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Upfront charges for overseas patients a ‘distraction’ to underfunding

The BMA has warned that proposals to charge overseas patients upfront for non-urgent medical treatment could lead to “chaos and confusion”, while the head of the influential Health Select Committee has branded the plans “just a distraction from the serious underlying problem of underfunding health and social care”.

The Department of Health (DH) has announced that from April, English hospitals will have to check whether patients are eligible for free treatment on the NHS, with the aim of recovering around £500m a year.

It comes after the Public Accounts Committee (PAC) concluded last week 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 DH has only really prioritised this issue in the last few years – and even then, progress has been sluggish.

Health secretary Jeremy Hunt said: “We have no problem with overseas visitors using our NHS — as long as they make a fair contribution, just as the British taxpayer does.

“We are announcing plans to change the law which means those who aren’t eligible for free care will be asked to pay upfront for non-urgent treatment.

“We aim to recover up to £500m a year by the middle of this Parliament – money that can then be reinvested in patient care.”

Last October, the National Audit Office (NAO) stated that the NHS is continuing to lose money because trusts are failing to implement regulations on charging overseas patients, adding that the government was not on target to recover £500m from overseas patients.

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

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

In a series of tweets, Dr Sarah Wollaston, chair of the Health Select Committee, lambasted today’s plans, saying that, in reality, the announcement was just a distraction from the serious underlying problem of underfunding of health and social care.

She also referred to the PAC report from last week, adding: “Today’s charging rhetoric [is] a bit of a ‘dead cat’ story. [The] real story should be let’s get on and fund health and social care properly.

“Once NHS gets around to charging overseas visitors (they already have powers to do this) will politicians stop blaming ‘health tourism’?”

Under the plans, it is thought that some trusts will check the eligibility of patients by asking them to produce two forms of identity. This idea is not new, as the DH told MPs last year that it was considering “controversial” plans to require patients to show passports to crack down on the cost of health tourism. As well as identifying patients, trusts will then be required to share the information across the NHS.

The DH added that refugees and asylum-seekers will be exempt from paying, and that trusts will work with people who do not have the required documents to establish whether they are eligible.

But the BMA’s council chairman, Dr Mark Porter, said that there is “no detail” as to how upfront charging will be introduced from scratch in just three months in an NHS already unable to cope with normal operations.

“It is right that we ensure all patients are eligible for NHS care and that we have in place a working system to recoup the cost of treatment from patients not ordinarily resident in the UK,” he said. “However, it’s hard to see how these new proposals will operate in practice, especially as they are to be implemented by law.

“We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS. Doctors and nurses cannot be expected to arbitrarily decide whether a patient gets treatment or not.”

He added that there is “patchy evidence” that this kind of system will achieve £500m in savings and even if it did, this would “not in any way solve the enormous funding crisis in our health service that the government has for too long ignored”.

(Image: c. Peter Byrne)

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