Cross border healthcare , the general principle is “If you are entitled to it here, you can get it there”, but… Patients are still waiting in excess of rights to a maximum wait time for surgery in more EU countries.

Patients are still waiting in excess of rights to a maximum wait time for surgery in more EU countries. In England The Patients Association report from June 2013 shows there to be a fall in the total number of procedures carried out and a noticeable increase in waiting times for elective surgeries. The national commissioning authority, NHS England, is using penalties, in their 2013/14 Standard contracts, for building up backlog of waiting patients. However, there are evidence of increasing pressures on waiting times. At the end of june 2013, NHS Gooro data showed that 161.503 patients were waiting for more than the statutory standard of 18 weeks. This is a 15% increase from the 141.000 number at the end of december 2012. End of september 2013 numbers are 168.951, a 20% increase.

The directive has been implemented by all EU member states by 25 october 2013

The general principle is : “If you are entitled to it here, you can get it there”, but… Member States retain discretion as to whether to authorize planned treatment in another Member State except in cases where “undue delay” is relevant – i.e. where treatment cannot be provided by the NHS within a time that is medically acceptable, based upon an objective clinical assessment of the patient and their individual circumstances. Where this is the case, authorisation must be given The department of health in England has published information that explains the rights of patients and helps the NHS understand the obligations set forward by the directive. NHS England is the national point of contact, and has provided the CCGs with detailed information.

Whether the waiting time is medically justifiable must be based on an objective medical assessment of the individual patient’s condition, including the patient’s medical history, the extent of the patient’s pain, disability, discomfort or other suffering attributable to the medical condition; whether that pain, disability or discomfort makes it impossible or extremely difficult for the patient to carry out ordinary daily tasks; and the extent to which the service would be likely to alleviate or enable alleviation of the pain, disability, discomfort or suffering.

The NHS reform April 2013

The NHS commissioning system was previously made up of primary care trusts and specialized commissioning groups. Most of the NHS commissioning budget, about £65 billion (of the NHS £100bn), is now managed by 211 clinical commissioning groups (CCGs). These are groups of general practices which come together in each area to commission the best services for their patients and population, around 250.000 – 1.000.000.

Nationally, NHS England commissions specialized services, primary care, offender healthcare and some services for the armed forces. It has 27 area teams but is one single organization operating to a common model with one board. Provision of cross-border care requires a strong focus on ensuring continuity and integration of care.

IMED Hospitales

IMED Hospitales is constantly improving our quality of integrated care by assessing patient centredness with a valid set of indicators. Indicators can be based onrecommendations from guidelines, but adding patient opinions (Patient reported experience measures – PREMs) leads to a more complete picture of patient centredness.

It is assessed using eight dimensions of patient centredness: access, follow-up, communication&respect, patient and family involvement, information, coordination, physical support (pain rehabilitation), and emotional and psychosocial support.

Research ( has found plenty room for improvements in all dimensions. information indicators include aim and follow-up of diagnostic procedures,treatment options pros/cons, estimation of possible cause of illness, eating well, options for pain medications, tions for naesthesia, es for emotional support, possibility of a second opinion.

IMED hospitales use evidence based PREM measues with available longitudinal national data for benchmarking – Picker based data in the NHS and PASOPP data in Norway. Enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty, and a vast number of other surgical procedures, has resulted in significant benefits to patients in several clinical domains, and reduced length of hospital stay .