UPDATE: The DoH has allocated a further £5m to continue to operate the scheme beyond the planned 30 June 2022 deadline. New applications will be accepted from 1 July 2022. These will be processed in chronological order and the scheme will continue until the additional funding has been committed. Further information on the scheme will be provided on this website. (NHS Website)
The Republic of Ireland Reimbursement Scheme, formerly known as the EU Cross Border Directive, provides people living in Northern Ireland and on a waiting list for orthopaedic surgery with the option to travel to Dublin for their surgery.
This webinar hosted by Sports Surgery Clinic focuses on the Republic of Ireland Reimbursement Scheme, covering the application process and how to apply for the ROI Reimbursement Scheme. It also focuses on the costs involved and what patients can expect when travelling to Santry for their orthopaedic surgery.
This event consisted of presentations from members of SSC’s team and was followed by a live Questions and Answers session on the Republic of Ireland Reimbursement Scheme.
How to apply for the Republic of Ireland Reimbursement Scheme
by Fiona Roche, Business Development Manager at SSC.
I am now going to talk about the Republic of Ireland Reimbursement Scheme, formerly known as the EU Cross Border Initiative Scheme, which most of you may know it as.
This is a picture of the hospital, as you can see. We are very close to Dublin Airport. The Sports Surgery Clinic is the leading private orthopaedic hospital in Ireland. We look after all joints, muscles and bones etc., for example, from your hips to your knees, backs, neck, foot and hand.
We cover all those surgeries. Most people are interested in hip and knee replacement surgeries. We also do joint replacement of those, shoulder replacement and some ankle replacement but not as many. Spinal surgery may also be an interest to some of you, we do some spinal fusions, but some of our surgeons do not do it as part of the reimbursement scheme, but if that is what you’re looking for, come and talk to me about it. We then also do foot and hand surgeries.
As I said, we are very close to Dublin Airport, about a ten-minute drive away, and we have underground parking here.
This slide is about the scheme, and this is what a lot of people want to know about.
The Republic of Ireland Reimbursement Scheme Application Process
|The one thing you need to apply for funding and to be eligible for it is that you must be on a waiting list. You can get proof of your GP or the hospital that you are on a waiting list for surgery.|
You will need to provide evidence of being on a waiting list when filling out your application form.
A lot of people think they are on a waiting list for surgery, but sometimes they are only on the waiting list to see the Consultant, not for surgery yet.
If this is your case and you may have to wait another year to see the surgeon, you can come and talk to me, and we can talk about other ways you can get on the list.
We can find a way to get on the waiting list and see a surgeon rather than waiting even longer before the scheme ends. As far as we are aware, the scheme is going to carry on until July 2022.
Once you have approval on the scheme you do have nine months to get your surgery. If you are unsure whether you want to go ahead with it, still apply, and then you have up to nine months to make your decision.
It takes about 4-6 weeks to hear about approval; they are very busy at the moment.
Payment wise, you pay it all upfront before your surgery. We take the payment a week before the surgery. Once the surgery is done, and you are discharged, you are given a receipt from us, and you hand that in with an application form to the Belfast office, where you get refunded about three weeks after that.
We have a team here at the hospital, including myself, Glenda Thorne from the finance side, Rebecca Lenagh and Margaret Cromwell.
All of us each talk to you about your individual cases, and we will provide the phone numbers at the end.
What’s included in the price you pay SSC?
When it comes to the surgery, what is included in the price?
The following is included: Hospital stay in semi-private accommodation this means there could be up to two people in a room, there is never more than two. Pre-assessment and cardio echo, if required, is included. The surgeon, anaesthetist fee, the surgery and hospital stay, pre and post-operative x-rays and two post-operative appointments plus x-ray is all included.
The price also includes a covid swab, so what we are saying to people is if they want to get the covid test done closer to home instead of driving up here 72 hours before the day of your surgery, you can get your test done closer to home and when you arrive for your surgery, we will take the cost off just be sure to let Glenda know when you are paying.
What is not included?
Any additional consultation’s you may require, for example, if you go for pre-assessment and they find you may have a heart condition or something came up in your blood, you might need to see another consultant to get clearance.
You can do this with your own Consultant at home; if not, we have a cardiologist here that you can see, but you will have to pay additional for this.
You may need to get additional CT scans or MRI’s which you will have to pay for. It is rare.
Any investigation not normal to the surgical process is not included in the package.
A private room is also not included in the price, so a room on your own. If you want this, you can contact Glenda and she will let you know the additional fee and other relevant information.
With regards to surgery, some people may have a preference for a particular surgeon they would like to see or have been recommended. We are happy to pass that information on to the surgeon’s secretary. If not, we are here to help you to make that choice.
All of our surgeons are specialists in Orthopaedic surgery. Appointments and surgery can be completed within 6-8weeks.
For a lot of people, this can be another pain, not knowing how long they will have to wait. Some people would prefer to have their surgery in 4 months’ time or around the Christmas holidays or after. That is okay; we can organise that by letting the surgeon know your preferences, and we can organise the surgery around that time for you.
To save you from doing too much travelling, we do book all your appointments on the first appointment on the same day as per assessment to avoid numerous journeys. The only time you would have to travel back down after your assessment is if you are getting your covid swab done down here or you want to see another consultant.
Appointments can be made on receipt of you getting approval from the ROI Reimbursement Scheme.
If the scheme is going to take 4-6 weeks to get approval, you can begin the booking process for pre-assessment; you just can’t book the actual surgery until approval.
After surgery, many people wonder how long they will have to stay. It depends on the surgery you require, your surgeon and how you are feeling.
Generally 2-3 nights for joint replacements. There are local hotels available for relatives who want to stay as we currently cannot take visitors at this moment in time, it could change, but now we are following Covid guidelines.
If you do have a relative that wants to stay, there are local hotels. The Crowne Plaza is closest but is currently being used as a quarantine hotel that may change, but as now it is not available, but the Carlton Hotel on the Dublin road is about ten minutes away from here.
If you need any convalescence or social care packages at home, you are still entitled to this under the NHS. Let us know beforehand what you will need. You are also entitled to your physiotherapy under the NHS if you are waiting longer than ten days. Book privately. Don’t wait.
Frequently Asked Questions
Do I need Insurance? No insurance will cover this trip.
What happens if there are complications? If it is not related to your surgery, for example, a problem with your bowl or liver, we may have to admit you to the public hospital. This is rare and has only happened once or twice. We have a good relationship with the other hospitals, so we have that option. There is a global card that will cover you if we admit you to another hospital. If readmission occurs within 30 days to do with your surgery, it is rare, but just so you know, there is no charge.
As you can see on the map, we are very close to Dublin Airport.
Thank you for listening tonight.
The Republic of Ireland Reimbursement Scheme overview from a surgeons perspective by Gavin McHugh Consultant Orthopaedic Surgeon at SSC.
Hello everyone, I’m Gavin McHugh, Consultant Orthopaedic Surgeon based in the Sports Surgery Clinic in Dublin. Fiona has kindly asked me to say a few words about the cross border initiative based on my perspective of it, I suppose.
My area of expertise is hip and knee, and I mainly do a lot of hip replacements, knee replacements, partial knee replacements and soft tissue knee work, which is arthroscopies and cruciate knee ligaments (ACL Repair).
Within the clinic itself, we have a broad area of expertise that covers all the subspecialties such as the spine, upper limp, shoulder, elbow and hand, then obviously foot and ankle as well. Over the past few years I have been here, a really huge growth of my practice has come from the cross border directive, and I have dealt with a lot of happy customers from the north.
From my point of view, people are coming down a little bit sceptical of what exactly is involved, and I always say to people I have never really seen any catches in the whole process, it has actually been quite seamless, they have done a lot of work on the cross border initiative to make it as easy as possible for patients. From a principle point of view, lots of people have issues in regard to moving away slightly from the NHS. I completely understand that, but from my point of view, I have seen patients that are in a really bad way, and they are looking at waiting lists that are really long, potentially years-long and ultimately, you need to make a call that is right for yourself. We have a similar process here that lots of patients end up going the other direction, and also, there are lots of waiting lists. That is when I say to patients there has to be a safety net there for people. The NHS is still responsible for your care. So if you’re on a waiting list for surgery and I perform your surgery, if there is a problem down the line, your consultant up north is still bound to look after you and the same works both way here’s. You won’t be left behind on. In terms of what you get,
|the care you receive in the sports surgery clinic is state of the art, one of the best in the world, and I am happy to say that.|
There are no real catches in the care. I say to everyone this is something we really fought for over the years. The price the clinic pays you is the price you pay for a job. If there are any problems and you may need to stay an additional few nights, there are no issues in regards to this. We want you to do well following your surgery. We want you going home safe and ultimately doing well.
In terms of what I do, the breakdown of the vast majority of patients that I see here is for hip or knee replacements. The time people have developed a lot of pain in the hip, it is time for a hip replacement, and there are various methods of doing so. Knee replacements have slightly more options, such as partial knee replacements rather than just full knee replacements. Quite often, patients tell me they have been told they needed a full knee replacement when often I have only needed to give them partial, which has its advantages such as maintaining the knee that they have half and the recovery process.
One other area where I have really developed an area of interest potentially has either joint done at the same time, as in both hips together or both knees together. This can sound daunting to patients initiatively, but obviously, the huge advantage of this is getting both operations done in the one and one recovery progress. It offers huge advantages to people that may be in a bad or painful way. The partial knee is easier to get both knees done, it’s not an easy thing to go through, but it is a case of getting your life back again in one go. We try to get to your pre-assessment and consultation on the same day to make it straightforward for you. It is as seamless as we can’t make it. I am happy to see everyone and give my opinion. I often laugh when people say when doctors suffer, patients suffer, which is not the case. It is important that I am happy to do it and see you beforehand. I look forward to seeing many more patients.
Q&A Session – Republic of Ireland Reimbursement Scheme
The following questions were asked live by the public and answered by Fiona Roche and Glenda Thorne.
How long do you stay in hospital after hip surgery?
2-3 nights depending on your surgeon and how well you are recovering.
What happens after the operation? Do I attend my own doctor or hospital for updates?
All post-operative reviews are here in the sports surgery clinic. You should only need to see your own doctor for wound review or stitches removal. Other than that, all post-operative reviews are done here.
Do you need to be on the NHS waiting list for orthopaedic surgery for a specific length of time to qualify for the scheme?
No, you only need to be on a waiting list to qualify.
How long does the whole process take from applying to getting the surgery?
Approval at the moment takes 4-6 weeks. Allow six weeks. You can wait 4-8 weeks for surgery with us as it is our busy period, each surgeon has different times. You can contact us to find out specific waiting times.
How soon can you pay before surgery?
We need the payment completed five working days before admission as paying on the day can delay admission.
I’m in need of 2 hip replacements. How much could I expect to pay after everything is taken into account?
There is specific pricing for a specific procedure. You can contact Glenda Thorne for more information. You can also now get a bilateral hip replacement, so both hips are done at the same time, or you can do it separately. It is interesting to know for one single hip replace place you will receive 6,500 sterling pound back from the cross border scheme.
How can you pay?
You can pay by direct bank transfer, over the phone through Glenda Thorne, Online portal and bank overdrafts. Contact Glenda Thorne for more information.
My wife, who is 82, is in urgent need of a hip replacement. The Orthopaedics has said it will be at least three years before she can obtain one in Northern Ireland. A member of the Orthopaedic team advised me to contact you re the reimbursement scheme. Any advice would be gratefully appreciated.
You can apply for the reimbursement scheme once you have a letter of evidence of being on an NHS waiting list for surgery. The application form is available on our website, or you can contact us if you have any more queries.
My Mother was referred by a GP for x-ray revealed arthritis in the rotator cuff. GP referred her for a scan on 03/21, which was done privately on 04/21 as the NHS waiting list was too long. Further scan in 06/21 privately was to have surgery by 08/21 (privately) Private appointment cancelled due to covid pressure. Does she qualify?
In order to qualify for funding, you must be on an NHS waiting list. If your mother is not on a waiting list and went privately, you do not qualify. I would recommend going to see a surgeon privately up north as you will be waiting a long time to see one publicly. You can ask a surgeon to put you on a waiting list.
I had MRI / X-Rays completed years ago for hip impingement, but as I have been waiting eight years for surgery, perhaps those scans are now outdated and no longer relevant. Do I need to go get MRI’s and X-Rays again?
You don’t always need MRI. We do an x-ray for you on the day of the pre-assessment. I recommend making the appointment first, as you do not even need an MRI.
Will Santry clinic have all up to date relevant information about me if I go this route to surgery?
We would not automatically have your information. You will need to provide or ask your GP for a printout of your medical history and bring it on the day of assessment.
If I have not yet submitted an application yet, should I go ahead and book my consultation with a surgeon to start?
Don’t make any appointments until you have submitted your application form, as this can take up to 6 weeks.
As you can have all your appointments booked and you may not have heard back yet.
Is it possible to have your consultant appointments in the North if the surgeon works in ROI & NI?
No, it isn’t. They won’t cover the appointment you have in the North. You are only covered for appointments outside of the North. Although some of our surgeons work in the North, you will not be covered. You need to come down to Dublin anyways for your pre-assessment.
What is included in the pre-assessment? Does it include X-ray & blood tests?
Included in the pre-assessment are X-rays, blood, ECG, cardio echo etc.
The only thing not covered is any additional MRI or tests not related to your surgery that may need to be done if any issues are found or a cardiologist if needed to be seen. Some assessments are done through the phone since covid, which is cheaper.
Is 100% of the cost covered by NHS?
No, usually, you would get between 40-60% back.
Are Cheilectomy performed at Clinic, please?
Yes, they are, that is, foot and ankle. All prices are done in euro as we do not accept sterling.
Do you have to self-isolate before surgery?
You need to get a covid test done 72 hours prior to surgery, and we do recommend self-isolating after getting your test done up until the surgery.
Do all the surgeons vary in a package price?
No, they all charge the same. All surgeons have an agreement with us as a part of this scheme. It doesn’t matter what surgeon you choose. They will all charge the same.
Are many people turned down for funding? And if so, why?
We have not heard of anyone being turned down so far in the last eight years. Once you are on an NHS waiting list, there should be no complications.
Can you get two knee replacements at the same time?
If you don’t want to get them done bilaterally, most surgeons wait eight weeks between each surgery, depending on the surgeon and how well you did in the first surgery.
If you need more physio, is it organised back in Northern Ireland?
It depends on what surgery you are having. Usually, you’re GP would organise this, and yes, it would usually be in Northern Ireland as it would be too far to be travelling back and forward.
If there are any emergency complications after you are home, will the NHS take over?
If you got very sick at home, yes, they would take over. If you had any complications to do with your surgery, yes, you would come back down once you are fit and able to travel. If you need to be Re-admitted within 30 days, there is no fee.
If an emergency happens at home, of course, the NHS will step in.
Do you do laminectomy for Spinal canal stenosis?
Yes, we do. Consultants will want to see your letter of referral and evidence of being on a waiting list. Spinal surgery is more difficult to price as there is a lot more surgeries and codes.
Once you have approval, do you have nine months past July 2022?
Once you get approval, you have nine months to get your surgery done.
Can pre-assessment be booked if verbal confirmation has been given of approval?
No, you must have a letter. You must provide a letter of evidence of being on a surgical waiting list in Northern Ireland.
What is the cost of a private room, please?
If you wish to take a private room, the difference from a semi-private room is approximately 1000 euro. A semi-private room only has two people.
How successful is knee replacement? How many have been completed within the last month?
It takes up to 12 months for a full recovery and hard work. Everyone is different, and this should be discussed with your surgeon. You should contact your surgeon. We do about a thousand a year, one of the highest rates in comparison to other hospitals in the country.
I’m just wondering if it is means-tested to determine which percentage is refunded?
Whatever happens, there is a standard price. They don’t do means-testing. For example, if they give you 8000 for a hip replacement, that is what you get no matter where you go. There is a set price, and that is the standard price
Who would supply specialised seating etc., for aftercare for a hip replacement?
You will need a high toilet seat that is included when you are going home from here after surgery. If you need anything else like seating or other equipment, you would need to go through the community for that and occupational therapists for that. Sometimes you cannot request these things until you are a patient in the hospital, but anything like that will be discussed when you come for pre-assessment, and that is when you talk about what you may need when you go home.
If you have any questions at all regarding the Republic of Ireland Reimbursement Scheme, the application process, pricing or any query relating to a potential hospital stay, please do not hesitate to contact Fiona Roche: +353 1 526 2168; or Glenda Thorne on +353 1 5262071 or Email: email@example.com