Plans to allow patients to receive health treatments abroad that are not available on the NHS have been defeated, according to a confidential document seen by HSJ.

The agreement between the European parliament and the council of European ministers, due to be signed off next week, concludes years of EU horse-trading.

It was previously unclear on what grounds PCTs would have refused to pay for patients with rare diseases - classed as those affecting fewer than five people per 10,000 - to travel elsewhere in the EU for treatment not available at home.

However, the wording of the directive has been tightened, granting PCTs much greater powers to withhold payments.

NHS Confederation European office director Elisabetta Zanon said previous versions of the legislation would have had a “negative impact on the ability of NHS organisations to manage their finances and resources in the interests of patients”.

The reworded directive will “end the uncertainty NHS trusts currently face over decisions about what care patients can receive abroad”, she said.

But NHS organisations now faced the “tricky task” of working out how the directive will work in practice.

It is expected that when PCTs are abolished, their role in authorising patients’ treatment abroad will transfer to the NHS commissioning board.

GPs will continue to play a “gatekeeping” role by carrying out medical assessments to determine patients’ suitability for treatment abroad.

The new directive allows more flexibility in how the NHS pays for treatments received abroad. Under earlier drafts of the legislation, healthcare systems would have had to transfer payments directly to the country in which the intervention was carried out.

The NHS Confederation has been lobbying for a simpler process whereby patients pay up front and are reimbursed, despite fears this could affect health inequalities. Now, individual EU member states can decide for themselves on the best system to implement.

The agreement is expected to be voted on by the full European parliament on 19 January.

While the number of UK patients wanting to travel abroad for healthcare treatment is thought to be low, this is expected to change with the spread of patient choice within the NHS.

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