THE future of an EU healthcare scheme used as a last resort by patients stuck on waiting lists in Northern Ireland is looking uncertain due to Brexit.
It has also emerged that the number of people make applications to the programme - which allows patients to pay upfront for surgery in other European countries and then be reimbursed by the NHS - has rocketed.
Desperate pensioners facing five-year delays for hip replacements are among those who have availed of the initiative, with some getting loans of up to £10,000 to fly to Lithuania and other parts of eastern Europe for cut-price surgery.
A total of 1,119 people were approved by the north's Health and Social Care Board in for 2019/2020 - compared to just 63 in 2015/16.
Not everyone who successfully applies "decides to proceed" with treatment, according the board.
Health minister Robin Swann has confirmed the scheme, known as the EU Cross Border Directive (CBHD) will only apply to the UK "until the end of the implementation period" under the Brexit Withdrawal Agreement.
While the UK left the EU on January 31, it is currently in "transition" until December 31, when arrangements largely remain the same.
However, Mr Swann clarified that at the end of the implementation period the scheme "will no longer apply to the UK unless it comes to an agreement with the EU on this matter".
"My department is currently considering the policy options in relation to the principles within the CBHD, in the post implementation period environment," he added.
Two years ago, The Irish News reported the health service paid out £1.5 million in reimbursements to 416 patients who had sought treatment outside the north.
Orthopaedic procedures account for the majority of the surgeries performed but others with brain-related illnesses and kidney conditions have also travelled to countries including Slovakia, Cyprus, Lithuania, Hungary, Spain, Germany and the Czech Republic.
Procedures have also been carried out in private clinics in the Republic of Ireland, as well as France, Poland and Germany.
SDLP health spokewoman, Sinead Bradley, whose party sought information from the health minister on the issue, said it was clear an alternative "must be sought".
"Using this avenue in the first place is not ideal, we must look at increasing capacity here to begin with. Patients still have to pay upfront for any procedure under the EU directive, in effect creating a two-tier health system whereby fast-track treatment is only available to those in a financial position to do so.
“The Department must look at cost differentials going forward, to ensure the most viable option is determined. Measures need to be put in place to guarantee that all trust areas and orthopaedic services are properly resourced to meet current demand for procedures covered under the EU Directive.
"A health service, free at the point of delivery must be protected at all costs."
