E112 Form Treatment Abroad

The E112 Form

For certain painful conditions where you face a long waiting list for treatment, the NHS will fork out for treatment abroad.

Thanks to a ruling in the European courts it's now possible to get the NHS to cough up for treatment in other member states of the European Union.

But it's not easy.

First, you need the OK from an NHS consultant.

Once you get the green light from your friendly neighbourhood consultant, you have to write to the finance or contracts department of your local health authority.

They then seek clearance from the Department of Health.

This is where stamina comes in.

And a big pain threshold.

You can expect them to take anything up to 6 weeks - but possibly 6 months, or maybe more - to organise the necessary E112 Certificate for treatment abroad.

Waiting game

Don't make the mistake of going ahead and booking your health treatment abroad without the official say so, or you'll end up paying for it all yourself.

This is one area where sometimes, it pays to play the waiting game.

But you may have to grit your teeth quite a lot.

Now for the official version, courtesy of the Department of Health

Form E112 - Non-Emergency Treatment in an EEA Country or Switzerland:

The E111 Form will not cover you for free or reduced-cost treatment if you are going to another EEA country or Switzerland specifically for medical care.

For this, you will need Form E112, which is not issued automatically but requires authorisation from the Department of Health.

Unless you have an E112, you will have to pay for the treatment you receive and you will not be able to obtain a refund of the costs.

Need for treatment

Please note, however, that Form E112 is only available where a clear need for treatment is established. The form is not available on a 'just in case' basis.

If you are going to another EEA country (or Switzerland) specifically to give birth, and are not returning to the UK, write to the address(es) below explaining why you want care outside the UK and enclose a copy of your E111 and evidence from your GP or midwife of your expected date of confinement.

Or, for Northern Ireland:

Interim guidance on obtaining medical treatment outside the UK

This is interim guidance, based on the Department's understanding of the law as stated in the case of Watts v Secretary of State for Health and Another.

It is under appeal and what follows may change.

The issue of Form E112 for people going to another EEA country specifically for medical treatment will not usually be considered unless:

• your UK NHS Consultant recommends treatment in the other country;
• your Primary Care Trust (PCT), your local Health Board in Wales, or NHS Board in Scotland or Northern Ireland agrees to meet the cost of the treatment;
• the treatment is available under the other country's state health insurance scheme;
• you are entitled to Form E111.

How to Apply For Form E112

To apply for Form E112 in these circumstances, write a letter explaining your reasons for seeking treatment outside the UK.

Send this letter to your Primary Care Trust or Board together with a letter from your NHS Consultant explaining why he/she is recommending treatment in another EEA country or Switzerland.

The decision about whether to issue an E112 is made by officials of the Department of Health or its Northern Irish equivalent.

Once they receive your application, the PCT or Board should send your application together with the letter from your consultant and their agreement to fund the treatment to the appropriate address above.

Degree of Pain

Authorisation may not be refused where the treatment is of a kind provided by the NHS and where the person concerned cannot obtain the treatment within the UK without undue delay.

In considering the question of undue delay, account must be taken of all the circumstances of the individual case including, for example, the degree of pain or the nature of the patient's disability which might affect his or her ability to carry out his or her job.

Refusal

Account must also be taken of international medical practice.

In cases where the PCT or Board refuse to recommend issue of E112, you can write directly to the Department of Health or its Northern Ireland equivalent.

There are other possibilities, besides use of the E112 procedure, for people to go to an EEA country for elective treatment and for the costs to be met in part or in total by the NHS.

PCTs and Boards have discretion to refer you direct to a provider with which the NHS has an agreement for services.

Quality of Care

The difference between this route and the E112 procedure is that the NHS organisations involved in this type of scheme will know about the quality of care provided by the European provider, and there will be established links between the clinicians there and in the NHS.

Up-Front Payment

Also, there will be no up-front payment required by the patient for treatment as the costs will be met between the NHS and the contracted provider.

This route is more likely to be available where a local PCT has identified sufficient numbers of patients with a similar condition.

It is usual for patients to be contacted directly by their local NHS provider where such schemes are active.

You may check if this is available in your area with your local PCT.

Clinical Assessment

Patients will only travel to mainland Europe for treatment under these schemes where this is what they want and after a full clinical assessment shows that it meets their needs.

Following decisions by the European Court of Justice and our domestic Courts, a patient can also approach a provider in an EU country directly, i.e. outside the E112 procedure or NHScommissioned service.

Resources

As you would have to pay from your own resources for such treatment and then claim reimbursement from the NHS retrospectively for such treatment, you are strongly advised to seek advice from your PCT or Board before proceeding.

As this is a complex area of developing law you are also strongly advised to take your own legal advice.

No Reimbursement

If you go ahead without both a recommendation from your consultant and the agreement of the PCT you may find that you are subsequently unable to obtain reimbursement.

You are also advised to check the Department's website Department of Health for any updating of this guidance.

If your application for an E112 is refused by your PCT or Board, the reasons should be made clear to you.

Unhappy?

If you are unhappy with the explanation, you should raise the matter in the first instance with the Department of Health.

If you wish to appeal against the Department of Health's decision, you can apply for a judicial review of the decision through the UK courts.

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