The Cross Border Directive (CBD) Scheme was an EU scheme which helped many.

If you were on a public health waiting list and in discomfort waiting for a hip or knee replacement or a cataract operation, you could bypass waiting lists by availing of what’s called the Cross Border Directive (CBD) Scheme.

With this, you paid upfront to get your surgery done in another EU country and were reimbursed by the HSE a few months later.

A total of 6,728 people availed of this scheme in 2018 and many chose Belfast for those operations - for obvious commuting and handiness reasons.

HSE figures

The bulk of those who accessed healthcare in 2018 via this scheme travelled to Northern Ireland, the UK and Poland.

HSE figures for 2017, for example, show that 1,741 patients from the Republic who availed of the directive went to the UK, with the majority of those (1,660) accessing treatment in Northern Ireland.

Credit Unions came on board with this scheme too, making arrangements with agencies such as Charter Medical, Trasna and Surgery Now – companies that organised such trips – to lend patients money for the three to six months until they were reimbursed, so it was a smooth-running system.

Is this pathway to care now totally closed off to Irish patients

Given the UK has now left the EU, is this pathway to care now totally closed off to Irish patients?

Irish Country Living got an answer from the Department of Health.

While An Taoiseach Mícheál Martin had said on 16 December that this initiative will continue “on an administrative basis into the new year despite Brexit occurring”, it wasn’t exactly certain what was happening.

“We have to develop a scheme unilaterally following the UK’s exit,” he said, responding to TDs who have been known to help constituents travel to the North for the likes of cataract operations and hip and knee replacement surgery.

The type of scheme in mind, he said, “will provide that Irish residents can continue to access services provided by private health service providers in the UK post the end of the transition period”.

Up to date news

A scheme to replace the above is now in place, so it will be possible to have one’s surgery in Northern Ireland and be reimbursed afterwards.

The Department of Health states the following: “Since 1 January 2021, the provisions of the EU CBD no longer apply to the UK.

"On 28 December 2020, the Government approved the implementation of a new Northern Ireland Planned Healthcare Scheme.

“The new scheme will operate from 1 January 2021 for 12 months and will enable persons resident in the State to access and be reimbursed for private healthcare in Northern Ireland, provided such healthcare is publicly available within Ireland.

“The HSE is also implementing transitional arrangements for certain patients who have a legitimate expectation of continuing to access care in the UK under the current provisions of the EU CBD Scheme, including provision for reimbursement of healthcare costs by the HSE to persons who fall into certain categories, such as patients who can show evidence that they have treatment booked prior to December 2020 for treatment in 2021.

A European health identification card.

“In the context of the COVID-19 pandemic, persons seeking to utilise these schemes should review and adhere to the public health guidance and restrictions in place at any point in time.”

Availing of the scheme in other EU countries

Irish people may, of course, travel to other EU countries for reimbursable treatment under the EU CBD Scheme.

“You can continue to access healthcare in other EU and European economic area (EEA) states and Switzerland under the CBD Scheme,” the Government website (www.gov.ie) states.

This will, of course, cost more in terms of travel accommodation, as you usually need someone to travel with you. Accommodation costs are not reimbursed.

While the COVID-19 situation will affect people's ability and inclination to travel for some time to come, the CBD scheme and the new one-year Northern Ireland Planned Healthcare Scheme will help many who need surgery sooner rather than later.

€11.1m in reimbursements in 2018

Interest in this CBD scheme grew exponentially as Irish people realised its value.

In 2018, the HSE paid out more than €11.1m in reimbursements, compared with just €29,000 in the first year of the scheme and €4.4m in 2017.

Other EU schemes

Treatment Abroad Scheme

As a public patient, you can apply to the Treatment Abroad Scheme (TAS) to be referred for treatment that is not available in Ireland, but is available in the public health system in:

  • Another country in the EU.
  • Another country in the EEA or Switzerland.
  • Unlike the CBD scheme, you don’t have to pay upfront for the treatment.

    Fall sick when visiting the UK? What happens?

    Because Ireland and the UK are part of what’s called the common travel area (CTA), this won’t be a problem.

    You won’t have to worry about not being able to use your European health insurance card (EHIC) in the UK.

    This card entitles you to free treatment if you fall ill while visiting another EU country, but it wasn’t necessary when visiting the UK because the CTA agreement was already in place.

    As long as you haven’t travelled to the UK to receive treatment, you will be able to access care if it is needed when you are visiting, according to the Northern Ireland Dept of Health press office.

    “At the end of the transition period, under the terms of the protocol on social security co-ordination in the trade and co-operation agreement agreed by the UK and the EU, UK insured people will be able to access needs arising care while visiting the EU including RoI (Republic of Ireland) and visa versa.

    "Under long-standing arrangements in the CoTA, the UK and Ireland do not insist on the presentation of an EHIC or GHIC (the new UK Global Health Insurance Card), but proof of residency in the UK or RoI is generally sufficient to access necessary healthcare in the other country as long as you have not travelled to receive that treatment.”

    North-south co-operation will continue

    The Co-operation and Working Together (CAWT) partnership between health services in the North and the Republic has been in place for over 25 years and this work will continue, the Government states.

    This partnership includes the HSE, the Western and Southern Health and Social Care Trusts, Public Health Agency Northern Ireland and Health and Social Care Board in Northern Ireland and involves service level agreements that include:

  • All-island paediatric cardiology services.
  • North West Cancer Centre, Altnagelvin Hospital, Derry.
  • Cross-border percutaneous coronary intervention services (surgery to treat narrowing of arteries).
  • Ambulance services

    The National Ambulance Service and the Northern Ireland Ambulance Service work together in border areas. Both services will keep working together. You can continue to dial 112 or 999 in the case of an emergency.

    Medicine availability after Brexit

    Ireland is unlikely to face general medicine supply issues now or in the near future, according to the Department of Health.

    It said: “In the unlikely event that issues for some supplies do happen, we are well placed to deal with them. We will continue to monitor the situation.”

    Prescriptions

    The advice here is to continue to fill your prescription as usual.

    You do not need to order extra medicines (because Brexit has happened). This could disrupt stocks and reduce the supply of medicines for other patients.

    If you have any concerns, please speak to your pharmacist or doctor.

    For Brexit health-related information, visit the Department of Health website or email any HSE-related Brexit questions to brexit@hse.ie.

    Jury with a difference

    There is a call for members of the public to apply for citizens’ jury on access to health information, with a deadline of 31 January 2021.

    A nationwide campaign has been launched to identify 25 members of the public, broadly representative of the Irish population, willing to step up as members of a citizens’ jury to deliberate on the matter of access to health information.

    It’s about teasing out the pros and cons of patients’ health information being available to health professionals and for wider purposes such as research. At present, the jury is out on this issue.

    The campaign is the brainchild of the Irish Platform for Patients’ Organisations, Science & Industry (IPPOSI).

    Following careful deliberation by the jury, the aim is to arrive at a consensus on the issues raised, with recommendations delivered to Government in the context of the development of new health information legislation and the creation of a national electronic health record.

    Issues such as transparency and how the system can be safeguarded for use will be discussed.

    Have your say

  • The citizens’ jury will sit virtually during the month of April.
  • Members will receive a €400 gratuity for their participation.
  • Applicants must be aged 18 years and above, and be resident in Ireland.
  • See www.ipposi.ie/citizensjury to apply.