Six years v two weeks: The Irish patients beating the waiting lists to get treatment abroad

With the HSE covering the cost of treatments under the EU Cross Border directive, more Irish patients are avoiding the long waiting lists here to get treatment abroad and stop their pain

Michael Carroll from Cork who had cataract surgery in Spain under the EU Cross Border Directive. “Through the HSE, they were saying there is going to be a new cataract centre in the South Infirmary, but that could be two years down the road.” Photo: Sergi Albir

When Michael Carroll’s two-year-old granddaughter took his hand to steer him through his own house in Cork, he realised his failing eyesight was affecting everyone in the family.

Understanding this and unwilling to wait on a list for years, he found his way to a Spanish hospital near Alicante where he had cataract operations a few days ago, reassured by the fact the HSE would cover the cost under the EU Cross Border directive.

The directive has entitled all EU citizens to get medical treatment abroad and have the cost repaid by their own country, since 2014. It's ideal for anyone trapped on a waiting list, with Irish patients free to apply to the HSE Cross-Border Healthcare Directive Department, Kilkenny, once they have a medical referral.

More broadly, however, it poses a challenge for governments to consider whether they want a functioning, accessible public health system, or to continue farming patients out to private companies. It's also an opportunity for private hospitals, knowing they are guaranteed payment by the State.

Mr Carroll is one of over 300 Irish patients who have travelled to Spain for treatment this year alone. Speaking to the Irish Examiner in Denia, he recalled his granddaughter telling him to ‘take care’, as she guided him around her toys.

Only 65, cataracts had blurred his sight so badly he was no longer steady on his feet and had stopped driving.

He said:
I got glasses, and I don’t think I had seen the television properly in a couple of years before that. 

“It was very blurred. The glasses improved it a bit for me, and that really pushed me then to get the cataracts done.”  Like many people, he knew about “cataract buses” taking people to Northern Ireland for operations there.

Post-Brexit these buses continue under a new scheme called the Northern Ireland Planned Healthcare Scheme with similar criteria to the EU Directive. He considered using this but decided against it after searching online and finding an Irish agency that connects patients to hospitals in Spain. 

This was when he realised that "cross-border" is not just about the Irish border, a common misunderstanding.

There are a number of these agencies in Ireland, operating on commission from private hospitals. They help with loan paperwork, with up-front costs for a hip replacement coming to €10,000. 

First South Credit Union in Cork is among the credit unions now offering a new streamlined loan process, open to new members and built around the operation costs. Having successfully navigated this, Mr Carroll had his cataracts removed last week. 

He was one of the first patients at a new hospital, purpose-built for travelling patients. He and his wife Geraldine said their stresses have melted away.

“Through the HSE, they were saying there is going to be a new cataract centre in the South Infirmary, but that could be two years down the road,” he said. “I could be walking into walls by then. 

The waiting lists are unreal, I would have preferred to get it done in Cork, but it was the waiting time.

Geraldine explained: “We stayed in Benidorm, and we were brought back and forth to the hospital. There was no pressure on us.” 

Last year, 571 patients travelled to Spain, but this year that reached 326 by June, according to Catherine Donohue, general manager at the HSE commercial unit, acute hospital services. Poland is also becoming more popular with 390 this year, up from 376 in 2021.

Ms Donohue attended the opening of this hospital, but stressed the HSE does not approve hospitals only individual operations on application. She said the directive has created “ a huge market” for private healthcare.

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“In an ideal world we wouldn’t have patients waiting, but there are patients waiting,” she said. GPs frequently refer patients directly to the Kilkenny office, where patients apply for treatments under the Cross-Border Directive. There is no obligation to use an agency, but HSE approval is mandatory.

Ms Donohue recommended that any patient who is choosing an agency do their homework first.

“The HSE is going to ask you for your PPS number, GP number, home address, telephone, everything. That is very sensitive information, you need to be sure if a third-party provider is helping you, that they have appropriate data protection systems,” she said.

One of the agencies, Healthcare Abroad, who Mr Carroll went with, recently entered the market. Its team includes Chris Goodey, former chief executive of the National Association of General Practitioners, and the financial collapse of this group in 2019 is understood to be under investigation. 

Chief operations officer Paul Byrne said of their partnership with HCB Denia hospital in Spain: “We are trying to make Irish patients more comfortable. They will have Irish radio stations, TV stations, we are trying to source Irish newspapers.”

This hospital hopes to deliver up to 1,500 operations a year for Irish patients. Almost all procedures available in the public health service in Ireland are carried out at the Spanish hospital. Hospital director Ana Vasbinder said: “For our Irish patients it will be very much a home away from home.” 

Another agency Trasna, established in 2018, has supported 100 patients this year, with 400 in planning, said director of marketing Bronagh Twomey. “It’s not us who decides where the patient will go, it’s the patient’s choice,” she said.

Hips, knees and cataracts are the most popular requests for partner hospitals in Germany, Northern Ireland and elsewhere. English-language reports are sent to GPs.

“There is wonderful healthcare in Ireland, but it’s about accessibility,” Ms Twomey said. “We are trying to make it simple, there is massive capacity across Europe.” 

Another agency, MPTM,  has focused on Polish hospitals since 2019. They have helped 300 patients travel from Ireland, again with patients choosing the hospital. “Almost all my clients are Polish,” said MPTM's Mariusz Pleśniar.

Orthopedic operations are the most requested, followed by neurosurgical interventions, physiotherapy or pain management.

“Apart from these interventions, ENT (ear, nose, throat), including paediatric ENT, gynaecology, and general surgical services remain popular, as well as various specialist diagnostic procedures,” he said.

Some of my clients were stuck on waiting lists for as long as six years. On the other hand, it usually takes no more than two weeks to arrange treatment in Poland.

In Northern Ireland, the ROI Reimbursement Scheme, set up after Brexit, was this week extended until June 2023. By the end of February, 540 people had travelled from North to South for treatment under this scheme.

Chief executive of the Mater Private Network in Cork and Dublin, David Slevin, said: “Applications have grown and continue to grow with the long waiting lists in Northern Ireland. People should not have to wait unnecessarily with chronic pain.” 

It is clear this directive offers greater choice to patients, although it must be demoralising for Irish surgeons to see their patients having to travel abroad. Many have urged instead for a real tackling of Irish waiting lists, but from a patient’s perspective, this faster option wins. 

Irish Patients Association’s Stephen McMahon called for an information campaign. 

“Administrators, including consultants and GPs, should as a continuum of the duty of care inform patients of their rights, and how to go about exercising those rights,” he said.

Many people will be reluctant to travel, perhaps in too much pain to join thousands of public patients crisscrossing the continent. Only serious investment in public health across Europe can give them realistic options of care at home.