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28.10.16

Government not on target to recover £500m from overseas patients – NAO

The NHS is continuing to lose money because trusts are failing to implement regulations on charging overseas patients, a new National Audit Office (NAO) report says.

The Department of Health has set a target of recovering £500m a year from treating overseas visitors by 2017-18.

The amount recovered has grown from £73m in 2012-13 to £289m in 2015-16, but the department estimates that only £346m will be recovered in 2017-18.

Sir Amyas Morse, head of the NAO, said: “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 £500m of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of £150m.”

The report also said that the growth in recovered cash could be attributed to increases in the amount that could be charged, rather than trusts implementing existing regulations more rigorously.

For example, a new surcharge for temporary migrants from outside the European Economic Area generated £164m in 2015-16, while a change in the charging rules allowed trusts to charge 150% of the tariff prices for treatment.

There was also significant variation in how much trusts charged, with just 10 London trusts accounting for half the total amount charged to visitors from outside the European Economic Area (EEA).

The auditor said this could not be fully explained by variation in trust location and size, and suggested some trusts were better at identifying patients to be charged than others.

The report did, however, acknowledge “many elements of good practice” with the Department of Health cost recovery programme, with a clear governance programme and periodic reviews of the programme from the Infrastructure and Projects Authority.

The NAO said the department should set an expected trajectory for the net cash it expects charging overseas visitors to generate for the health system.

It recommended that the department and NHS Improvement work with trusts to build up an evidence base of good practice in securing payment from patients from outside the EEA.

Furthermore, they should identify trusts which are outliers in charging patients, and work with them to tackle the problem.

The NAO also said NHS England should encourage CCGs to take more responsibility for challenging trusts to identify overseas patients.

St George’s University Hospital, for example, announced earlier this month that it is piloting an initiative where pregnant women will have to prove they are UK or EU nationals before they receive obstetric care, which the Home Office said it would support in other areas.

A Department of Health spokesperson said: "This government was the first to put in place measures to ensure the NHS isn't abused, and as this report finds, we are making very good progress - the amount of income recovered has already more than trebled in three years to £289m.

"We consulted earlier this year on extending the charging of migrants and visitors using the NHS to other areas of healthcare.

"We will set out further steps in due course to ensure we deliver on our objective to recover £500m a year by the middle of this parliament."

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