Faced with the prospect of waiting for up to three years for a hip replacement on the NHS, Brian Ashworth took matters into his own hands.

He found a way to have the operation within 30 days — in Lithuania, 1,700 miles from his home in Northern Ireland. And, incredibly, it was paid for by the NHS.

Brian, 56, from Bangor, is among thousands of patients who have used a little-known EU scheme that allowed them to bypass NHS waiting lists by visiting hospitals across Europe.

Yet, with Brexit looming, its future could hang in the balance.

Thousands of patients are choosing to bypass NHS waiting lists by visiting hospitals across Europe but with Brexit looming, its future could hang in the balance. (Stock image)

Under the Cross-Border Healthcare Directive, or another scheme called S2, patients deemed suitable for surgery on the NHS can choose to have treatment in any other EU country if it cannot be provided on the NHS within a 'medically justifiable time period'.

Patients who choose the Cross-Border scheme pay for the treatment (up to the amount it would cost on the NHS) and the NHS reimburses them, while on the S2 route the NHS pays the EU hospital directly (S2 covers only state-provided healthcare; the directive scheme covers both state and private treatment).

Travel and accommodation expenses have to be covered by the patient, but that can still work out cheaper than a private operation in this country — a private hip replacement costs around £10,000, whereas a return flight within the EU can be a few hundred pounds.

Around 4,000 patients took advantage of these schemes last year, at a cost to the NHS of more than £10 million.

The number of people using the S2 route rose by 5 per cent a year between 2012 and 2018.

'This year, as uncertainty about Brexit's aftermath increases, unusually big numbers of British patients are inquiring about knee or hip replacements,' says Professor Sarunas Tarasevicius, an orthopaedic surgeon at the private Nordorthopaedics Clinic in Kaunas, Lithuania, which has been treating NHS patients for five years.

'The monthly number of patients from the UK has doubled since last year to 40.'

Patients can seek treatment abroad under the Cross-Border Healthcare Directive, or another scheme called S2. (Stock image)

The Clinica Sandalf, in Malaga, Spain, also reports an increase in NHS orthopaedic patients.

Dr Alf Neuhaus, a consultant orthopaedic surgeon at the clinic, told Good Health: 'I have noticed an increase in the past 18 months or so. I estimate I've had a 30 per cent increase in NHS patients compared to 2018.'

More than 4.4 million patients are waiting for operations in England alone, according to figures published in October.

If the schemes are scrapped under the future terms of Brexit, their loss is unlikely to have a significant impact on these figures because of the relatively small number of patients using them.

But this would remove a valuable option for people such as Brian, a pastor who is married with three grown-up children. He says: 'At the beginning of last year, I knew I needed my right hip replaced. Twenty years ago, while working as a tree surgeon, I fell 15 ft from a tree and landed on all fours — my right hip never really recovered from the injury.

'X-rays had shown I was eligible for a hip replacement, but I couldn't bear the idea of going on an NHS waiting list for two to three years.

'In early May, I found out about the directive scheme through an acquaintance who had just had knee replacement surgery at Nordorthopaedics. He said it was five-star treatment.'

Brian made an appointment with the clinic and submitted his application to the NHS. He was told it would cost around £6,000, which he would have to pay personally after the procedure.

Three days before he was due to fly out, the application was approved by the NHS. He had his own room and 24-hour care, and he was bearing weight on his hip the first day after surgery.

Against the clinic's recommendations, Brian flew home two days after the procedure, as he didn't want to pay for the aftercare package. A few days later, significant bruising started to develop down the back of his leg.

At the Nordorthopaedics Clinic, follow-up of NHS patients is done via phone and email.

'We normally ask patients to send in an X-ray after three months so we can evaluate their hip or knee joint,' says Aurelija Bivainyte, manager for orthopaedic patients at the clinic.

However, this X-ray has to be done by the NHS and, if a problem is detected, the NHS has to pick up the bill.

Brian had a video consultation with the surgeon who had operated on him and he talked through his concerns.

'He reassured me everything was OK and the bruising was normal and would dissipate,' says Brian.

Within three weeks, he was off crutches, and a couple of weeks after submitting the receipts, he had been reimbursed by the NHS. Brian is now back to full fitness.

A Department of Health and Social Care spokesperson says: 'The Government has agreed a deal with the EU.

'Once ratified by Parliament, this will mean current reciprocal healthcare arrangements will remain the same until December 31, 2020, including the Cross-Border Healthcare Directive.'