Playing politics with passports to the NHS | Brief letters

The government’s sudden interest in tackling health tourism (Show your passport for NHS treatment, 22 November) is a transparent distraction tactic. The unclaimed cost of treating non-entitled patients is said to be £200m, a mere 1% of the amount the government is trying to strip from the NHS budget through its ludicrous and unachievable “efficiency savings” target.
Dr Bob Bury
Leeds

• Last year, while staying with French friends, I fell down a short flight of steps which resulted in my going to A&E. At reception, I was asked for my passport along with my EHIC card and the usual name, address etc. It took no longer to process than any of the other information. If it can be done in France, why not here in the UK?
Freda Worland
Harpenden, Hertfordshire

• To understand the present state of British universities, institutions whose success depends on free and open discussion, we need only read your letters pages where academics fear to have their names and employing universities displayed (Letters, 21 November).
Nick Williams
Auchenblae, Aberdeenshire

• So the Department for Transport can pay £50m to provide Wi-Fi on some trains (Report, 22 November) and yet families are being turned out of their house to wander the streets. We seem to have lost our way.
Gill Johnston
Peterborough

• As students at UEA 40 years ago, my boyfriend and I had a friend in the coypu eradication unit on the Broads. He left a freshly eradicated coypu on our doorstep in Norwich which we skinned and butchered. I roasted it with carrots and potatoes and we found it delicious (Letters, 21 November) – even better cold the next day.

Certainly not rats!
Helen Wolvey
St Albans

• Will the Queen insist that all the plumbers working on the palace (Report, 19 November) are Corgi registered?
Gerard Gordon
West Kirby, Merseyside

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Playing politics with passports to the NHS | Brief letters

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?

Hospitals may require patients to show passports for NHS treatment

Patients could be told to bring two forms of identification including a passport to hospital to prove they are eligible for free treatment under new rules to stop so-called health tourism.

The most senior official in the Department of Health told MPs on Monday that he was looking at making hospitals check patients’ papers to find out whether they should be paying, a proposal he admitted was “controversial”.

It would mean that those trying to access health services, including British citizens, might have to prove their identity before having operations and undergoing tests in hospitals, but it would not cover care received at GP surgeries.

Chris Wormald, the department’s permanent secretary, told the public accounts committee that passport checks were already taking place at one hospital in Peterborough which services a high immigrant population.

Wormald said: “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.”

Peterborough and Stamford hospitals trust covers an area that has received a high number of eastern European immigrants in recent years.

The senior civil servant told MPs that he accepted it was not part of “health service culture” but that it may be necessary to crack down on use of the NHS by visitors from abroad who do not have an automatic right to free care.

A National Audit Office report issued last month said the government paid out £674m to other European countries for the treatment of Britons abroad, but received only £49m in return for the NHS treatment of European citizens.

Wormald said he could not guarantee that ministers would meet their target to increase the amount the government claws back from European countries from the current £49m to £200m.

Other parts of the NHS have been experimenting with tougher identity checks. It was disclosed earlier this year that at least one hospital in south London piloted a scheme to cut what has been described as “maternity tourism”.

Expectant mothers going to St George’s in Tooting will have to provide papers showing they are eligible for free NHS care when they arrive for scans. Those unable to do so will be referred to the Home Office, and could face deportation.

Wormald said NHS trusts need to do far more to identify foreign people with no eligibility for NHS treatment if the target is to be met.

“Some trusts are looking to see whether they need to require people to prove their identity by bringing in a passport or some other form of ID – which is not the culture of the health service up to now,” he said.

“We are looking at whether more trusts should go down that route, as had been done in London and elsewhere, on people having to prove their identity.

“And we are looking at whether that is proportionate – whether in just some places, or the whole country.”

Wormald’s comments show that such an approach is being considered more widely. He said: “We are not here to criticise NHS frontline staff, but what we want is a culture of everybody who works in it to understand financial rigour. We need a culture where we are more careful with the tax pound.”

Asked whether the NHS will ever meet Jeremy Hunt’s target of clawing back £200m a year form European countries, he said: ‘I’m not going to guarantee whether we will meet it.”

A source close to the health secretary confirmed that the idea of passport identification had been floated and piloted and that plans for a nationwide scheme have not been ruled out.

But the source added that that the pilot was still at an early stage and that checks might only be applied in areas with shifting populations and large influxes of immigrants. “We have not yet made any decisions on this,” the source said.

A spokeswoman for Peterborough and Stamford hospitals NHS trust said: “In response to a national requirement, our trust devised a process for recovering money for the NHS from the treatment of non-EU citizens.

“This was looked at by the Cabinet Office and we understand our system may be used as a basis for other trusts to follow. We are delighted to have been identified as an exemplar of good practice.”

Hospitals may require patients to show passports for NHS treatment