Eimear Flanagan
NI News

Images copyrightScientific Photo Archive

Image captionThe management helped the patients by reimbursing them for doctor’s visits and surgeries.

The EU health option, no longer available in the UK due to Brexit, is becoming increasingly popular on both sides of the Irish border, according to figures from .

Reimbursement is considered for both privately and publicly funded procedures.

Over the past five years, more than £50 million has been spent on reimbursing CBHD patients on both sides of the Irish border.

It is particularly popular with cataract patients in the Republic of Ireland, around 2,000 of whom have travelled on cataract buses to Belfast in recent years to undergo eye surgery in private clinics.

However, as the transition period for the Brexit ends on 31 December 2020, no new applications for paid care for UK patients will be accepted under this policy after that date.

This means less choice for UK patients at a time when waiting lists are getting longer and NHS services, even urgent cancer surgeries, have been cut back as a result of the pandemic.

However, critics of the European system have argued that the NHS should not accept the Private Healthcare Abroad Bill if it does not normally propose to fund private care domestically.

Brexit also means that EU citizens, including those from the Republic of Ireland, will no longer be able to claim healthcare in the UK through the CBHD.

However, the Irish government has a system in place to temporarily replace its residents seeking medical treatment in Northern Ireland.

How many people have used this program?

The EU Cross-Border Healthcare Directive was more popular in the Republic of Ireland than in Northern Ireland, according to data obtained by News NI.

Over the past five years, the head of the Irish Health Service (HSE) has processed nearly 16 500 successful claims and reimbursed Irish patients a total of €47 million (£40 million) for treatment abroad.


The bill was paid by the Irish taxpayer because the CBHD fee is paid by the claimant’s country of origin.

A further breakdown of the data shows that where Irish patients have sought prior authorisation for treatment in the UK in the last five years under the GBHD, 97% of the treatment sought has taken place in Northern Ireland.

Belfast or blind

About two years ago, Cork politician Michael Collins began organising buses to Belfast for cataract operations for patients from the Republic, with the CBHD covering the cost.

He told News NI that some of his passengers had to wait five years for surgery in the Republic and that some of them were at risk of losing their sight.

Mr Collins, along with fellow MP Danny Healey-Ray, organised bus trips to Belfast or for the blind. Together they have organised around 65 coach trips to cataract clinics in Belfast.

Image credit Michael Collins

Image captionPolitician Michael Collins (centre) says the buses in Belfast have been nicknamed the Cataract Express.

Patients who had no money to pay up front were supported with union loans on the assumption that they would be able to repay them by repaying the CBHD.

In Northern Ireland, the Health and Social Care Board has processed far fewer CBD applications than its southern counterparts in recent years.

However, between April 2016 and 31 December 2020, a total of £14 million will be spent on reimbursing patients from Northern Ireland for treatment with CBHD in the EU.


What happened after the Brexit transition?

The EU Directive no longer applies to all patients in the UK and was repealed on 1 January. January 2021 by the Health and Social Care Board of Northern Ireland (HSCB).

The board is not aware of any agreement between the UK and EU that would replace the scheme, NI News reported.

The HSCB said it is still looking at NHS patients’ claims for healthcare funding in European countries under the recent Brexit trade deal, but in a different way.

However, unlike the EU Directive, patients in the UK no longer have the option to choose private healthcare in an EU Member State, pay for the treatment upfront and seek reimbursement.

The destination country is also not obliged to provide British patients with access to publicly funded elective care, and if there is a public health waiting list, British applicants must be placed on a waiting list.

Can Irish patients continue to cross the border for elective treatment?

photo copyright photographic library

Image captionCataracts usually worsen over time without surgery.

This will enable patients from the Republic of Ireland to continue to receive certain private health services in Northern Ireland and to claim reimbursement from the Irish State.

Collins plans to bring his Belfast or Blind buses back under the new regime as soon as possible, when the Republic emerges from Covid 19’s highest suspension.

However, since the new plan is only for 12 months, Collins wants to find a long-term solution for patients on both sides of the border.

How does the Cross-Border Healthcare Directive work?

Under these rules, EU citizens have the right to seek treatment in another EU country and to be reimbursed for the cost of treatment in their own country.

The main condition is that the treatment must be available in the applicant’s country of origin through the public health care system.

Specifically, applicants can choose a public or private health care provider when traveling for treatment.

Reimbursement is based on the amount the public health system in your country would pay for the same treatment in your home country, and therefore does not include travel costs.

Moreover, not all treatment costs are necessarily covered. Patients should seek advice from their healthcare provider before travelling.

Prior authorization is not always required, but it may be mandatory if a particular treatment is expensive or requires an overnight stay.

How will patients access care outside the Institute after Brexit?


Image captionPrince Edward Island patients can still travel for treatment, but they have less personal control over the arrangements.

There are two ways for NHS patients to receive routine treatment outside Northern Ireland.

The first is known as the S2 route (or E112 route), which is available under the terms of the recent Brexit trade agreement, the Trade and Cooperation Agreement.

Under the S2 contracts, patients from Northern Ireland can seek treatment in any of the 27 EU member states, especially if there is a long waiting list in their country.

However, this option can only be used if the treatment is already available in publicly funded health facilities, both in the UK and in the country to which the patient wishes to travel.

S2 applications must also be supported in writing by a Northern Ireland consultant and be pre-approved by the Health and Social Care Board (HSCB).

The second route is known as Additional Contractual Referral (ECR) – this happens when a consultant recommends that a patient is transferred outside Northern Ireland because the care they need is not available in local NHS services.

Generally, young people are recruited to work with young people who require specialist treatment in the UK, but in some circumstances they may be sent abroad.

However, patients cannot arrange their own care – ERAs must be recognised as clinically necessary by a consultant and must be approved by the HSCB.

Why has the UK closed CBHD to new patients?

Image copyrightGetty Images

the inscription on the photoIreland is disproportionately affected by the CBI because of the Irish land border, Parliament has been told.

The EU Directive is a reciprocity agreement that will no longer apply to the UK after the end of the Brexit transition period.

In 2019, the UK Department of Health set out in Parliament why the scheme should be abolished after the Brexit.

The legislative notice states: It is strange to set up this system when British patients cannot be reimbursed for their private medical purchases in the UK.

He added that there is also a risk of inequality, as patients who can afford to seek treatment abroad can be treated more quickly than they otherwise would be and reimbursed by the NHS, while less fortunate and vulnerable patients cannot.

The UK Department also noted that Northern Ireland is disproportionately affected when it comes to access to cross-border healthcare, due to the land border with the Republic of Ireland.

She says the EU directive is already putting a strain on the UK Department of Health’s budget and warns: All other financial risks rest with the NI of the DoH.

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