Once again the Government has interfered politically in that politically neutral area – the NHS.
After junior doctors contracts, increasing use of private funding, companies, resources etc, alterations to the GP system and structure in 2013, now the NHS has been dragged into the immigration arena.
Hospitals will be able to charge fees up front from certain foreign patients (mostly non EU) for non urgent medical treatment and procedures. Usually, non EU foreign nationals are billed and invoiced for non urgent treatment afterwards. However, that has incurred a loss of several millions in unpaid healthcare bills. Indeed, in 2016 NHS Imperial College Trust in London spent £4m on care for overseas patients – and managed to recoup a mere £1.6m.From April, however, NHS hospitals will obliged to inform foreign patients of fees prior to any treatment, and (if applicable) to make payment arrangements prior to any medical treatment.
Whilst the checks and enforcing payment will be across the board – indeed a legal obligation – under the proposals, enforcing and assessing foreign patients will be left up to individual Trusts to oversee and manage in the most appropriate manner. It has been suggested that some hospitals might ask for two forms of identification – one with a valid UK address – to help them establish nationality and eligibility to free healthcare.
According to NHS Improvement (which oversees the Trusts) and the Health Secretary, this will prevent NHS Trusts from losing money in unpaid bills for non urgent treatments. Whilst healthcare for EU nationals is automatically billed to their home nation – for non EU nationals payment can be problematic, especially when some patients simply can’t pay, or even avoid paying. According to Health Secretary Jeremy Hunt MP, there is “no problem with overseas visitors using our NHS – as long as they make a fair contribution, just as the British taxpayer does.” He went on to state that the aim of the proposals was to recover up to £500m a year by the middle of the current Parliament, to be reinvested in the NHS. A National Audit Office report from October 2016 suggested that the money raised in 2017 would in reality fall far short of this target.
The NHS is perpetually in issues with funding and financing the amazing service it provides. As such, from a financial and economic perspective, any efforts of the Health Secretary to tackle financial loss – be it unpaid bills or elsewhere – should be welcomed. Extra checks to ensure the NHS does not lose money should be welcomed.
Where this sensible financial plan falls down is on moral and ethical grounds. Indeed, when a similar idea was proposed previously, the BMA and other healthcare groups were vocal in condemning the idea. As many expressed, doctors and nurses are healthcare professionals, not immigration assessors. Further, what doctor or nurse will turn away a patient who needs medical assistance because of their immigration status or ability to pay? The answer is very few, if any at all.
A further issue is practicality. Assessing a foreign patient’s immigration status and payment ability (presuming there is no language barrier) prior to any care given, and ensuring they understand the finances behind their healthcare, will place an extra burden on an already strained and overstretched NHS. In many cases the priority will be swift medical care an attention rather than setting up a payment plan for the healthcare.
Despite those and other practical issues, some hospitals already operate a similar system – with mixed results. Indeed, as an illustration of the pressure of NHS resources and staffing, one senior doctor highlighted how there is only one Overseas Visitor Manager – who identifies those foreign patients who are not eligible for free healthcare – for three major hospitals in London. Former cancer surgeon Dr Meirion Thomas said of the plan that it ”is not going to work because there are not trained people to identify and charge overseas visitors upfront … Anyone going into any of the Schengen countries, when they apply for a visitor’s visa, they have to prove that they have 30,000 euros worth of health and travel insurance and that is the cure for this problem in this country.”
Whereas trying to cut costs, and recoup money, for such an organisation as the NHS is eminently sensible – billing foreign patients prior to treatment will give rise to moral questions being asked. The extra burden will also add to an already overloaded and complex system, with the BMA warning of potential “chaos and confusion” arising from the proposals. BMA Council Chairman Dr Mark Porter stated 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.”
Above all, amidst the ever present issue of immigration and refugees, the fear is that NHS hospitals could be used to perform unofficial immigration checks. As many have clearly pointed out previously, the NHS is a healthcare provider, not an extra arm of the UK Border Agency (UKBA). Doctors and nurses are there to save lives, not to carry out immigration checks – which is what these proposals would mean in effect.
Although the NHS is politically neutral, this is not the first (or the last time) that the venerable public healthcare provider will be dragged into politics, and away from patient’s bedsides. Maybe it is to be expected as the NHS is a publicly funded organisation responsible to the Health Secretary and Parliament.
What is not to be expected were the results of a recent survey. However, given the rising spectre of nationalism and populism, maybe it was not surprising to find that 74% of those surveyed support increasing charges for foreign nationals when receiving NHS treatment to help fund the NHS.
Whereas the prospect of the NHS effectively becoming another arm of UKBA is unpleasant – what is more unpleasant is the divisive and fear based nationalism that underpins such sentiments as revealed in the survey.