CONSUMING PASSIONS

Yet again, that hardy summer perennial, the story about NHS patients flocking to Europe and beyond for treatment, bursts into flower in late July and August. The tabloids conjure up visions of package holidays with a difference: 'Hips in Hamburg', 'Prostatectomies in Paris' and 'Cataracts in Calais' - or even Calcutta.

This year the stories followed a European Court of Justice ruling that governments of member states could not refuse to pay for a patient's treatment abroad unless they could offer 'the same or equally effective treatment without undue delay'.

1I should have been tipped off by an urgent request to our national waiting list helpline. A group of German hospitals wanted information about the longest waits for heart by-pass operations and hip replacements around the UK.

Instead, I was caught on the hop by a Daily Mail journalist just as I was dishing up Sunday lunch one day in late July. Though ambivalent, for reasons I explained at length, I was quoted next day as being generally in favour of the idea of shopping around for treatment abroad.

The phones did not stop ringing. Press, radio and television were competing with patients desperate to know whether there might really be a chance of having their operation done sooner in Europe.

The BBC was interested in sending a TV crew to follow the experience of the first NHS patient to be treated in another European country. Ironically, it was the same programme that had paid for me to follow a group of patients to the colonie anglaise at the hospital in Boulogne exactly 10 years ago.

Back in 1991, it was GP fundholders in Kent who were considering sending their patients to France for cut-price - and speedy - hip replacements and cataract surgery. This time round, it was a West Sussex primary care group in talks with a German hospital group.

In 1991, the Department of Health's international branch told me that it would be foolish to raise the hopes of patients who were simply facing a very long wait for NHS treatment.Of the 500 people who had applied to it for treatment in an EC country in 1990, only a quarter had received approval under the E112 scheme.

Ten years on, the DoH told me that 1,100 authorisations were granted in 2000.

2As previously, around a quarter of these were women having babies in their home country. The others received authorisation 'for a wide variety of conditions where good medical or social reasons were demonstrated or excessive waiting times were involved'.

We were told, however, that a more detailed breakdown 'is not in the public domain' - and 'excessive'was not defined.

By mid-August, GP magazine was reporting that the DoH had stepped in to pre-empt PCGs sending patients abroad, saying that it was 'technically illegal' to purchase services for patients abroad.

The BBC television reporter, still desperate to find some patients to follow, told me that all her attempts to speak to someone at the PCG had been intercepted by the health authority.

So why do I feel ambivalent about the idea of NHS patients being treated abroad? First, because patients shouldn't even have to contemplate putting themselves to the expense and hassle of travelling abroad when they should be able to get timely treatment here.

Second, for all the rhetoric about informed choice, patients in England now have less choice than in the history of the NHS about where they can be treated in their own country, never mind overseas.

This is despite the large geographic inequalities which exist, making waiting times a lottery. The recent National Audit Office report showed, for example, only 1.2 per cent of orthopaedic patients waiting six months or longer in Dorset, compared to 52 per cent in Croydon.

The struggle with bureaucracy in getting first an NHS consultant and then your HA's approval before even being able to apply for an E112 would almost certainly not be worth it for most people on long waits.

Finally, there is the negative attitude patients are likely to come up against. Even if they are elderly, in considerable pain and have paid a lifetime's taxes, the charge too frequently levelled is one of 'middle-class queue-jumping'.

Though I think it cruel and unfair, I nevertheless have to agree that every pound spent on other countries' healthcare systems is a pound less to be spent here.

For me, the bottom line was spelt out by the orthopaedic consultant I interviewed in Boulogne 10 years ago: 'I cannot believe that your government is not ashamed that English patients have to come to France for necessary surgery'.