| Verified against primary record | |
| Statutory test | A time limit which is medically justifiable, on an objective assessment of the individual[1] |
|---|---|
| Phrase not in the law | Undue delay appears once in the Directive, concerning the speed of reimbursement[1] |
| Illustrative scale | 7.3 million incomplete pathways in England, about 6.2 million unique patients, May 2026[2] |
| Records read | Directive, Regulation and waiting times release, 30 September 2026 |
| Independently reported | |
| Reason for travel | Not a field in any official collection consulted[3] |
| Bands apply only to the rows beneath them. The English waiting figures illustrate the scale of waiting in one system; they do not measure travel. No provider-supplied figures are used. | |
Medical travel and waiting lists concerns the circumstances in which a delay at home becomes a legal or practical reason to obtain treatment elsewhere. In the European Union this is one of the few medical travel motives written into statute, which makes the exact wording of the statute worth reading carefully.
The phrase that is not in the legislation
Commentary on this subject almost universally speaks of a right to treatment abroad in cases of undue delay. The phrase appears exactly once in Directive 2011/24/EU, at Article 9(5), where it governs the speed at which money must be paid back: member states shall ensure that patients receive reimbursement without undue delay.[1] It has nothing to do with clinical waiting. In Regulation (EC) No 883/2004 the phrase does not appear at all.[4] Undue delay is a gloss from case law and secondary literature; it is not the operative statutory language, and attributing it to the Directive misstates what the Directive says.
What the instruments actually require
Article 8(5) of the Directive states that the member state of affiliation may not refuse to grant prior authorisation when the patient is entitled to the healthcare in question and when that healthcare cannot be provided on its territory within a time limit which is medically justifiable, based on an objective medical assessment of the patient’s medical condition, the history and probable course of the patient’s illness, the degree of the patient’s pain and the nature of the patient’s disability at the time the request was made or renewed.[1] The mirror provision, Article 8(6)(d), permits refusal where the care can be provided within a time limit which is medically justifiable, taking into account the current state of health and the probable course of the illness of each patient concerned.[1]
Article 20(2) of Regulation (EC) No 883/2004 uses the same formula: authorisation shall be accorded where the treatment is among the benefits provided for by the legislation of the state of residence and where the person cannot be given such treatment within a time-limit which is medically justifiable, taking into account his current state of health and the probable course of his illness.[4]
The structure of the test matters. It is individual, not comparative. A published waiting time, however long, does not by itself satisfy it; an objective medical assessment of the particular patient does, and the Directive expressly directs attention to that patient’s pain and disability. Ireland’s national scheme renders the same test operationally, covering treatment not available in the time normally necessary to get it in Ireland, taking into account the applicant’s health and the likely course of the condition, on referral by a public hospital consultant and with approval before travel.[5]
The scale of waiting
Waiting list statistics are published in detail by some systems and not at all by others. In England, at the end of May 2026 there were 7.3 million incomplete referral to treatment pathways, described in the release as approximately 6.2 million unique patients. Of those pathways 65.6 per cent were waiting within 18 weeks, against an operational standard of 92 per cent. There were 104,734 waits of more than 52 weeks, 6,740 of more than 65 weeks, 1,144 of more than 78 weeks and 177 of more than 104 weeks. The median wait was 12.4 weeks and the 92nd percentile wait 38.6 weeks.[2]
The distinction between pathways and patients is not pedantry. A single patient can hold several pathways at once, and the release itself separates the two counts. The widely repeated formulation that a given number of people are waiting takes the pathway figure and attaches the wrong noun to it.
What is not recorded
No official collection consulted for this entry records why a patient travelled. The European Commission’s data collection under the Directive covers requests, authorisations, reimbursements and amounts, and contains no question on patient motivation, whether waiting times, cost, quality or proximity.[3] The statement that patients travel abroad because of waiting lists is therefore an inference rather than a measurement, however plausible it is.
The published authorisation figures also have to be read with care. For the reference years 2018 to 2020 the Commission reports prior authorisation requests received and requests authorised, but does not publish refusal counts.[3] Subtracting one from the other does not give refusals, because the residual may include pending, withdrawn, incomplete or duplicate requests. The same report records that several countries could not answer parts of the questionnaire, that France could not separate requests made under the Directive from those made under the coordination rules, that eight countries operated no prior authorisation system at all, and that 2020 was severely affected by the pandemic.[3] The annual totals are not drawn from a constant set of countries and should not be read as a trend.
See also
- Government-funded treatment abroad, the routes under which such authorisations are granted
- Cross-border healthcare, the legal category and its EU definition
- Medical travel and treatment affordability, the other commonly asserted motive
- Elective medical travel, the category most affected by waiting
References
- European Parliament and Council. Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare. OJ L 88/45, 4 April 2011, Articles 8(5), 8(6) and 9(5). Verified against primary record: Official Journal text read. Retrieved 30 September 2026.
- NHS England. Statistical Press Notice: Referral to Treatment waiting times, May 2026. Published 9 July 2026. Verified against primary record: official statistics release opened and read. Retrieved 30 September 2026.
- Olsson J, De Smedt L, De Wispelaere F. Data on patient mobility under Directive 2011/24/EU: Trend report, reference years 2018 to 2020. European Commission, December 2021. Verified against primary record: official data collection opened and read. Retrieved 30 September 2026.
- European Parliament and Council. Regulation (EC) No 883/2004 on the coordination of social security systems. OJ L 166/1, 30 April 2004, Article 20. Verified against primary record: Official Journal text read. Retrieved 30 September 2026.
- Health Service Executive, Ireland. Treatment Abroad Scheme. Verified against primary record: national health service page opened and read. Retrieved 30 September 2026.
- European Commission, Directorate-General for Health and Food Safety. Cross-border healthcare: overview. Verified against primary record: institutional page opened and read. Retrieved 30 September 2026.
Sourcing note: both EU instruments were opened in the Official Journal text and searched for the phrase undue delay, which is why this entry can state where it does and does not appear. The English waiting figures are national statistics for one health system and are used to show the scale of waiting, not to describe travel; the Directive route is an EU mechanism and the two are not linked here. Case law is referred to in general terms only, because no judgment text was read for this entry. Refusal counts are not stated, because the Commission does not publish them and deriving them by subtraction would be unsound.