The Planned Treatment Scheme (S2 funding): an alternative to long NHS waiting lists or private care

Lucy Douglas is a salaried GP in Huddersfield and a member of the Anglo-French and Anglo-German Medical Societies.

NHS backlog data analysis from May 2025 in England showed 7.4 million people were waiting for treatment, with 3.1 million waiting over 18 weeks and almost 200 000 waiting over 12 months for treatment.¹ Data from Scotland, Wales, and Northern Ireland show many patients experiencing similar delays in their respective countries.^2–4

According to a report from the Royal College of Obstetricians and Gynaecologists in June 2024, 763 694 women across the UK were on NHS waiting lists for gynaecology treatment. This number would fill Wembley stadium almost eight and a half times, seated would fill 9500 double decker buses, or standing would stretch from London to Exeter.⁵

A freedom of information request by the Labour party in 2023 estimated that over 120 000 patients died on NHS waiting lists in the preceding year. This was double the number of comparable deaths in 2017/2018.⁶ The principle cause was thought to be related to a lack of NHS resources rather than the effects of the COVID-19 pandemic.⁷

Patients waiting for necessary secondary care treatment have been shown to use more healthcare resources overall than those treated promptly, and much of this additional workload falls on primary care in the form of interim prescriptions and appointments,⁸ thereby limiting available capacity for other primary care work.

For those with medical insurance or savings, private treatment may enable patients to bypass long NHS waiting lists. Evidence suggests there is increasing private healthcare expenditure in the UK, particularly in the South of England.^9,10 Unfortunately, however, many adults in the UK have no savings immediately available^11,12 and would be unable to choose private medical treatment without risking significant personal debt. Some patients may source private health care abroad in order to save costs, but there may be risks in seeking treatment in less well-regulated settings.¹³

Another potential option does indeed exist. The Planned Treatment Scheme (S2 funding route) enables eligible patients to access NHS funding for planned medical treatment in the state healthcare system of a European Union (EU) country, Switzerland, Norway, Iceland, or Liechtenstein.¹⁴ Similar schemes operate in Scotland, Wales, and Northern Ireland.^15–17

Unfortunately, there seems to be limited awareness of the S2 funding scheme among healthcare providers or patients.

To be eligible for S2 funding:

• the patient must have an authorised application before the treatment;
• the planned treatment must fall under the providing country’s state healthcare scheme (not private);
• the treatment must be routinely available to the patient under the NHS in their medical circumstances;
• the NHS must confirm that it cannot provide the specified, or equivalent, treatment in a medically acceptable timeframe for the patient’s condition;
• there must be medical written support from a clinician/healthcare provider from the providing country for the need for treatment following their full medical assessment;
• there must be medical written support from a clinician/healthcare provider from the providing country for the planned treatment dates and estimated costs;
• the patient must be a resident in the UK, registered with an NHS GP, and entitled to treatment on the NHS; and
• the patient must have seen their NHS GP for a consultation/assessment about the condition in question.¹⁴

The scheme requires the patient to source the provider of care; that is, it is a patient-led system and does not therefore adversely impact GP workload. The patient must check that provider organisation is part of the state healthcare system and is willing to accept S2-funded patients. GPs could be asked by patients to provide access to documentation detailing diagnosis and need for treatment, although in many cases patients will already have letters sent directly to them from secondary care, or will be able to access the necessary evidence online.

NHS England have confirmed, when approached, that S2-funded patients should be able to access any necessary follow-up within the NHS in common with patients who have received their NHS care in this country. This is an important distinction between S2-funded patients and those who have sought private treatment abroad.

NHS England have also confirmed that in non-complex cases a funding decision is usually made within 20 days following receipt of the necessary paperwork.

Many UK patients will have friends or family or other links to EU or relevant European Economic Area countries enabling them to source a healthcare provider with relative ease and confidence.

For patients without such contacts, organisations, such as Trasna, can help patients connect with and navigate state healthcare provision abroad.

Thomas Syburra is Senior Consultant Cardiac and Thoracic Vascular Surgeon working at La Tour Hospital in Geneva, Switzerland. He is able to help cardiac and vascular surgery patients navigate the S2 scheme when electing for treatment in Geneva. He trained at the Royal Brompton and Harefield NHS Foundation Trust and is one of the very few holders of the triple qualification as a cardiac surgeon, a class 1 aviation medicine examiner, and a pilot.

According to Aonghus O’Rourke, Director of Operations for Trasna:

‘Trasna has a network of healthcare providers around Europe with which it arranges treatment for patients. Trasna guides patients through schemes such as S2 and EU Cross-border Healthcare and does not charge patients for using its service. Trasna’s partner group, Helios, in Germany (The largest healthcare provider in Europe) is able to treat S2 patients. Hip and knee replacements are among the most in-demand treatments facilitated by Trasna, and patients, post-surgery, can avail of 2 weeks residential rehabilitation in Helios’ Orthocampus, which is included in the treatment tariff. Helios’ acclaimed Centre for Endometriosis, too, has proven to be very well received by patients. Through Trasna, patients can be directed to Helios’ relevant medical team. The medical team will respond with a recommendation for treatment and quote to be submitted for the S2 funding application. This is all done free of charge and the patient can then decide on how they wish to proceed.’ (Personal communication, 2025)

Both Switzerland and Germany largely provide NHS-equivalent level tariffs for S2-funded patients; therefore, treating patients via the S2 scheme in these countries will not generally cost the NHS more than treating them in the UK. In addition, as noted, treating patients promptly reduces total NHS workload and overall health expenditure compared to delayed treatment. Also, treated patients are often able to return to work, pay tax, and resume caring responsibilities. All of which benefits the UK economy.

There will be some costs to the patient when using the S2 scheme. For example, travel costs for the patient and any accompanying family or carers, travel insurance, and treatment co-payments in line with local policies. However, these combined costs are likely to be vastly less than private self-pay medical treatment in the UK.

When approached, Karin Smyth MP, Minister of State (Department of Health and Social Care), stated that the S2 scheme ‘does not form part of the elective recovery scheme’ (Paul Davies MP, personal communication, 2025). However, a report from The Health Foundation concludes that the government’s plan to make greater use of the private sector will only have a limited impact on the NHS backlog,¹⁸ while the required investment in the NHS and social care required to truly tackle waiting lists will take time.

In the meantime, for suitable patients the S2 scheme may mean the difference between health and ill health, working or not working, and quite possibly life and death. It is important that patients and GPs therefore know about this option.

References
1. British Medical Association (BMA). NHS backlog data analysis. 2025. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis (accessed 14 Jul 2025).
2. BMA. NHS under pressure — Scotland. 2024. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-under-pressure-scotland (accessed 14 Jul 2025).
3. Hatherley S, Jones H, Wilkes J. Reducing the NHS waiting list backlog. 2025. https://research.senedd.wales/research-articles/reducing-the-nhs-waiting-list-backlog (accessed 14 Jul 2025).
4. Health and Social Care Northern Ireland. Belfast HSC Trust — outpatient. https://online.hscni.net/my-waiting-times-ni/bhsct/bt-outpatient (accessed 14 Jul 2025).
5. Royal College of Obstetricians and Gynaecologists. Waiting for a way forward: voices of women and healthcare professionals at the centre of the gynaecology care crisis. 2024. https://www.rcog.org.uk/media/4hnc5qg3/waiting-for-a-way-forward.pdf (accessed 14 Jul 2025).
6. Campbell D.  ‘National tragedy’: figures show large rise in people dying while on NHS waiting list. The Guardian 2023; 31 Aug: https://www.theguardian.com/society/2023/aug/30/national-tragedy-figures-show-large-rise-in-people-dying-while-on-nhs-waiting-list (accessed 21 Jul 2025).
7. BMA. Patient deaths while on NHS waiting lists ‘terrible indictment of this Government’s mismanagement’, says BMA. 2023. https://www.bma.org.uk/bma-media-centre/patient-deaths-while-on-nhs-waiting-lists-terrible-indictment-of-this-governments-mismanagement-says-bma (accessed 14 Jul 2025).
8. James C, Denholm R, Wood R. The cost of keeping patients waiting: retrospective treatment — control study of additional healthcare utilisation for UK patients awaiting elective treatment. BMC Health Serv Res 2024; 24(1): 556.
9. Keith J, Lawless A, Ewbank L, et al. Is the use of privately funded health care on the rise? 2024. https://www.health.org.uk/reports-and-analysis/analysis/is-the-use-of-privately-funded-health-care-on-the-rise (accessed 14 Jul 2025).
10. McCann L, Holdroyd I, Emberson R, et al. Analysis of orthopaedic private healthcare patterns in England: a potential emerging two-tier system. Public Health Pract (Oxf) 2024; 9: 100578.
11. Thornhill J, Pratt K. Average savings by age in the UK. Forbes 2025; 7 Jul: https://www.forbes.com/uk/advisor/savings/average-savings-by-age-in-uk (accessed 14 Jul 2025).
12. Office for National Statistics. Household total wealth in Great Britain: April 2020 to March 2022. 2025. https://www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/bulletins/totalwealthingreatbritain/april2020tomarch2022 (accessed 14 Jul 2025).
13. Crooks VA, Turner L, Cohen IG, et al. Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives. BMJ Open 2013; 3(2): e002302.
14. NHS. The Planned Treatment Scheme (S2 funding route). 2024. https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route (accessed 14 Jul 2025).
15. NHS Inform. Travelling to Europe for planned healthcare (S2 scheme). 2023. https://www.nhsinform.scot/care-support-and-rights/health-rights/european-cross-border-healthcare/travelling-to-europe-for-planned-healthcare-the-s2-scheme (accessed 14 Jul 2025).
16. NHS 111 Wales. Planned medical treatment in the EU, EEA/EFTA and Switzerland — the S2 funding route. 2024. https://111.wales.nhs.uk/travelhealth/plannedmedicaltreatmentineu (accessed 14 Jul 2025).
17. Health and Social Care Northern Ireland. S2 (E112) mandated treatment. https://online.hscni.net/our-work/travelfortreatment/s2-e112-mandated-treatment (accessed 14 Jul 2025).
18. The Health Foundation. Greater use of private hospitals will have ‘limited impact’ on NHS backlog. 2023. https://www.health.org.uk/press-office/press-releases/greater-use-of-private-hospitals-will-have-limited-impact-on-nhs (accessed 14 Jul 2025).

Featured photo by Christian Lue on Unsplash.