target waiting times are not decisive and consideration should also be given to the patient's clinical need. Mrs Watts' case is currently under appeal and the issues raised have been referred to the European Court of Justice. The final judgement is awaited and may move the law closer to clarifying the state's obligations to patients travelling abroad under the E112 scheme.
Compared with the commissioning scheme, the E112 scheme may well present more problems for patients. Patients authorised to travel abroad under the E112 scheme are likely to travel to hospitals for which the UK lead commissioners do not hold contracts and therefore cannot guarantee the standard of treatment they will receive. The onus is more greatly on the individual to research the standards and reputation of the foreign hospital they wish to travel to. Patients are also more likely to face language barrier problems, not having the benefit of a 'Euro-PAL'. Further, assistance under the scheme may be limited, with patients still being required to pay for some expenses, such as their travel costs.
Lisa Jordan comments: "Both the Commissioning and E112 schemes offer patients financial assistance with the costs of medical procedures abroad. There are however other factors patients must consider. For patients travelling alone there is the issue of how they will cope with being away from the support of friends and family during their initial recuperation period and in all cases the possible complications that could arise from the travelling itself.
"Medical tourism is still in its infancy and, as yet, the law in this area is still very much developing. However, it's fair to say that patients who receive medical treatment abroad without taking either the E112 or Commissioning route, should be extremely wary. Not only could they face the full costs of medical treatment alone but they are leaving themselves open to all manner of potential problems."