An EU law has just come into force that may shake up the NHS more than any political party has ever been able to do. The Directive on Patients' Rights in Cross-border Healthcare gives the right to any EU citizen to get healthcare in any other EU Member State - and their local health authority must pay the bill.
Doesn't sound like a big deal? On the one hand it's not - only about 1% of of UK patients are estimated to seek treatment abroad - but the NHS is quaking in its boots because it must do something that it has never done since it was founded in 1948: publish their costs of treatment.
"I have spent years trying to find out the NHS's costs of treatment," said Peter McCann, the chairman of Castle Craig Hospital, the Scottish rehab clinic where I work. "I can assure you that the NHS have no idea how much their treatments cost. But they must now work out these costs and publish them in a way that is transparent, in order to comply with the EU's directive. It's going to cause the biggest shake up in the NHS in a generation."
Health ministers from all 28 EU Member States have been working over the details of the new directive since 2008, and it's a sensible document that could bring huge benefits to health services across the union. Not only could the NHS save money by encouraging patients to get treated abroad but they could finally address an issue that has plagued them for years: unacceptably long waiting lists.
But the health services of Britain, and many other EU member states, have been quietly resisting the implementation of the directive. The absence of any publicity about the directive coming into force is telling (most doctors in Britain simply don't know about it) and the NHS only put the relevant application form online a few days ago.
According to a Brussels based publication, "The vast majority of member states will miss a deadline (25 October) to transpose the cross-border healthcare directive, which is meant to make it easier to obtain pre-planned medical treatment in another European Union member state. Only a few member states have set up the required transparency websites and control centres that the law requires to be in force."
Fear and ignorance are the key reasons why health services around Europe are avoiding the implementation of this directive. When in Brussels the UK is in agreement with the directive and helped the European Commission to shape it, but back home they are subject to the forces of nationalism, populism and the the media. Politicians and health services seem to be afraid of an influx of poor foreigners claiming free health costs, and ignorance about the directive mean that few people in government are aware of the potential benefits that it can bring.
The issue of foreigners abusing the system was studied in depth by the London School of Hygiene and Tropical Medicine and York University. Researchers analysed the records of 18 NHS hospitals and found that "more people leave the UK seeking medical treatment abroad than arrive in this country for care: about 63,000 people from the country travelled to hospitals and clinics abroad in 2010, while considerably fewer, about 52,000 people, came here." They also calculated that foreign patients visiting the 18 hospitals spent an estimated £219m on hotels, restaurants, shopping and transport in the UK.
Rupert Wolfe Murray is the European Representative of Castle Craig Hospital.