A pilot scheme in which patients are asked to show two forms of identification before receiving NHS treatment could compromise access to care, parliament’s spending watchdog has said.
The public accounts committee urged caution before officials extend the scheme, saying it could lead to entitled patients staying away from hospitals. The MPs have also told the Department of Health to take urgent action to renew a “chaotic” system of recovering money from so-called health tourists.
Trusts are supposed to charge visitors from outside the European Economic Area and Switzerland for non-emergency hospital treatment. For patients from the EEA and Switzerland, trusts should recoup their costs through an insurance scheme.
In November the department’s permanent secretary, Chris Womald told the committee that ID checks were taking place at a hospital trust in Peterborough, an area with a high number of immigrants.
Patients are asked to show passports and utility bills but the committee says in a report: “These documents do not demonstrate entitlement to free NHS care. The biggest challenge is that there is no single easy way to prove entitlement.”
The MPs also point out that some UK-based patients would struggle to bring in such documents. “We are conscious that some people who live in this country and are eligible for free healthcare may struggle to provide passports and utility bills and it is important that their access to care is not compromised,” the report added. “The department should consider a system that would allow verification without compromising patient care.”
The report recommends extending the use of NHS numbers and electronic patient records. “This could help tackle both the very low levels of cost recovery for European Economic Area and Swiss patients, and the problem that some people resident in this country may find it hard to show documents that indicate their entitlement,” it said.
In evidence to the committee, the health department admitted “very little happened” for more than 30 years after legislation was introduced in 1982 to recover money from overseas patients.
In 2014/15 the UK recovered £50m from other European countries and paid out £675m. The health department has set a target to recover up to £500m a year by 2017/18, but forecasts that only £346m will be charged.
The report calls on GPs to do more to help identify patients who should be charged for NHS care following a referral to hospital. It points to a wide variation between NHS trusts in debt collection rates, from 15% to 100%. Just 10 out of 154 hospitals accounted for half of the charges to visitors from outside the EEA – the EU plus Norway, Iceland and Liechtenstein – and Switzerland in 2015/16.
Departmental officials say there will be policy changes and improvements to IT, but admit they have much more to do to enforce the rules.
A health department spokeswoman said other trusts were trialling the scheme piloted in Peterborough, and still more were exploring their own ways of identifying patients.
“We will be announcing further steps very shortly to recover up to £500m a year by the middle of this parliament,” she added.
Prof Helen Stokes-Lampard, chair of the Royal College of GPs, welcomed the committee’s report. She said: “It is the role of GPs and our teams to deliver care to our patients, free at the point of need, regardless of their individual circumstances. We must stop perpetuating this idea that general practice should, in whatever way, assist with border control.”
Dr Mark Porter, chair of the British Medical Association, said his members had also raised concerns. “Any charging systems should not prevent sick and vulnerable patients receiving necessary care, otherwise there may be serious consequences for their health and that of the public in general,” he said.
The MPs’ report concludes that the department should publish an action plan by June complete with milestones and performance measures for increasing the amount of revenue from foreign users of the NHS.
Meg Hillier, the chair of the public accounts committee, said it was unacceptable that so much money owed should continue to go uncollected. “This is a problem for the health service as a whole and work to put it right must be driven by central government,” she said.
“We are concerned that financial progress to date does not reflect meaningful progress with implementing the rules and the Department for Health and NHS have much to do if they are to meet their target for cost recovery.”
NHS ID scheme could deter eligible patients, say MPs
