latest health care news


DH needs action plan by June as patchy overseas cost recovery starving out NHS

NHS England and CCGs, along with the government, are not doing enough to recover the costs of treating patients visiting from overseas, meaning there is less money available to treat UK residents and even more pressure piled on the health service’s finances.

The influential Public Accounts Committee (PAC) concluded today that the system for cost recovery currently in place “appears chaotic”. While hospital trusts have had a statutory duty since 1982 to recover costs of treating overseas visitors, the Department of Health (DH) has only really prioritised this issue in the last few years – and even then, progress has been sluggish.

For example, since the department launched its overseas visitor and migrant cost recovery programme in 2014, the amount charged has grown from £97m in 2013-14 to £289m in 2015-16. Most of that progress, however, was due to changes in the charging rules – such as the introduction of the immigration health surcharge – rather than trusts actually implementing the existing rules more effectively. It is also “a long way” from meeting the government’s target of recovering half a billion pounds by 2017-18.

Remarkably, the UK also recovers “far less” from other EEA states than these claim from the UK. In 2014-15, for example, the department recovered only £50m, but paid out £675m.

But NHS Improvement (NHSI) has argued that it can be extremely difficult, especially in busy clinical areas, to identify chargeable patients since there is no single document or piece of information – such as a passport or NHS number – that can confirm whether or not the person should be charged.

During its inquiry, the PAC also identified a large extent of “unexplained variation” between trusts, suggesting the NHS as a whole is not effectively pinpointing its chargeable patients. Some trusts, such as in Peterborough, are now requiring patients to prove their identity by showing passports and utility bills – but these documents don’t necessarily prove entitlement to free care, and some UK residents may struggle to provide this type of proof.

Not only do CCGs and NHS England have a role to play in cracking down on this issue, but the government itself has been urged to publish, by June this year, an action plan setting out “specific actions, milestones and performance measures” designed to boost cost recovery.

This plan should go as far as naming senior individuals in the department and within NHSI whom the committee can hold to account as it explores this issue further.

Meg Hillier MP, PAC’s outspoken chair, argued that Whitehall’s “failure to get a grip” on this lingering issue is “depriving the NHS of vital funds”.

“Our committee has reported extensively on the financial pressures facing the health service and it is simply unacceptable that so much money owed should continue to go uncollected,” she said.

“We are concerned that financial progress to date does not reflect meaningful progress with implementing the rules and the DH and NHS have much to do if they are to meet their target for cost recovery. That is why we are calling on the department to set out a detailed action plan now.”

The plan must make clear, added Hillier, what the government will do to increase the amount of recovered costs and who will be accountable for achieving this – thus satisfying the public’s expectation that the DH enforces the rules.

Today’s damning report closely trails similar findings from the National Audit Office, which concluded in October last year that the NHS is continuing to lose money due to its failure to implement regulations properly. At the time of that report, the DH estimated that only £346m would be recovered by 2017-18, against a £500m target.

At the PAC hearing, the department told MPs that it was planning further charges relating to policy and regulation, good practice and IT, but the committee remains unconvinced that enough is being done.

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here 


Jeremy Nettle   01/02/2017 at 14:03

Currently one of the hot debates is around who receives the benefits of NHS treatment. There is talk of asking patients to show passports and proof of citizenship for non-urgent treatment. Some visitors are using the NHS and should pay; health tourism is costing the country billions, it is claimed, as we pay out more for treating Britons abroad than we recoup in charges for treating ill foreigners. As a result, there have been numerous mandates to encourage payment from non-eligible individuals. Increasing overseas visitor income is one of several measures intended to help improve the financial position of the NHS. Under the most recent initiative, the government aims to recover up to £500m a year by 2017-18. No single document determines eligibility The National Audit Office (NAO) reviewed the scheme earlier in 2016. Within the existing arrangements, the amount charged is forecast to be £346m in 2017-18 – over £150m less than the target, but still an improvement on previous years. However, the NAO is sceptical. These increases have been achieved, it says, down to changes in charging rules, such as a new £200 health surcharge on people who would previously have received care for free. The NAO review found that there is significant variation in the amount of income that trusts identify as being available through this route. It found that only around half of debts are recovered. The most confusing aspect of this whole area is that we cannot say, in a simple and straightforward way: Who is a NHS patient? This is determined by those who are ‘ordinarily resident’. This means people living lawfully in the UK, voluntarily and for settled purposes as part of the regular order of their life. There are detailed rules on what this means in government guidance, but no simple way of enabling NHS staff to decide on what this means.

Add your comment

national health executive tv

more videos >

featured articles

View all News

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us throu more > more last word articles >

health service focus

View all News


NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental ... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Bei... more >


Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual... more >

the scalpel's daily blog

Covid-19 can signal a new deal with the public on health

28/08/2020Covid-19 can signal a new deal with the public on health

Danny Mortimer, Chief Executive, NHS Employers & Deputy Chief Executive, NHS Confederation The common enemy of coronavirus united the public side by side wi... more >
read more blog posts from 'the scalpel' >