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Proposals to help NHS charge overseas patients ‘go much too far’

DH proposes asking all patients for two forms of ID before non-urgent NHS treatment

Louise Prime

Tuesday, 22 November 2016

The Department of Health’s proposals that patients could have to show two forms of identification, such as a passport and driving licence, to prove that they are eligible for non-urgent NHS treatment “go much too far”, BMA chair Dr Mark Porter warned this morning. He added that the unclaimed cost of treating ineligible patients is “little more than a pinprick” compared with the rest of the financial problems facing the NHS.

In July 2014, the Department of Health (DH) set an ambition to recover, by the middle of this Parliament, £500 million annually from improving identification and recovery from chargeable patients, and from introducing a new immigration health surcharge – a target that represents a substantial increase from the £73 million recovered in 2012-13. Yesterday, Chris Wormald, permanent secretary at the DH, reported to the Public Accounts Committee.

He pointed out that the NHS is simply not set up to check identity and charge people – although once EEA people have been identified and their EHIC number obtained, he said, “the reclaiming bit is actually pretty easy”. He admitted that although the number of EEA nationals being identified is going up, it is not going up fast enough, adding: “We accept that, and that is one of the things we need to take further action on.”

Mr Wormald explained that certain things had started to lead to improvement. He said: “We are much more linked up with Home Office systems around the visa charges, so that people who are on the visa scheme are now flagged on the NHS IT system … [and also] we are making it much more explicit on the NHS record where someone has been identified as being chargeable, and we are allowing the overseas visitor managers within trusts to directly amend that record so that when they have identified somebody who has been identified for charging in one part of the health service, forever more they will be charged wherever they then present.”

Despite this, he admitted, although the statutory obligation for healthcare providers to identify users has been in place for 34 years, “for the majority of free healthcare, hospitals do not routinely either ask people to [prove their] identity or charge, so we are trying to introduce this system”.

He told the committee that some trusts are now, either for some services or more generally, asking people to produce two forms of ID (including one photo ID) before treatment. He said: “That is obviously a controversial thing to do, but … those are the kinds of things you will look at. We do not have evaluated results of those things yet. What those trusts are reporting is that that does lead to an increase in identification.”

But the BMA responded that obliging patients to show two forms of ID to access some forms of NHS care would be excessive. BMA Council chair Dr Mark Porter said: “Ensuring eligibility for NHS services is always important, but these proposals go much too far and it is unlikely they could ever be turned into a serious policy that would be accepted by patients and the public, that is, showing your passport before undergoing treatment.”

Dr Porter told BBC Radio 4’s Today programme this morning that although he supports the principle of providing free care only to those eligible, given the rocketing financial pressure on the NHS overall, the unclaimed cost of care of those not eligible is “little other than a pinprick on top of the actual problems facing the NHS”.

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