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NHS in England: travelling to Europe for medical treatment

What is the S2 route?

The S2 route may entitle you to NHS-funded treatment in another European Economic Area (EEA) country or Switzerland. However, there are certain qualifying criteria that need to be met, as set out below.

Eligibility criteria

In order to approve your S2 application, NHS England will need to be satisfied that the following eligibility criteria are met:

  • You are ordinarily resident in England and entitled to treatment on the NHS.
  • The requested treatment would normally be provided on the NHS to an individual in your circumstances.
  • You have provided written evidence that you've had a full clinical assessment by a clinician in either the UK, any EEA country, or Switzerland. The clinician's statement must clearly state why the treatment you seek is needed in your circumstances, and what the clinician considers to be a medically justifiable time period within which you should be treated again, based on your circumstances. The clinician should support his statement by giving objective reasons.
  • The requested treatment is available under the treating country's state healthcare scheme.
  • Taking into consideration the information provided by the clinician, NHS England has determined that the same or equivalent treatment cannot be provided to you on the NHS within a time period that is medically justifiable.  
  • The requested treatment is not experimental or part of a drug trial.
  • The requested treatment is not emergency treatment.

If your supporting documentations are in a different language, you will need to provide English translations for them.


If your application under the S2 route is approved, your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you'll be treated in. This could mean you have to pay a percentage of the costs personally (co-payment charge).

In some countries, patients cover 25% of the costs of their state-provided treatment. The state covers the other 75%. If you received treatment under such a healthcare system, you would be expected to pay the same co-payment charge as a patient from that country.

For example, for an operation that costs £8,000, of which you're expected to pay a standard patient co-payment charge of 25%, you will pay £2,000. The NHS will pay the remaining £6,000 to the healthcare provider treating you.

You may be able to claim back some or all of your contribution when you return to the UK. To apply for a refund of your contribution, you will need to contact the Overseas Healthcare Team within the Department for Work and Pensions on 0191 218 1999 or email

In some countries, as in the UK, healthcare is completely free. This means an approved S2 will cover 100% of the costs of your healthcare, so you would not be required to pay any treatment costs. 

NHS England will not reimburse travel or accommodation costs. 

How to apply

For your healthcare to be funded under the S2 route, you will need to apply for funding (PDF, 105kb) prior to treatment. To avoid any difficulty, you should read the application guidance notes (PDF, 80kb)

Make sure you use the latest form, as provided on this site, to submit your application. If you use an outdated form you may be asked to supply further information or resubmit the application. 

An application should include evidence demonstrating that the eligibility criteria are met, as well as full details of the type of treatment and the proposed provider – including admission and discharge dates and estimated costs – and your National Insurance number or NHS number, as appropriate.

Send your completed form and accompanying documents to the following address:

European Cross Border Healthcare Team
NHS England
Fosse House
6 Smith Way
Grove Park
LE19 1SX

Or email:

NHS England is not obliged to approve an S2 application that does not satisfy the above criteria. In exceptional circumstances, however, it has the discretion to do so. NHS England will not approve an S2 application retrospectively, unless there are exceptional circumstances.

If NHS England approves your application, you will be issued with an S2 guarantee form, which you will need to present to the relevant healthcare provider abroad. For more information, contact NHS England.


S2 applications relating to maternity are processed differently. For more information, see Giving birth outside the UK.

Review and appeal

Request a review

If you're unhappy with the outcome of your application, you can request a review of the decision if you have additional information or evidence that was not provided as part of the original application that you believe may impact on the rejection decision.

Request an appeal

You should request a formal appeal if you do not agree with the rejection decision, but do not have any additional information or evidence.

Email NHS England on and quote the reference number that was included with the application outcome. 

Page last reviewed: 28/04/2016

Next review due: 28/02/2019

Compare routes

Compare the S2 and EU Directive routes and decided which one to apply for if you wish to have NHS funded treatment in Europe