Mary Webb, who is in her sixties, travelled to Malta in April for a knee replacement operation. It cost her about £5,000 to have it done privately, and she says she would have been delighted to have saved the money if she could have travelled abroad and been paid for by the NHS.

“I would definitely have considered it,” she said. “I had one knee replaced by the NHS nine years ago, but when I went in with the other, they said I was too heavy to have the operation.”

She travelled to Malta through Mobilise, a company that arranges operations in clinics on the island. A number have emerged in recent years, often concentrating on patients in need of orthopaedic surgery - on knees and hips, for example - which involves a longer wait than for most other operations on the NHS.

“I did inquire about France and other countries but I though I might as well go somewhere nice and warm to recuperate,” Mrs Webb said.

“The NHS is fine if you're at death's door, but it's not so good if you have simpler problems,” she said. “We had some savings so I could afford the operation, but obviously it would have been better if the NHS had paid.”

Mrs Webb's experience raises an issue not dealt with by the draft directive - whether a health service is obliged to pay for treatment abroad when it has refused it at home on medical grounds. That might need to be tested in the courts.

However, the directive is not about clinical care but a citizen's rights to seek care throughout the EU. If that care is available, it places an obligation on the country of origin to pay for it.

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club