UK-Ireland healthcare deal agreed

A new healthcare scheme between Northern Ireland and the Republic of Ireland is to be set up for a 12 month period from July 2021. Ian Youngman looks at what it means for cross-border medical travel.

The new Northern Ireland scheme is, according to the Department of Health, a temporary measure to help reduce Northern Ireland waiting lists, and will be subject to strict criteria.

The scheme is separate from the EU Cross-Border Healthcare Directive that allowed patients to arrange health treatment in most other European countries.  Under this Directive, over the last five years, patients in Northern Ireland had received £14.1m worth of healthcare in the Republic. This ended with Brexit for Northern Ireland, but not for the Republic of Ireland.

Cross-border healthcare from Northern Ireland

Source: Northern Ireland Health and Social Care board. Payments only under EU Healthcare Directive, and only Northern Ireland to Republic of Ireland.

The new deal allows Northern Ireland patients to seek and pay for routinely commissioned treatment in the private sector in the Republic of Ireland while having the cost of the treatment reimbursed.

On 1 January 2021, the Irish government introduced a new arrangement for its own residents known as the Northern Ireland Planned Healthcare Scheme. This allows patients from the Republic of Ireland to continue to access certain private healthcare treatments in Northern Ireland and apply for reimbursement from the Irish state.

5-year plan to banish waiting lists

The cross border deal is part of a new five year health framework in Northern Ireland, which aims to banish long hospital waiting lists by March 2026.

330,000 people are currently on some form of hospital waiting list in Northern Ireland, including 190,000 patients waiting more than a year for their first outpatient appointment. This is out of a population of only 1.9 million.

The new elective care framework proposes a £700 million (US$972m) investment over five years.  It sets out a twin-track approach of investment and reform to ensure that backlogs do not keep reoccurring.

The plan proposes to implement green pathways that will keep elected care services entirely separate from any exposure to Covid-19.

It will also see emergency departments kept separate from planned surgical hubs.

That means operations for hips, knees, cataracts and varicose veins can be performed on sites at speed and uninterrupted in order to cut through the waiting lists.

Other aspects of the plan include:

• Surgeries in ring fenced specialist hubs.
• A regional Northern Ireland-wide approach, as opposed to a disjointed postcode lottery system.
• Mega clinics for outpatient, assessment and pre-operative assessment clinics.
• Co-operation with the independent sector.
• Improved data, reporting and accountability.

The plan targets September for when mega clinics will be in place for orthopaedic outpatients, cataract assessments and for a range of pre-operative assessments. Some of these clinics will require patients having to travel slightly further than they otherwise would have, but the plan states this should reduce the time waiting to be seen.

By next March, it is hoped detailed proposals will be in place for how the service can provide rapid diagnostic centres.

The framework sets a target of March 2026 for no patient waiting more than 52 weeks for a first outpatient appointment and inpatient day case treatment, or 26 weeks for a diagnostics appointment.

The proposals must be signed off by the executive and there needs to be confirmation of long term funding from the executive and the Treasury.

Current cross-border travel restrictions

In the Republic of Ireland people who are fully vaccinated or who had a confirmed case of Covid-19 in the previous nine months can go abroad from July 19 without having a PCR test. They will need to have had two doses of vaccine or a one-shot Johnson & Johnson jab. The unvaccinated will still need to take a PCR test.

In Northern Ireland there are hopes that vaccinated tourists can soon travel to selected counties without having to quarantine on their return.

The test and quarantine rules do not apply to medical treatment travel between Ireland and Northern Ireland.