Patients travelling outside Northern Ireland for treatment

If you wish to receive medical treatment outside Northern Ireland, it’s important to understand how it works and the assistance you may be able to access.

This guidance applies to patients who are travelling outside Northern Ireland to access healthcare assessment and/or treatment. It is not relevant for travel within Northern Ireland for health and social care services.

Patients travelling to Republic of Ireland for treatment

This scheme is now closed to new applications.

We are keen to hear from service users, families or carers who have accessed the temporary ROI Cross Border Reimbursement Scheme. We want to hear about your experience of the scheme. Your feedback will help us to improve our services

Please fill in the survey here https://consultations2.nidirect.gov.uk/doh-1/24c244bf

Background:

On 16 June 2021, the Health Minister announced a new limited version of the Cross Border Healthcare Directive for the Republic of Ireland for a 12 month period from 1 July 2021. This temporary scheme was further extended to 21 September 2022.

The Republic of Ireland Reimbursement Scheme allowed patients to seek and pay for routinely commissioned treatment in the private sector and have the costs, up to the cost of the treatment to the HSC in Northern Ireland, reimbursed. This does not apply to treatment in the private sector in Northern Ireland.

The Scheme was opened to ordinary residents of Northern Ireland and managed by the Strategic Planning and Performance Group (SPPG) of the Department of Health and all treatments were subject to prior authorisation.

Note: your Global Health Insurance Card (GHIC) is for emergency treatment that becomes necessary while you are outside the UK. It does not cover planned treatment – also known as elective treatment.

(Please note that the summary details given here are not exhaustive and you are strongly urged to contact the SPPG for advice before travelling or arranging any treatment. Your entitlement to financial reimbursement will depend on the route used.)

There are two main ways by which patients may receive planned (not emergency) treatment outside Northern Ireland:

Transfer for treatment by the Strategic Planning and Performance Group
Transfer for treatment by the Strategic Planning and Performance Group (SPPG) is known as an Extra Contractual Referral (ECR) and occurs when the SPPG approves a consultant’s request to transfer a patient to a provider outside Northern Ireland for assessment or treatment which the consultant considers necessary but which is not available through HSC (i.e. NHS) facilities locally. This is normally to a provider elsewhere in the United Kingdom but may also be to a provider outside the UK where this is clinically justified.

Normally, the SPPG will approve a transfer of this sort where the treatment needed is of a specialist nature which is not available in Northern Ireland, or where there is an exceptional clinical reason why a transfer is appropriate.

In these circumstances the SPPG will:
- Pay approved treatment costs direct to the provider.
- Book flights or ferries.
- Reimburse accommodation expenses up to a maximum allowance. In exceptional circumstances accommodation may be booked on behalf of the patient.
- Provide a subsistence allowance for meals.
- Provide assistance towards other transport expenses.
No other costs will be reimbursed.

Travel expense reimbursement for ECR referrals is not means tested. Expenses in relation to this policy will be payable by the SPPG regardless of the patient’s financial circumstances. The SPPG will not provide cash in advance of travel.

If you feel that you may have grounds for transfer outside Northern Ireland under this arrangement you should contact your GP who may refer you to a consultant in Northern Ireland for an initial assessment. Please note GPs do not refer patients directly to providers outside Northern Ireland.

The SPPG’s Extra Contractual Referral (ECR) process allows patients to be treated outside Northern Ireland where a patient’s consultant feels that this is clinically necessary. Under this process, a patient’s treating Health and Social Care Consultant submits an application to the SPPG for funding approval to be treated outside Northern Ireland.

There are two ECR panels to consider and approve funding requests where a patient’s consultant feels that this is clinically necessary.
1. The SPPG Acute ECR Panel meet on a weekly basis to consider all funding applications received within the preceding 7 days. The panel comprises:
- - Assistant Director of Public Health (Chair)
  - Specialist or Consultant in Public Health
  - Assistant Director of Commissioning (or nominee)
  - Doctor in training Public Health
1. The SPPG Non-Acute ECR Panel meet on a fortnightly basis to consider all the funding applications received within the preceding 14 days. The Non-Acute Panel comprises as follows:
- - Deputy Director of Social Care & Children (or nominee) (Chair)
  - Social Care Commissioning Lead, Children
  - Social Care Commissioning Lead, Older People and Adults (or nominee)
  - Assistant Director of Nursing
  - Specialist Consultant in Public Health
  - Assistant Director of Commissioning (or nominee)
The referring consultant remains responsible for clinical oversight and management of the patient.

ECRs normally arise, and are eligible for approval, in the following circumstances:
1. The patient’s clinical condition requires specialised care that could only be sustained for a large catchment population and cannot be provided for a small geographic area such as Northern Ireland.
2. The patient’s consultant wishes to seek a second opinion from a provider outside Northern Ireland because of the complexities of the patient’s condition or circumstances.
3. The Treatment is available locally but the patient’s has some exceptional reason which renders their case different from the vast majority of other patients with the same condition and which therefore justifies a referral for care or treatment outside Northern Ireland.
4. The service being requested is not commissioned for the population of Northern Ireland, but the patient’s clinical circumstances are such that exceptionality can be demonstrated and a case justified for an ECR to access care from a provider outside Northern Ireland.
In relation to number 4 above, it would be a matter for the patient’s consultant to demonstrate the grounds for clinical exceptionality. The SPPG can only take account of the clinical circumstances that apply to the individual case. The SPPG is not in a position to take account of any personal or social circumstances such as age, dependants, occupation etc.

Downloads
- ECR Protocol/Guidance – SPPG arrangements for the consideration of requests for Care and/or Treatment on behalf of Individual Patients
- Patient Travel – Information Leaflet
S2 (E112) Mandated Treatment
Travel for Planned Treatment under Trade and Cooperation Agreement (TCA) between the European Union and the UK of Great Britain and Northern Ireland (Article SSC.18), known as the S2 or E112 route. This is where an individual seeks access to state-funded treatment in another European Economic Area (EEA) country. It is not suitable for treatment outside Northern Ireland in another part of the UK.

The EU countries are: Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland*, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden.

Note this scheme does not necessarily cover planned treatment in Norway, Liechtenstein, Iceland or Switzerland. Please contact england.europeanhealthcare@ nhs.net before you apply for treatment in these countries to check eligibility.

Where you have been assessed as requiring treatment which is not available locally, or is not available within a medically/clinically appropriate time period you may apply for treatment in another EEA country. Please note that this arrangement applies only to treatment in a state provider (i.e. not private) within the EU but outside the UK.

Responsibility

In choosing to access healthcare in another Member State, the home patient is effectively stepping outside of the Health and Social Care (HSC) system and using their rights under S2 to seek healthcare elsewhere.

At this point, the patient is taking individual responsibility for ensuring that the service they obtain is appropriate and safe within the laws of the country of treatment (not under UK legislation). The SPPG, under this legislation, will not be formally commissioning services from providers abroad and therefore will not be liable for the outcome of the treatment provided.

Although the SPPG may approve your treatment abroad, the country you want to go to is not obliged to accept you as a patient for treatment. If you are refused treatment in an EEA member state, they will have to explain their decision to refuse treatment.

You cannot expect to receive treatment in preference to a patient already within the country’s state healthcare system. This means you may have to observe local waiting times or the country’s guidance on particular treatments. The patient does not pay for eligible treatment costs (apart from any required co-payment costs which would be charged to a person insured within that system, which the patient must pay).

Applications for Maternity S2 funding must be made directly to the NHS Business Services Authority (NHSBSA) not HSC – for further information go to: https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/giving-birth-outside-the-uk/

The SPPG will consider applications for state-funded treatment in another European Economic Area (EEA) country where:
1. The treatment is not experimental or part of a drug trial, and
2. A Northern Ireland Health and Social Care Consultant confirms that the treatment is necessary and recommends that you receive treatment in the other EEA country either on the basis that:
- - The treatment required is not available in the UK; or
  - The treatment is not available in a medically appropriate time period based on an objective clinical assessment of your individual circumstances
In order for the SPPG to support the S2 application you will be required to submit the following supportive information:
- Clinical confirmation from your HSC/NHS consultant that they are recommending the treatment.
- If the treatment is available in Northern Ireland, written confirmation from your HSC/NHS consultant that the treatment cannot be provided by the health service within a time that is medically acceptable based upon an objective clinical assessment of your individual circumstances.
- Written confirmation from the state provider of the agreed treatment(s), proposed dates and estimated costs. Please ensure this is in English or that an English translation is provided.
Important information
- Applications must be authorised by SPPG before treatment.
- The treatment must be provided in the state healthcare system of the other country.
- Applications for maternity S2 funding must be made directly to the NHS Business Services Authority (NHSBSA) and not to this team (visit Department of Health (DoH)website for further information).
You are responsible for providing accurate and complete information to support the decision making process. Incomplete applications will cause delay in processing your request.

Note: The SPPG can only process claims for people ordinarily resident in Northern Ireland and entitled to access health and social care services. Patients will be asked to provide proof of residency and entitlement to health and social care services.

It can take up to 20 working days for a fully completed application form to be processed and a decision made. You will be informed of the outcome of your application once a decision has been reached.

Where an S2 application has been approved the SPPG will:
- Book flights or ferries.
- Reimburse other reasonable travelling expenses up to a maximum allowance.
- Reimburse accommodation expenses up to a maximum allowance.
- Provide a daily subsistence allowance.
- Provide assistance towards other transport expenses.
The cost of treatment is paid at national level (i.e. not by the SPPG) through the Overseas Healthcare Team in NHS Business Services Agency (NHSBSA).

Co-payment charges may be reimbursed by the NHSBSA at: nhsbsa.ohsapplications@nhs.net

No other costs will be reimbursed.

Travel expense reimbursement for S2 (E112) treatment is not means tested. Expenses in relation to this policy will be payable by the SPPG regardless of the patient’s financial circumstances. The SPPG will not provide cash in advance of travel.

Further Information
- S2 Application Guidance and Form
- NHS Choices

National Contact Point

If you are a resident in Northern Ireland seeking to travel elsewhere for treatment or, alternatively, if you are a non-resident interested in treatment in Northern Ireland please contact:

National Contact Point
The Strategic Planning and Performance Group
Commissioning Directorate – Patient Travel Team
3rd Floor
12 – 22 Linenhall Street
Belfast BT2 8BS
Email: NationalContactPoint@hscni.net
Telephone: +44 (0)28 9536 3152

Patient Travel Office

The Strategic Planning and Performance Group (SPPG) has a Patient Travel Office which provides assistance for approved patients who are travelling outside Northern Ireland for planned treatment.

If you are travelling for planned treatment outside Northern Ireland contact the SPPG patient travel office. Patient Travel Officers can provide you with assistance and advice:

T: 0300 555 0116
E: patient.travel@hscni.net

Patient Travel – information leaflet