Cost of operations

Cataract: NHS £880 Private £2,000 France £1,000 Hip: NHS £3,900 Private £7,600 France £4,000 Knee: NHS £4,400 Private £8,500 France £3,000

"The patients are now recovering from surgery and making good progress."

The four patients who had cataract operations and are expected home within days.

But the other five patients will be kept in for up to three weeks for intensive physiotherapy, to prevent follow-up work by the NHS.

Managers in the south-east of England plan to send 200 patients abroad at the taxpayers' expense by the end of March.

They refused to say how much the operations are costing, but the bill will be paid by the NHS.

Target areas

This is a quick fix, short-term solution to reduce the number of patients waiting more than a year for routine operations as set out in the NHS plan.

The decision to use foreign hospitals to tackle waiting times was made by Health Secretary Alan Milburn last October, under pressure from a European court judgement three months earlier.

It is bad enough that we endure the national humiliation of being unable to treat patients in our own country

Dr Liam Fox, Conservative MP

Judges said patients had the right to be referred elsewhere in the EU if they could not get treatment without "undue delay" in their home country.

The three test-bed areas for treatment overseas are in Kent, West Sussex and Portsmouth and the Isle of Wight - all with waiting time pressures and close to rapid transport links to mainland Europe.

Mr Milburn said the vast majority of patients would continue to be treated by the NHS.

There is concern about the programme and whether it is designed to divert attention from the issue of the need to improve the NHS.

Humiliating decision

Shadow health secretary Dr Liam Fox said sending patients abroad was a "national humiliation".

A Department of Health spokeswoman said if anything went wrong, patients would have the same rights as if they were having treatment in this country.

A second group will follow the first nine patients before the end of the month and there will be regular pilots until the end of March.

The hospital is looking at different hospitals beyond Lille and the pilots may move beyond France.

All patients' costs will be covered by the health trust, but any accompanying relatives will have to pay their own expenses.

The government's aim is to reform the health service to ensure NHS patients wait an average of just seven weeks for an operation in English hospitals by 2005.