Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

Rather than use World Health Day to draw attention to global health priorities, this year, healthcare providers are being asked to implement racist government policies and compromise our professional values. Earlier this year, health minister Jeremy Hunt announced that, from April 2017, NHS trusts would be legally obliged to check patients’ eligibility for NHS services upfront, and to demand payment before providing care.

These checks lead to racial profiling and will prevent those most in need of care from getting the treatment they need. This is already evident with pregnant women delaying or avoiding seeking necessary medical advice or treatment because of fears they will be unable to pay or will be reported to the Home Office.

As doctors, we are acutely aware of the devastating impacts of delayed medical attention. In my field – obstetrics and gynaecology – we know that getting the right care at the right time is critically important for the health of women and their babies. In 2014, a woman thought to be carrying a dead foetus declined induction of labour because she feared she would be denied re-entry into the UK if she was unable to pay her bill of thousands of pounds.

The amount of money [lost to "health tourism"] is a drop in the ocean for the NHS

Dena Bryant, a lifelong resident of Grantham, had her eligibility for care at her local hospital questioned by a nurse who justified her questioning because Bryant was “not white” and did not “look English”.

The reality is that these policies represent yet another instance of the government attempting to blame migrants for the devastating impact of their austerity agenda. The Department of Health’s own estimate is that “deliberate health tourism” costs at most 0.3% of the NHS budget annually. This amount of money is a drop in the ocean for the NHS, while a £5,000 charge may be everything to a patient seeking treatment.

We should be concerned about the sustainability of NHS funding, but this focus is a distraction from the real issues, such as the billions of pounds spent annually on PFI repayments. Checking passports at the point of care will not rectify budget concerns, and directly contradicts the values on which the NHS was founded. We are being asked to prioritise recouping costs over providing care to those who need it.

Docs not Cops, a group comprised of NHS staff and patients, has been campaigning against these changes. On Wednesday, the group blocked the entrance to the Department of Health with a makeshift immigration checkpoint. We believe everyone has a right to access the healthcare they need, regardless of their immigration status or ability to pay. NHS workers should not be forced to police the people we treat.

The relationship between the doctor or health professional and a patient relies on respect and trust. A policy that demands we verify eligibility and report ineligible patients prioritises money over care, and jeopardises the relationship between a patient and their care provider. As a doctor, the Declaration of Geneva and the International Code of Medical Ethics require that my patient is my first consideration, and declares that I owe my patients complete loyalty. Policing people seeking my care would directly contravene these guidelines that say we cannot allow race, ethnic origin, or social standing, among other characteristics, to intervene between our duty and our patient.

As NHS staff and patients we will continue to fight divisive policies that fuel racism and threaten the values on which our NHS was built. Docs Not Cops is working with groups around the country to build a network of sanctuary GP surgeries, hospitals and wards. These would be sites of non-compliance with ID checks. We encourage wards, GP surgeries and individuals to sign a pledge to never ask to see ID or deny anyone healthcare, and to sign our petition calling for an end to bedside charging.

The National Health Service was built on the principle that healthcare is a right not a privilege. Almost 70 years after its inception, we are here to demand that this core principle remains.

Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

NHS staff and managers condemn "passport before treatment" plan

Doctors, nurses and NHS managers have condemned government plans to make hospital patients produce their passport before being treated as unworkable and a burden on overworked staff that will not raise the £500m a year ministers hope.

There are also fears that marginalised groups – such as the homeless and the 13% of the population who do not have a passport – will find it harder to access care if the policy, currently operating only at the Peterborough and Stamford hospitals NHS foundation trust, becomes commonplace.

Despite growing anxiety among NHS staff, the Department of Health insisted that the policy – which its top mandarin admits is “controversial” – may still be rolled out nationally. It is keen for the NHS to increase dramatically the amount of money it recovers from people who are ineligible for free care from £73m in 2012-13 to its target of £500m a year.

Jon Restell, chief executive of Managers in Partnership, the union which represents health service managers, said: “Managers are worried about the unintended consequences for health inequalities, as marginalised groups may find it harder to access healthcare; for public health, where there are currently exemptions, for example around crisis mental health, TB and HIV. Will these continue?

“They are also worried about reciprocal arrangements with other countries. Is now the right time, at the start of Brexit negotiations, to be making these policy changes? What may be the impact on British citizens overseas?”

The likelihood that some patients would not have the two forms of identity envisaged by the DH will create problems, Restell added.

“Who is accountable for the care of a patient who can’t show ID? What happens if their condition subsequently worsens, possibly foreseeably, as a result of being turned away?” he asked. In addition, he added, “ID checks are likely to create delays in clinics and elsewhere as ID is checked and queries resolved”.

He also said the scheme was overly bureaucratic. “Most elective work [non-urgent care in hospitals] comes via referral from general practice, where registration requires eligibility checks. Why create a second check?” said Restell.

NHS managers doubt ID checks would generate any extra money beyond what is already received from overseas visitors and governments under existing arrangements. He added: “The system may well cost more to administer than the extra income it generates. Managers believe government underestimates how complicated this would be administratively. While we do not think it would necessarily burden clinical staff in practice, it would lead to delays and costs.

“The whole issue raises unresolved ethical questions about eligibility for healthcare and about compatibility with the values of the NHS and its staff.”

The Peterborough and Stamford trust saw its annual income from chargeable patients rise from £92,500 to £250,000 after it introduced identity checks in May 2013. Its total budget is £261m. It says 95% of invoices were recouped last year, compared to 37% in 2012. NHS bosses told MPs this week that the scheme “had made a big difference”.

However, the trust admits no formal evaluation of the scheme has been carried out. Four staff are employed on it, though they only spend a quarter of their time processing fees and pursuing unpaid bills. But the trust would not say how much the scheme costs, other than to say it did not outweigh the total income raised through charges.

Although some reports suggested passports would have to be shown to guarantee entitlement to free NHS treatment, they are not required in every case. Residents and EEA visitors who have lived in the UK for the past 12 months must provide two forms of ID such as a utility bill or payslip. If patients have not lived in the UK for the past 12 months, a passport or ID card is required.

Although the regulations enable an NHS trust to refuse treatment on the grounds that a patient requiring a non-urgent clinical intervention did not qualify for free treatment, Peterborough said it had never turned away a patient who said they were unable to pay.

Non-qualifying patients who do not pay invoices over £500 are reported to immigration and debt collectors are sometimes used.

Nurses said they were already too busy to help administer such a scheme and do not want to be distracted from looking after patients. Stephanie Aiken, the Royal College of Nursing’s deputy director of nursing, said: “Nurses and other staff on the frontline go to work to care for patients. While we recognise that the NHS is under extraordinary financial pressure, taking clinical staff away from the core job of treating patients is not the solution and must not be allowed to happen. Patient care must always be prioritised ahead of any administrative procedures.”

Sources at the NHS Confederation, which represents the NHS trusts who may have to implement the policy, said hospital bosses were “conscious of the practical and administrative burdens it would put on the NHS”.

A National Audit Office report last month estimated that hospitals are failing to collect about £200m from patients who should have paid for their treatment. But the chair of the British Medical Association, Dr Mark Porter, said: “We have got an NHS with a deficit approaching 100 times that amount opening up over the course of this parliament. This is little other than a pinprick on top of the actual problems facing the NHS.”

Charges only apply to non-urgent, planned care, not treatment in A&E. Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors, warned against changing that demarcation.

He said: “We do not believe the proposed plans to require patients to show identification before receiving treatment could extend to the emergency department, due to their sheer impracticality. However, if the plans include the ED, then we would be failing our patients on an ethical level. The patient’s health is – and must always be – the most important thing, not where they are from.”

NHS staff and managers condemn "passport before treatment" plan