Charging points

PhilHunt2015.jpgPhilip Hunt on his Regret Motion against the government’s expansion of NHS fees

On the face of it, charging overseas visitors to use our hard pressed NHS seems entirely reasonable. But the government’s latest plans to extend charges to community services will raise little money, place a huge burden on staff and deny healthcare to very vulnerable people.

The UK already charges some overseas visitors for most NHS hospital care after treatment. Patients ineligible for free care include short-term visitors, undocumented migrants, and some asylum seekers whose claims have been refused. Processes are already in place for hospitals to identify and bill these patients and Ministers are considering extending charging into A&E and GP services.

Under the new regulations came into force last month, community services receiving NHS funding – including charities and social enterprises – are now legally required to check every patient’s paperwork before they receive a service. For those who have to pay, charges are up-front with non-urgent care refused.

As paperwork or a passport is necessary to prove eligibility, there is a distinct possibility that those entitled to free care will be denied treatment because they don’t have the information to hand. (Especially vulnerable groups such as the elderly, asylum seekers, the homeless and mentally ill.) Having to to constantly provide details could also lead to longer waiting times and further bureaucracy.

In addition, introducing more overseas charges might lead to an increased risk to public health, if migrants or short-term visitors with contagious diseases or those requiring sexual health services can’t afford treatment. Even though certain diseases will be exempt, anyone unfamiliar with the internal workings of the NHS will find it hard to know whether or not the policy covers their disease.

There is also a fear that the NHS will rely on racial profiling as a means of identifying chargeable patients. Some hospitals are already targeting patients who don’t sound or look British, with staff directed to scan booking lists. There’s also a risk that the rules become so complex that staff may turn down those who are eligible for free treatment.

Nearly 200 organisations, including the BMA, Royal College of Paediatrics and Child Health (along with NHS England’s former CEO Sir David Nicholson), have signed a letter to the Health Secretary warning: "by denying healthcare to the most vulnerable in our society, these regulations will have negative consequences for us all".

Ironically, this policy fails on its own terms, as it won’t help solve the NHS’s funding problems as the number of overseas visitors using the NHS is negligible. Just £200,000 a year is the estimated saving – 0.00016% of the annual budget and about £13.64 for each provider.

While the rules have already become law, it is vital these fundamental changes receive parliamentary scrutiny and that plans for assessing their impact are carefully examined. In the House of Lords later today, I will be using a regret motion to press Ministers to agree to an early independent review. Until then, there must be no question of extending charging to yet more services.

Lord Philip Hunt of Kings Heath is a member of Labour’s health team in the House of Lords. He tweets @LordPhilofBrum

Published 16th November 2017

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