In December 2024 according to NHS England’s figures, 7.46 million people were on waiting lists, with nearly 200,000 waiting over a year for treatment. Patients residing in Scotland, Wales and Northern Ireland are experiencing similar delays.
According to a report from the Royal College of Obstetricians and Gynecologists in June 2024, 763,694 women across the UK were waiting for gynaecology care. This number of women would fill Wembley stadium nearly eight and a half times, would require the seating of 9,500 double decker buses, or standing in line would stretch from London to Exeter.
If you are a patient with sufficient savings or private health insurance you may well be able to access private treatment and move on with your life. However according to the Resolution Foundation up to 30% of working age adults in the UK have no savings immediately available. These patients would be unable to fund private healthcare in the UK without incurring significant debt or initiating a crowdfunding campaign.
Another treatment option without the high costs
What if there were another safe way to access timely and necessary healthcare? It seems there is, but not many people are aware of it.
The Planned Treatment Scheme (also known as the S2 funding route) entitles eligible patients to NHS funding for planned healthcare carried out within the state healthcare system of an EU country, Switzerland, Norway, Iceland or Liechtenstein, when the NHS cannot provide necessary treatment within an acceptable timescale.
Planned healthcare in the EU has been available for UK residents since 1973. It was initially known as the E112 route and then became the ‘S2 scheme’ in England under EU regulations that came into force in 2010. The scheme did not end with Brexit.
This funding route is not exclusive to England. Each of the countries within the UK has its own equivalent of the English S2 scheme.
Using excess capacity in neighbouring countries
It may come as a surprise to those of us used to NHS waiting lists and a system suffering from years of underinvestment and staffing shortages, but there is currently excess capacity in the state healthcare system of several EU and EEA countries such as Germany and Switzerland enabling them to take S2 funded patients.
Data from Germany and Switzerland suggest the tariffs charged by these countries’ state healthcare systems are not higher than those charged by NHS providers for equivalent procedures, and often less. This means it would actually cost the UK government less to fund a UK patient’s treatment in Switzerland or Germany than it would to fund their equivalent care in the UK.
There are of course further economic advantages to be considered when patients are returned to health and are able to resume their normal work and activities post treatment.
In order to be eligible for S2 funding, certain criteria must be met. Details can be found on the relevant NHS websites.
Eligibility criteria
To be eligible for S2 funding the following criteria must be met.
- Prior approval – applications must be authorised before treatment.
- State healthcare – the treatment must be available to you under the providing country’s state healthcare scheme (not as a private patient).
- Entitlement on NHS – the treatment must be routinely available to you under the NHS in your medical circumstances.
- Undue delay – the NHS must confirm that it cannot provide the specified, or equivalent, treatment(s), in a medically acceptable timeframe, for your condition or diagnosis (referred to as undue delay). The relevant NHS commissioner is contacted by the European Cross Border Healthcare (ECBH) team to provide this information.
- Medical support for diagnosis and treatment – there must be written support from an EU or Switzerland, Norway, Iceland or Liechtenstein clinician which, following their full medical assessment, supports the diagnosis, need for treatment and medical timeframe needed for the treatment. This can be supported by a UK clinician.
- Provider support for dates and costs – there must be written support from an EU or Switzerland, Norway, Iceland or Liechtenstein clinician or healthcare provider for the planned treatment dates and estimated costs.
- Residency – you must be ordinarily resident in England and entitled to treatment on the NHS.
You must be registered with an NHS GP. You must have seen your NHS GP for a consultation or assessment about the condition you are seeking funding for, where relevant.
Short timeframe for approvals
NHS England has given assurance, via a Freedom of Information Act request that the majority of applications are processed within 20 days in line with the timeframe described on the website. They have stated that occasionally complex funding requests may take longer.
It is important that patients are aware however, that the S2 route is not a cost-free option. In some countries co-payments may be required in line with local policies. Travel, accommodation (with the exception of hospital stays) and translation costs are not covered for the patient or any accompanying friends or relatives. Specialist travel insurance may also be required. However, these combined costs are likely to be significantly less than private medical treatment costs within the UK.
Testimonies from two patients who have accessed treatment in France and Lithuania, using the S2 scheme and the Scottish equivalent respectively, suggest their experience was positive:
“All went well … all hospital bills were funded by the NHS using her S2 certificate.”
“It all went very smoothly, after I had found out about it and managed to contact the right person in the health authority.”
Ideal stopgap while the NHS recovers
Ideally of course, medically necessary care should be carried out in this country, close to the patient’s home and in a timely manner. The current government has pledged to clear the NHS backlog in five years. This is to be welcomed, but it is small comfort to those suffering now.
The S2 scheme is not an ideal solution to the NHS’s woes, but it can be a good option for some patients in need of care now.
