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Government set to miss target for recouping costs of overseas visitor care

Projected annual £500m by 2017-18 likely to fall short by £150m

Caroline White

Friday, 28 October 2016

The government is set to miss its budgeted target for recouping the annual costs of treating overseas visitors not entitled to free care, by around £150 million a year, warns the spending watchdog, the National Audit Office (NAO) in a report* published today.

While some progress has been made to recover some of the money, which is one of several measures intended to bolster NHS coffers, the target of clawing back up to £500 million a year by 2017-18 won’t be met, on the basis of current trends, and without any changes to the charging rules, says the report.

Amid claims that the NHS was being “overly generous” to overseas visitors, the Department of Health launched an initiative in 2014 to extend the charges and implement the existing regulations more effectively.

But the ambition to recover up to £500 million a year represents a substantial increase on the estimated £73 million recovered in 2012-13, the report points out. And current data indicate that, within the existing cost recovery rules, the amount charged is forecast to be £346 million in 2017-18.

The Department’s management of the cost recovery programme demonstrates many elements of good practice, and it has taken action to help trusts identify chargeable patients more easily and to secure the engagement of NHS staff, says the report.

However, the charging regulations are complex, and the amount of overseas visitor income identified by trusts varies widely, with a significant proportion of hospital doctors unaware that charges for healthcare apply in some cases.

Furthermore, the government doesn’t really know why some trusts do better than others, says the report. In 2015-16, just 10 trusts, all in London, accounted for half of the total amount charged to visitors from outside the European Economic Area (EEA).

Factors such as the location and size of the trust, and the nature and complexity of treatment provided will inevitably affect costs, making it difficult to say how much money any trust should be charging, the report notes. And trusts face a particular challenge in recovering the cost of treating patients, mostly from outside the EEA, who are personally liable for the cost of their treatment, says the report.

Based on the available data, the report estimates that trusts recover around half of the amounts they charge directly to patients. And three out of four trusts (37 out of 50) who responded to the NAO’s consultation said that overseas visitor debts were a very important or a fairly important problem for them.

£97 million was charged for treating overseas visitors in 2013-14; by 2015-16 this had risen to £289 million.

Most of the increase in income – £164 million in 2015-16 – has come from a new immigration health surcharge that was introduced by the Home Office in April 2015. The surcharge is payable by most students and temporary migrants from outside the EEA. It is a new source of income for the health system because it extends the scope of charging to people who were previously eligible for free treatment.

The amount that trusts invoiced to patients directly – mostly visitors from outside the EEA – was 53% higher in 2015-16 than in 2013-14. This is likely to be mainly due to a change in the charging rules that allowed trusts to charge higher prices. Amounts charged to patients from within the EEA increased slightly, but remain well below the ambition that the Department of Health set in 2014.

Amyas Morse, head of the NAO, commented: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.

“If current trends continue and the charging rules remain the same, the Department will not achieve its ambition of recovering up to £500 million of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of £150 million.”

Chair of BMA Council Dr Mark Porter commented: “While those accessing NHS services should be eligible to do so, systems to charge migrants and short-term visitors need to be practical, economic, and efficient and must not jeopardise access to healthcare for those who need it,” adding: “A doctor’s duty is to treat the patient in front of them, not to act as a border guard.”

* Recovering the cost of NHS treatment for overseas visitors. National Audit Office, October 2016.

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