Wednesday 26 June 2019

'We skipped the waiting lists and went to Belfast for treatment'

In severe pain, Joe and Mary Bonallie were on waiting lists for their operations. Then they found out how to get treated quickly and with HSE funding - thanks to its Cross Border Healthcare Directive.

Joe and Mary Bonallie
Joe and Mary Bonallie
Joe and Mary Bonallie pictured near their home at Newgrange, Co Meath. They both travelled to Belfast for procedures. Photo: Frank McGrath

Áilín Quinlan

This time last year, pensioners Joe and Mary Bonallie were in severe pain - Joe, who has osteoarthritis, needed a hip replacement, while his wife Mary was in agony from carpal tunnel syndrome in her left hand.

Both were on HSE waiting lists but, says the couple, nothing appeared to be happening.

"I had osteoarthritis for several years and in recent years it got very bad. I was put on a waiting list for investigations into severe hip problems in August 2016," recalls Joe.

"I was in very bad pain; I was barely able to move with my left leg."

Then one day his daughter-in-law heard about an initiative called the Cross Border Healthcare Directive (CBD) on the radio.

She told Joe about it; he'd never heard of it, he says.

So the 75-year-old Newgrange, Co Meath resident went to his computer and researched the Cross Border Healthcare Directive on the internet.

This health initiative, which began in Ireland in 2014, and was implemented under legislation prepared by the European Commission, allows patients, who have a referral letter from their GP, to travel to another EU country to access healthcare that they would be entitled to in their own country.

Under the scheme, patients pay for treatment themselves upfront and later claim it back from the HSE. Any treatment available in an Irish hospital or funded by the HSE is covered - from hip operations to cataracts and oncology treatment (see table).

Joe was immediately interested. "I rang the CBD office in Kilkenny and was sent all of the necessary forms," he says, recalling that the form asked him to specify where he wanted to go for the operation. Because he lives in Co Meath, Belfast seemed to be a good option:

"I rang the health service in Belfast and they sent me a list of both private and public hospitals. I picked out a private hospital."

Joe got a referral letter from his GP and, within two weeks, was attending a consultation and pre-op check-up at Kingsbridge Private Hospital in Belfast.

"The hospital filled in the forms for me and everything was organised. I sent away the paperwork."

The operation on his left hip took place in May 2016, within two months of that first phone call to the CBD office. "The cost was stg£9,000. This was paid by me upfront. I got about 95pc of it back from the HSE afterwards, about six weeks after the operation. Later today I'm being admitted for an operation on my right hip. I paid again, and will again be reimbursed by the HSE," he says at the time of this interview.

Joe is delighted with the service.

"It couldn't have been better - they looked after me like I was a guest at a four-star hotel," he says.

"The programme worked extremely well and the HSE were very helpful. I'd recommend it." He adds: "You have to have a referral letter from your doctor. I got that from my doctor, who was very interested in hearing about the directive."

His wife Mary (75) was similarly delighted with her experience of the CBD.

"I had carpal tunnel syndrome in my left hand. It has been bad for the last few years, but it got even worse over November and December 2016," she recalls.

She saw her GP about the hand in December 2016 and was put on a waiting list for further investigation. "Nothing happened," she recalls.

At the end of June 2017, Mary applied to participate in the CBD initiative.

"I got a referral letter from my GP to Kingsbridge Hospital and was accepted for an operation for carpal tunnel."

The operation was carried out last July, two weeks after she had initially contacted the hospital.

"It was very fast. I had to pay stg£950 to the hospital and I am now waiting to be reimbursed by HSE.

"A few days after that operation I got a letter from the HSE offering me an appointment just to have my hand checked out - for June 2018! I was delighted with my operation and Joe is hugely improved now - people who haven't seen him for a while cannot believe how well he is - it's unreal!"

The CBD scheme is working effectively, agrees Catherine Donohoe, general manager of the HSE Acute Hospitals Division, who points out that anyone in Ireland, once they have a letter of referral from their GP, is eligible.

Many patients will use personal savings, a credit union loan or a mixture of both to fund the up-front payment to the hospital in question. If patients need to take out a loan, the HSE will provide a letter of prior authorisation, stating that the patient is eligible for reimbursement:

"There's no waiting list - once people have the referral letter they can organise care abroad and typically, for example with an operation such as a hip replacement, this operation can be organised within a month.

"You organise your own appointment and choose your own doctor," says Donohoe, who adds that the scheme covers both private and public hospitals. When the operation has taken place you submit your invoices, receipts and proof of travel," she explains, adding that shopping around is recommended, as more reasonably-priced treatment is available in countries like Germany, France, Poland or Czechoslovakia. The HSE, for example, is prepared to pay up to €10,000 for a typical hip replacement through the HSE. However, prices vary and some hospitals may charge up to €13,000 for the same operation. Hence the need to shop around.

"If you're willing to think about travelling further afield, you'll get healthcare that's more affordable."

The only problem is that - although CBD is working well - there's very low take-up.

In 2016, just over 5,500 nationwide inquiries were received by the CBD office in Kilkenny, but these translated into just 1,303 claims for reimbursement - so, as Donohoe points out, just 23pc of the queries actually transposed into people who ultimately sought treatment under the directive.

This low number, says Donohue, is the result of a number of factors, one of which is that, culturally, Irish people are not comfortable about going abroad for treatment. They worry about language barriers, she says.

The fact that patients have to foot the bill for their travel and any accommodation is also a disincentive for some.

Other reasons for low take-up include a belief that the scheme is "too good to be true", and a significant lack of awareness about it, both within the general public and amongst GPs, she says, even though the service has written to every GP and every consultant in the country to inform them about CBD. This concern is underlined by Dr Andrew Jordan, Chairman of the National Association of GPs, who said that in July the organisation announced its intention to undertake an information drive highlighting the benefits of the Cross Border Healthcare Directive to members and patients.

"Feedback from our members highlighted the considerable lack of awareness among GPs and patients that they have the right to seek healthcare in another EU country," he says. "This has resulted in low levels of uptake."

He adds that the scheme has potential to alleviate the pressure on hospitals and cut waiting times,

Dr Jordan, a practising GP, said he himself didn't fully understand the initiative until earlier this year.

"I thought patients had to be on a public waiting list; I thought that to avail of the programme you had to be in the system, on a waiting list and I wasn't aware that we as GPs could refer someone," he said, adding that he now has a "number of patients" in the CBD system for issues like hip and knee replacements, and nose and throat problems.

"The HSE is committed to it and very strong - it is a very robust system in place to process all applications in a timely manner. I want to see more and more patients successfully going through the system.

"My experience of it has been good and I'm very happy if I can find some way to get a person seen to - for example, someone with osteoarthritis in a hip. You know it will take three to five years of pain, of taking anti-inflammatory medication and painkillers while they wait. At the moment we have 687,000 people on waiting lists to be seen for an assessment and 87,000 awaiting surgery of different kinds.

"We have 3,000 GPs in Ireland and if every GP only referred two or three patients that would be up to 9,000 patients off the waiting lists, so it has the potential to make a huge impact on waiting lists for surgical care."

π The CBD allows for patients that are normally resident in Ireland and availing of public health services to be referred to and avail of healthcare funded publicly in Ireland in another EU/EEA membe state. The UK withdrawal from the EU could affect patients being able to access care in NI and the rest of the UK under this directive. For more, see

'They carried out the pre-op and did the paperwork for me'

Julie Barrett from Kildare had her hip replacement in Belfast

* Julie Barrett began to experience pain in her right hip in 2013.

"I put it on the long finger," she confesses.

However, by October 2016 the pain had become unbearable and, she recalls, her hip had "basically locked."

"I was unable to move," recalls Julie, who is in her sixties and from Monasterevin, Co Kildare.

* At the time she was on a HSE waiting list for a hip operation, but concerned about her pain levels, her three adult children had begun exploring the possibility of having a hip replacement carried out privately.

"One of my sons read about CBD on the internet and phoned the office in Kilkenny," she says.

"He was told we needed a letter from the GP - a referral saying that I needed a hip replacement."

* The family contacted Kingsbridge Hospital in Belfast to make an appointment for a pre-op consultation in February of 2017.

"They carried out the pre-op consultation and did the paperwork with me."

* Julie was told she could have had the hip operation carried out within four weeks of the consultation, but decided to wait for her daughter-in-law who had arranged to travel from India to care for her while she was recovering.

* "I waited for her to come and I had my hip operation in the first week of June," recalls Julie, who added that her children paid the cost stg£9,000, and were subsequently reimbursed. "I'd certainly recommend it to other people."

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