Passports for NHS access plan: what are the implications?

Patients could be told to bring two forms of identification including a passport to get treatment at hospital, according to the most senior civil servant in the Department of Health. Chris Wormald told MPs on Monday night: “On the general question of, are we looking at whether trusts should proactively ask people to prove their identity – yes we are looking at that.

“Individual trusts like Peterborough are doing that and it is making a big difference. They are saying, ‘Please come with two forms of identity, your passport and your address,’ and they use that to check whether people are eligible. It is quite a controversial thing to do, to say to the entire population you’ve got to prove your identity.”

If that happens, what are the implications?

Q. Could British people be denied access to treatment if they fail to produce a passport?

A.The latest figures show that 13% of British citizens do not have a passport so it could be a very serious problem if they were denied NHS treatment for failing to produce a passport. The current NHS Choices advice to overseas visitors says that “if you do not have valid documentation, you may be charged for treatment”.

So a British citizen who cannot provide a passport to prove their nationality or country of residence will be treated but may later face a hospital inquiry about the possibility of being charged. This could be dealt with by providing a birth certificate or other proof of British citizenship or residence short of a passport. The NHS describes itself as a “residence-based system, unlike many other countries, which have insurance-based healthcare systems”.

Q. What happens to people from outside the European Economic Area who want NHS treatment at present?

A. The rules changed in April last year as part of the Immigration Act 2016 which was designed to ensure Britain has “a national health service, not an international health service”.

Non-European migrants who have permanent residence in Britain, ie indefinite leave to enter or remain, continue to be eligible for the same NHS care as a resident British citizen.

But those who are temporary migrants or students and intend to stay more than six months are now required to pay a health surcharge when they apply for their visa. This is £200 a year or £1,000 for a five-year visa. In the past year £164m has been raised from the immigration health surcharge.

Q. What happens to people from inside the European Union or elsewhere in European Economic Area who want NHS treatment?

A. EU citizens who are resident in Britain can access the NHS on exactly the same basis as British citizens. The difference is that as a result of an EU directive the NHS can claim back the cost of treating EU visitors, students or temporary migrants to Britain from their home governments.

MPs are concerned that while the UK paid out £650m last year to cover the treatment of British citizens in other EU countries, it only managed to recoup £49m for the NHS treatment of EU citizens here. The government thinks that an annual target of £300m is possible if hospitals do more to identify EU citizens being treated in British hospitals.

The NHS is thinking of asking everyone to prove their identity so they can identify EU citizens so their governments can be charged. EU citizens without European health insurance cards (EHIC) may be asked to pay the charges upfront and then to recover them from their own government. The NHS might do better to ask EU citizens to produce their EHIC card rather than ask the whole population to provide a passport or other form of identity.

Q. Is this a national ID scheme by the back door?

A. A national identity scheme is about having a single government searchable database on which the whole UK population is listed. Asking for a passport or other form of ID card, such as a driving licence, to prove British residence does not mean the proposal is introducing an ID card by the back door.

Passports for NHS access plan: what are the implications?