NHS to send patients abroad for surgery

PATIENTS from Lothian are set to be flown to foreign countries for complicated operations because local hospitals are unable to treat them on time.

NHS Lothian has said it will have to offer patients hospital places in Europe or elsewhere in Britain, if it is to comply with new Scottish Government legislation which offers a legal guarantee of treatment within 12 weeks of diagnosis.

It has emerged that between 400 and 500 patients are on course to miss the December deadline, following the introduction of the treatment time guarantee at the start of this month, which is part of the SNP’s flagship Patients Rights Act.

Some will be offered operations elsewhere in Scotland, but others will be asked to travel to England, European Union nations or Switzerland for the complex procedures before the end of the year.

NHS Lothian said that only a small proportion of the hundreds of patients are likely to be offered the operations outside Scotland, but MSPs and patients groups expressed concern at the development.

And the Scottish Government insisted it “did not envisage” patients being sent abroad, despite NHS Lothian’s admissions that some were likely to be offered the foreign operations.

Tim Davison, NHS Lothian’s chief executive, said that the health board would “move heaven and earth” to ensure none of the patients were waiting longer than 12 weeks by December, even if it meant sending them overseas.

He said: “We can’t plan to break the law. If we keep going the way we are, we could have 400 to 500 patients who require complex procedures who may not be seen. We need to ramp up our scope for where we look for treatment.

“Any patient listed for inpatient or day case treatment from October 1 has a legal right to be treated within 12 weeks and our job is to try and treat them locally and we will do all we can to ensure that happens.

“If we can’t do that we’ll try to do it in Scotland, if we can’t do it in Scotland we’ll try in the United Kingdom, if we can’t do it in the UK it’s Europe, but we expect the numbers who are offered treatment outwith Scotland to be low.

“We are discussing the processes for identifying and selecting healthcare providers outwith Scotland with NHS National Services Scotland and processes will be in place to ensure the standards and quality of treatment.”

Patients who agree to travel to UK or European hospitals could be there for more than a week while they recover, although flight and accommodation costs will be paid for a friend or family member to go with them.

Independent Lothians MSP Margo MacDonald said the patients potentially being sent abroad as a result of the legal contract had shown the policy to be a “silly idea”.

She said: “It’s a law and they can’t ignore it – NHS Lothian are following best practice and they have to try and comply. If a patient is sent away from his or her home area, then they don’t get the visits, support and practical help that friends or family can give, so in terms of the recovery process, it’s likely to be slower.

“I’m also concerned about the cost, and I don’t imagine for a moment that NHS Lothian won’t be concerned about the cost either.”

Labour Lothians MSP Sarah Boyack said she found it “astounding” that the health board would be paying for patients to travel overseas.

She added: “I’ve been arguing for more investment to target the backlog of patients needing treatment. We were previously told that new staff were being recruited and that facilities in other health boards and in private hospitals would be used. It seems that even these measures will not be enough to sort out this problem.

“Given the pressure on NHS funding these are scarce resources that should be invested locally. I’ll be asking for more information to pin down the scale of this issue and how much its actually going to cost.”

Patients will not have to accept the offer of treatment outside their local area, although if they refuse they are likely to have to wait longer than the 12 weeks and the health board will not be classed as being in breach of the treatment time guarantee.

It is not yet known how health boards will be punished if they miss the 12-week deadline, although patients could potentially take legal action.

The legislation states that patients must be offered operations elsewhere in Scotland, the UK, the EU or Switzerland if local health boards are unable to treat patients in their own area promptly.

MSP and Conservative health spokesman Jackson Carlaw said that while all patients had to be treated on time, he found it “extraordinary that the mismanagement of waiting lists by NHS Lothian” has led to the scenario of patients being sent overseas.

He added: “We have to remember why this situation has come about. It should never have got to this stage, and there are those – some who are no longer with the organisation – who still have serious questions to answer about this.”

But Keith Pollard, managing director of medical tourism company Treatment Abroad, said that patients travelling to Europe could experience better treatment than at UK hospitals.

He said: “Healthcare quality and standards are improving right across Europe. In the 2012 Euro Health Consumer Index which ranks 34 European health care systems, countries such as the Netherlands, Denmark, Belgium, Sweden, France and Norway all outperformed the UK. So patients visiting these countries for treatment may benefit from a better patient experience and a better treatment outcome than they might expect in the UK.

“The biggest concern for the patient who travels is obviously ‘what happens if something goes wrong’, but the same applies to surgery whether it is at home or abroad. Provided the right hospital or clinic is selected, and the patient’s doctors in Scotland are kept informed then this barrier to travel can be overcome.”

The latest figures have revealed that there were around 1000 patients waiting for inpatient or day case treatment for longer than 12 weeks at the end of September - with the figure having halved in six months.

But the 400 to 500 patients on course to be over 12 weeks by December require “highly complex” care in plastic surgery, urology, colorectal surgery and paediatrics.

The health board has said it could take two years for internal capacity to be increased to appropriate levels, and sources admitted that more patients could continue to be sent outside Scotland after the 400 to 500 patients are treated.

Even after NHS Lothian admitted that patients were likely to be offered the foreign procedures, the Scottish Government said it did not believe patients would have to be sent abroad.

A government spokesperson said: “We have made clear to NHS Lothian that patients should be treated as locally as possible. NHS Lothian has been asked to precisely quantify and demonstrate that all possible treatment options are considered and will be utilised if appropriate. We do not envisage patients travelling to Europe for treatment.

“We know that – because of complex needs - some patients may need to be treated externally or at another health board, or in some limited circumstances, and with specialised cases, elsewhere in the UK, but only if patients are happy to do that and they are appropriately supported.”

ANALYSIS

Dr Jean Turner

Ex-GP, MSP and executive director of the Scotland Patients’ Association

I WOULDN’T say that no patients would want to go to Europe for treatment – I’m sure that some will be delighted to go, but they should be involved in the decision and not just be expected to pack up and go.

Now we’re in this situation, it’s good that people are being given the option. It’s paramount that people get the best care as soon as they can possibly get it. But they must not be penalised or put to the end of the list if they don’t want to travel.

I don’t have any problem with the quality of care in European hospitals - but it is a problem if we can’t provide it in Scotland or the UK.

When people are ill it makes it easier to have their relatives around them. It’s easier for a lot of people to recover when they have that support. Even with the best surgeon in the world there can be complications following surgery and people could be stuck in France, Germany or wherever.

I think there’s been very poor management – when NHS Lothian had problems the health secretary should have been informed earlier. Who knows if other health boards will now have similar problems?

This is a solution for having ended up in a mess. We could have spent this money on more staff which would have allowed us to do the job properly in Scotland.