As a matter of good administrative practice, it makes sense to charge non-UK residents for non-urgent health treatment (there is no suggestion that anyone in urgent need would be turned away). Reclaiming patients’ costs from other European countries, under the existing reciprocal arrangement, is also sensible. But doing it in a system like the NHS that is predicated on the principle of providing treatment free at the point of use is complex, expensive and, as a Department of Health briefing paper released last winter shows, scarcely cost-effective. The trouble is that the target of a seven-fold increase in what is reclaimed, which is estimated to raise the total from £73m to £500m, has been factored in to NHS England budgets.
It is the question of how to achieve it that led the senior official at the Department of Health, Chris Wormald, to tell MPs on Monday that it might involve requiring all patients to produce their passports. As Mr Wormald readily admitted, that is a course of action fraught with difficulty. It might do more harm, by putting off people in need of treatment for the public good as well as their own, than it saves money; and although for individual budget-holding trusts it may be important – which is why trials are under way in the Stamford and Peterborough area – in the context of NHS England’s annual budget of £120bn, it is a very small drop. That point was underlined by the coincidence that, as Mr Wormald was talking to MPs, the National Audit Office was releasing its latest bleak assessment of the financial sustainability of NHS England. It showed that at the end of the last financial year, more than two-thirds of trusts were in deficit, and it concluded that its financial problems are endemic and not sustainable.
This is not a piece of gratuitous shroud-waving on the eve of Wednesday’s autumn statement. The NAO is the nation’s accountant, and its audits are based on scrupulous analysis. But nor is it necessarily the right answer for the chancellor, Philip Hammond, to reach immediately for extra cash for hospitals. His predecessor, George Osborne, might have seen tackling the headline as the priority, but ever since Theresa May became prime minister the message of no more money (often framed in the context of the deep cuts that have been survived by Home Office dependents such as the police) has been unmistakable. The Department of Health’s defence is that it has given the NHS England boss, Simon Stevens, just what he asked for in the Five Year Forward view – which committed the NHS to heroic and probably unachievable savings in return for front-loaded extra money.
Ministers’ arguments have been vitiated by a Nuffield Trust analysis which suggested the billions promised were worth just £800m in real money. More important is that it also ignores the role of council-provided social care that Mr Stevens said was integral to the success of his plan. Social care budgets have been brutally shrunk. A million people are not getting support to stay at home, with the predictable consequence that many stay in hospital when they no longer need to. It is hinted that councils may be allowed to raise the ringfenced precept that they put on council tax for social care: but that would, on King’s Fund numbers, raise at most £388m. The estimated shortfall next year is £1.9bn. Paradoxically, that means the best help for hospitals may be extra cash not for them, but for councils.
The Guardian view on the NHS cash crisis: social care comes first | Editorial
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