Talking point: Cross-border tales

Written by Tom Freeman on 10 June 2014

One of the most famous children’s hospitals in the world was forced to enter the debate on Scottish independence last week, after a cinema advert by the ‘Vote No Borders’ campaign appeared to suggest Scottish children would not be prioritised for specialist treatment there.
The Great Ormond Street Hospital (GOSH) for Children in London asked the group to remove the advert, which depicts two actors discussing the NHS after independence. “They can join the long list of foreigners waiting to be seen” at the hospital, one says.
GOSH responded: “We would like to reassure Scottish families we already have reciprocal healthcare agreements with numerous countries, and we regularly treat patients from across Europe because of our very specialist expertise.”
The NHS already has to operate cross-border agreements in the UK because of the sweeping structural reforms in England. Scotland’s NHS is completely devolved, and the two systems have grown increasingly apart. As private companies take on more service delivery south of the border, and less north of the border due to political decisions, the practicalities of transferring patients will become more complicated. What is unlikely to change, however, whatever happens in September, is the transfer of patients for highly specialist treatments, such as the ones Great Ormond Street Hospital delivers for Scottish children. European directives on patient mobility ensure patient rights across the whole European economic area, which includes non-EU countries such as Iceland, Norway, Switzerland and others, and without cost to the individual patient. The directive was ratified by the Scottish Parliament last year.
Although the NHS is devolved, some matters are still resolved on a UK-wide basis, but when the Scottish Government adopted the advice of the NHS pay review body when the UK Government had not, cracks began to show. What next for medicine pricing or regulation of the professions?
The ‘Vote No Borders’ advert was right about one thing – there is uncertainty about cross-border healthcare. But that is true whatever the result of the referendum.

Tom Freeman

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