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In March 2011 the EU adopted a directive to clarify patients’ rights to be reimbursed by their home health system if they seek treatment in another EU country. This RCN position statement explores the background and implications of the legislation which needs to be adopted in the UK by October 2013. It outlines the RCN’s position and how the directives’ provisions should be applied to ensure better patient care. 

The RCN supports the provision of greater choice and control for patients over their treatment and care, with care planned with full patient participation. However, the provision of choice should not be an end in itself but a tool for the delivery of better health outcomes.

• The provisions of the European directive need to be applied in such a way that they are equitable and enhance patient care. The RCN believes that: 
• Funders in the UK need clear information and processes for patients in their locality so that they know when and how they should seek prior authorisation for EU treatment, the costs covered, and reimbursement mechanisms. 
• If patients choose to be treated in another EU member state, they should be encouraged to discuss this with their local commissioners beforehand, even where prior authorisation is not required, in order to support greater continuity of care for any follow up on their return to the UK. 
• It is important that patients understand that the responsibility for quality, safety and liability applied to cross border care rests with the country where the treatment occurs not with UK providers or regulators. 
• The system should not be based on reimbursement of costs after treatment alone as there are concerns about inequities arising from patients having to pay up front for potentially costly treatment, which could make it very difficult to access cross border care. 
• Greater cooperation, rather than harmonisation, is needed between member states on quality and safety issues; health technology assessment; centres of excellence; and e-health. In relation to e-health and information, the focus should be on safe communication to support safe care, rather than prioritising data standards. 
• There needs to be a balance between the need to plan for effective health service delivery in the UK and patient choice. Given that the overwhelming majority of UK citizens choose to access healthcare in this country, arrangements to implement the cross border care directive should not undermine domestic planning, provision and financing of health services.

For further information, please email papa.ukintl.dept@rcn.org.uk