Only a few will benefit from U-turn on treatment abroad

One of the NHS's sacred cows was unceremoniously slaughtered over the bank holiday weekend: health secretary Alan Milburn suddenly announced that restrictions on patients being treated abroad were to be lifted. This has been officially discouraged until now, and bureaucratic obstacles strewn in the path of all but a few tightly defined types of individual contemplating an operation overseas.

Beneath this attitude, perhaps, lay national pride and a belief - however misguided - that the NHS was, after all, the 'envy of the world': in the natural order it was to be expected that others might have to seek treatment here, not vice versa. Maybe this isolationist stance was tinged too with natural caution and conservatism, and suspicion of all that lay beyond these shores. Reinforcing it, professional medical opinion stressed the clinical disadvantages, and possibly found a ready echo in many people's conviction that to be ill abroad was the stuff of nightmares.

And the government, fearful of the drain on budgets that would follow a patient exodus, saw no reason to challenge any of this - nor, to be fair, did other EU governments, which for this very reason have been far more reluctant to break down barriers in healthcare than in other areas.

So what has led to the unexpected change of heart? Rather more than simply Mr Milburn returning from his Florida holiday tanned and newly enthusiastic for all things foreign. A European Court ruling earlier in the summer removed legal impediments to patients who face 'undue delay' in their home healthcare system seeking treatment elsewhere in the EU. To that extent, Mr Milburn is merely stepping out of the path of an approaching juggernaut. But he has no doubt been spurred too by the relentless search for extra capacity to shorten NHS waiting times, and the dawning realisation that meeting pledges to cut them will be near impossible. Every little will help, even if it means denting the NHS's - or the national - pride in the process. The concordat with the private sector brought agreements with hospitals in France or Germany one step nearer.

A shrill campaign by the anti-NHS national newspapers over the summer may have also played a part. They greeted the announcement with self-congratulation and labelled it 'the NHS's shame': expect them soon to move on to trailing all the pitfalls of the policy.

For they remain formidable. Comparatively small numbers look set to benefit, so the effect on waiting times will be marginal. They will be more able and younger patients, perhaps disproportionately from the South East. Experience of the internal market suggests most, if offered the option, would be reluctant to travel. Ensuring quality and value for money, as well as aftercare, will test inspection regimes. And it will all take time to set up - by when patience may have long since run out.