Referral for Behçet’s Patients in Northern Ireland

Transfer for treatment to England by HSCB is available here

ECR Protocol/Guidance is available here

Transfer for treatment by the Health and Social Care Board (HSCB) is known as an Extra Contractual Referral (ECR) and occurs when the HSCB approves a consultant’s request to transfer a patient to a provider outside Northern Ireland for assessment or treatment which the consultant considers necessary but which is not available through HSC (i.e. NHS) facilities locally. This is normally to a provider elsewhere in the United Kingdom but may also be to a provider outside the UK where this is clinically justified.

Normally, the Board will approve a transfer of this sort where the treatment needed is of a specialist nature which is not available in Northern Ireland, or where there is an exceptional clinical reason why a transfer is appropriate.

In these circumstances the Board will:

  • Pay approved treatment costs direct to the provider.
  • Book flights or ferries.
  • Reimburse accommodation expenses up to a maximum allowance. In exceptional circumstances accommodation may be booked on behalf of the patient.
  • Provide a subsistence allowance for meals.
  • Provide assistance towards other transport expenses.

No other costs will be reimbursed.

Travel expense reimbursement for ECR referrals is not means tested. Expenses in relation to this policy will be payable by the HSCB regardless of the patient’s financial circumstances. The HSCB will not provide cash in advance of travel.

If you feel that you may have grounds for transfer outside Northern Ireland under this arrangement you should contact your GP who may refer you to a consultant in Northern Ireland for an initial assessment. Please note GPs do not refer patients directly to providers outside Northern Ireland.

The HSCB’s Extra Contractual Referral (ECR) process allows patients to be treated outside Northern Ireland where a patient’s consultant feels that this is clinically necessary. Under this process, a patient’s treating Health and Social Care Consultant submits an application to the HSCB for funding approval to be treated outside Northern Ireland.

There are two ECR panels to consider and approve funding requests where a patient’s consultant feels that this is clinically necessary.

  1. The HSCB Acute ECR panel meet on a weekly basis to consider all funding applications received within the preceding 7 days. The panel comprises:
    • Assistant Director of Public Health (Chair)
    • Specialist or Consultant in Public Health
    • Assistant Director of Commissioning (or nominee)
    • Doctor in training public health
  2. The HSCB Non-Acute ECR panel meet on a fortnightly basis to consider all the funding applications received within the preceding 14 days. The non-acute panel comprises as follows:
    • Assistant Director Mental Health and Learning Disability (chair)
    • Assistant Director Social Care and Children (or nominee)
    • Social Care Commissioning Lead, Older People and Adults (or nominee)
    • Assistant Director of Nursing
    • Specialist Consultant in Public Health
    • Assistant Director of Commissioning (or nominee)

The referring consultant remains responsible for clinical oversight and management of the patient.

ECRs normally arise, and are eligible for approval, in the following circumstances:

  1. The patient’s clinical condition requires specialised care that could only be sustained for a large catchment population and cannot be provided for a small geographic area such as Northern Ireland.
  2. The patient’s consultant wishes to seek a second opinion from a provider outside Northern Ireland because of the complexities of the patient’s condition or circumstances.
  3. The Treatment is available locally but the patient’s has some exceptional reason which renders their case different from the vast majority of other patients with the same condition and which therefore justifies a referral for care or treatment outside Northern Ireland.
  4. The service being requested is not commissioned for the population of Northern Ireland, but the patient’s clinical circumstances are such that exceptionality can be demonstrated and a case justified for an ECR to access care from a provider outside Northern Ireland.

In relation to number 4 above, it would be a matter for the patient’s consultant to demonstrate the grounds for clinical exceptionality. The Board can only take account of the clinical circumstances that apply to the individual case. The Board is not in a position to take account of any personal or social circumstances such as age, dependants, occupation etc


A Patient Travel Information leaflet is available here