A common market for health

British patients may soon have the right to be treated anywhere in the EU

Europe stands on the brink of a historic decision to open its borders to medical tourism, casting a dramatic spotlight on the performance of the UK's health system against that of neighbouring countries.

Cancer treatment, heart surgery and hip replacements could be available, in certain circumstances, to UK citizens in any of the EU's 27 countries. Under the plans, they would have the right to seek treatment anywhere which offered quicker access to care than was available on the NHS, with the NHS picking up the bill.

Citizens of other EU countries would have a corresponding right to come to the UK for treatment. Patients would have to be referred by a doctor and demonstrate they faced an "undue" delay for treatment in their own country.

Labour MPs yesterday warned the Brussels proposals would worsen inequalities, increase bureaucracy and undermine the financial stability of the NHS. Patients who go abroad would have to pay for their treatment and claim reimbursement, favouring the "well-off and well-informed".

The British Medical Association said there would be difficulties in providing follow-up care and UK doctors could be left to "pick up the pieces".

But assuming the proposals are eventually approved, the expansion of choice will keenly focus attention on the performance of the NHS against other health systems as patients across the EU try to work out the best countries to seek care.

As details continued to be fine-tuned, the European Commission yesterday delayed until the new year an announcement of the draft plans which are expected to vastly increase the choices available to EU citizens in need of medical care.

Making the eventual decisions on treatment will involve a careful assessment of the services offered, the standard of treatment and the individual patient's needs, as well as the criteria for eligibility. The health statistics published on our front page, taken from the OECD report Health at a Glance 2007, provide a snapshot of the overall performance on health of a selection of EU countries.

After five years of unprecedented investment, with an extra 45bn poured into the service, the NHS has moved up the league of health spending and now matches the EU-15 average at more than 9 per cent of GDP.

There has been a big expansion in staff, with 80,000 more nurses and 17,000 more doctors since 1997. Heart disease deaths are down 36 per cent in the past decade and cancer deaths down 16 per cent.

Waiting times have fallen dramatically, down to a maximum of six months for routine surgery. In 2000, more than 200,000 people were waiting more than a year. The Government claims the NHS is on course to reduce waits to a target maximum of 18 weeks from GP referral by the end of next year.

Despite these improvements, Britain's health record falls short against our closest neighbours. The UK still has the lowest number of doctors among leading EU countries for its population, though the gap has fallen since 1999.

The OECD report says: "An adequate supply of well-trained and geographically well distributed doctors is critical for providing patients with access to high quality medical care."

The death rate from heart disease in both genders and from cancer among women is still higher in the UK than among many comparable European countries. On infant mortality, a widely used indicator of a country's overall health, the UK comes bottom of the league of comparable nations with the highest death rate.

Most patients seeking treatment abroad would be likely to go for routine surgery such as hip and knee replacements where waiting lists are longer, or for rare conditions or specialised treatment not available in their own country. The EU commission proposals were drawn up partly in response to the case of Yvonne Watts, a 75-year-old grandmother from Bedford, who paid 3,900 for a hip replacement in France because she was initially told she would have to wait a year for an NHS operation in the UK, later reduced to three months.

The NHS refused to reimburse her but the European Court of Justice ruled she should have been allowed to shop around for treatment because she faced "undue" delay. The Bedford primary care trust had claimed she had been offered treatment "within the Government's NHS Plan targets", but the EU judges said the decision on what constituted an undue delay should be based solely on the patient's individual condition and circumstances.

The EU said the delay to yesterday's announcement was for "agenda reasons", to allow other business to be dealt with. But reports suggested the draft directive had been held back for further work after it provoked widespread criticism. It requires approval by EU ministers and could become law by 2010.

The UK Department of Health said it would oppose the move. A spokesman said: "We think it is critical that the legislative framework ensures that the NHS retains the ability to decide what care it will fund to meet the needs of individual patients."

A European Commission statement said primary responsibility for providing health care rested with national authorities: "In most cases patients will have the care they seek from their domestic health system, without needing to consider health care abroad."

But it went on: "In some instances, health care may be better provided in another member state for rare conditions or specialised treatments for example, or in the case of border regions where the nearest appropriate facility may be in another country. Therefore the Commission has developed a legal instrument to help realise the potential of the European dimension for health care."

The aim, it said, was "safe, efficient, high-quality" cross-border treatment.

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