Sheep farmer Paddy Hoban was in so much pain with his hip that working on his Mayo farm had become increasingly difficult.

“I was crippled with pain and couldn’t do anything really,” he says. “The pain was excruciating.”

When the hospital told him he could face a wait of between six months and a year for a hip replacement, Paddy felt he needed to look at another option.

“I just couldn’t see myself waiting that long,” he says.

He is far from alone in facing a wait for treatment. At the end of August, 114,921 patients were waiting for inpatient or day-case treatment in Ireland’s public hospitals, according to the National Treatment Purchase Fund (NTPF), up from 107,181 at the end of December 2025.

For patients living with pain and reduced mobility, those waits can have an immediate impact on everyday life and work.

Paddy, who lives near Westport in Co Mayo, discovered an alternative through a neighbour who had undergone a hip replacement the previous year and told him about Healthcare Abroad.

On 8 June, Paddy contacted the company. Less than two weeks later, he was on a flight to Alicante in Spain and underwent a full hip replacement at HCB Denia hospital.

“I booked my flight for 20 June and then I had my operation two days later,” he says.

Healthcare Abroad works with patients accessing planned treatment in Spain through the EU Cross Border Directive. Under the scheme, eligible patients can receive qualifying healthcare in another EU or EEA country and subsequently apply to the HSE for reimbursement.

For Paddy, the immediate priority was getting his hip treated and returning to everyday life. Travelling abroad for an operation also required some planning at home. Farming does not stop when the farmer needs surgery, and Paddy’s son was able to step in and help with the sheep while his father was away.

Travel and care

Paddy travelled to Spain on his own and was there for two weeks while he recovered. While this may sound daunting to some people, he says that Healthcare Abroad helped him organise much of the practical side of the trip which made the experience more manageable.

“I was picked up at the airport and brought back again,” he says.

Transport was also arranged for physiotherapy and hospital appointments, as well as trips to the pharmacy when he needed dressings or medication.

Paddy also says the healthcare team at home assisted him in preparing for the operation, including arranging the necessary paperwork, blood tests and X-rays before he travelled.

His recovery was not entirely straightforward. Following the operation, Paddy required two blood transfusions while still in Spain.

Despite the setback, he says the care he received during his recovery left him grateful to the hospital team.

“The care I got at the hospital, I owe a serious thanks to them,” he says.

By his second week in Spain, Paddy was mobile enough to make the journey home alone.

“The flight was fine, no bother,” he says. “I got great help at the airport.”

The contrast with life before his operation is considerable. Before travelling, Paddy says the pain had become so severe that carrying out his normal work on the farm was extremely difficult.

Patients can access healthcare under the Cross Border Directive in the same way they would access public healthcare in Ireland. \iStock

Now back in Mayo, he continues to attend physiotherapy organised through his own doctor, but says the pain that prompted him to seek treatment abroad has gone.

“No pain whatsoever, and I’m back to my normal,” he says.

Paddy’s experience comes at a time when hospital waiting lists continue to affect patients across the country. For those considering planned healthcare elsewhere in Europe, the Cross Border Directive provides one possible route, although there are practical and financial considerations involved.

Reimbursement

Patients generally pay the healthcare provider abroad upfront before subsequently applying to the HSE for reimbursement. The amount reimbursed is subject to limits, while travel and accommodation costs are not covered under the Directive.

The HSE advises patients considering this route to establish their eligibility and likely reimbursement before committing to treatment. An optional prior-notification process can confirm eligibility and provide an indication of the amount a patient may be able to claim back.

Healthcare Abroad says it assists patients with the logistics involved in accessing treatment in Spain, including hospital arrangements, transport and accommodation. For Paddy, however, the outcome is more straightforward. After a period when pain was severely restricting what he could do, he is home, back to his normal routine and able to work again.

The Cross Border Directive (CBD)

  • The EU Cross Border Directive allows people who are entitled to public healthcare in Ireland to access certain planned healthcare in another EU or EEA country and apply to the HSE for reimbursement.
  • Patients generally pay the healthcare provider abroad upfront before applying to the HSE. The amount reimbursed is limited to the lower of the cost of treatment abroad or the amount the same treatment would have cost within Ireland’s public healthcare system.
  • Not every treatment or patient will qualify, so anyone considering travelling should check their eligibility before making arrangements.
  • The HSE also offers an optional prior-notification process. This can confirm whether a patient is eligible under the Directive and provide an indication of how much they may be able to claim back before travelling.
  • Travel and accommodation costs are not reimbursed under the scheme.
  • Further information on eligible treatment, documentation, prior notification and applying for reimbursement is available from the HSE.