Cross border Ireland/UK healthcare post Brexit

In 2020, almost all of the 7,850 cases of EU Cross Border Healthcare Directive reimbursements to Irish patients travelling to the UK for treatment, were in Northern Ireland. Much of this was eye surgery in Belfast.  Ian Youngman looks at the new Ireland-UK cross border healthcare arrangements, now that the UK is not part of the EU Directive.

In 2020, 98% of the 7,850 cases (including multiple cases for patients) involving Cross Border Healthcare Directive (CBHD) reimbursements allowed under EU law for treatments accessed by Irish patients in the UK, were in Northern Ireland.

Treatment accessed by Irish patients in the UK represented 90% of all treatments accessed by Irish residents under the directive in 2020.

In 2020, Ireland’s Health Service Executive (HSE) processed 4,614 successful applications, reimbursing Irish patients at a total cost of €14.9 million (US$17.7 million) for treatment outside the state.

The CBHD provides for reimbursement to patients of the cost of receiving treatment abroad in another EU Member State, where the patient would be entitled to such treatment in their home state.

In Northern Ireland, the Health and Social Care Board spent £6 million (US$8.3 million) in 2020 reimbursing 1,300 Northern Ireland patients for CBHD treatments in EU states, including Ireland. Since January 1 this year, as a direct consequence of the UK’s withdrawal from the EU, the CBHD no longer applies to the UK.

Under a new scheme for 2021, with the ending of the Directive for Irish patients travelling to the UK, patients resident in Ireland have been eligible since January 1, 2021 to be reimbursed for accessing private healthcare in Northern Ireland by the Health Service Executive (HSE), provided such healthcare is publicly available within Ireland.

The new scheme is to operate for 12 months on an administrative basis initially and along similar parameters as the CBHD, with the drafting of a general scheme planned to place the scheme on a statutory basis.

The new Northern Ireland Planned Healthcare Scheme allows both new and current patients to continue to access care in Northern Ireland and to be reimbursed for it by the HSE.

Aside from the new scheme, the HSE has put in place transitional arrangements for patients who have a legitimate expectation of continuing to access care in the UK under the current provisions of the EU CBHD Scheme. This includes provision for reimbursement of healthcare costs by the HSE to persons who fall into certain categories, such as patients who could provide evidence that they had treatment booked prior to December 2020.

Within the new scheme are cross border health services such as cardiology and cancer treatments in Altnagelvin Hospital in Derry, and paediatric cardiology and related maternity services in Dublin. Provision of emergency paediatric care to young infants from the North continue to be on an all-island basis.

A memorandum of understanding signed by the Chief Medical Officers of Ireland and Northern Ireland on November 9, 2020, provided a formal framework to manage the transfer of patients between jurisdictions in cases where critical care capacity has been overwhelmed in either jurisdiction.

The Northern Ireland Planned Healthcare Scheme is temporary to replace the former CBHD. This will ensure access to continued healthcare north and south on an all island basis.

There is the possibility of people availing of surgeries without the requirement to pay upfront, as the scheme is no longer constrained by the EU rules.

At a time when the UK is revising deals on Northern Ireland that it agreed with the EU as part of Brexit, getting the new deal agreed and signed is not going to be easy.