Chris Skidmore is the Member of Parliament for Kingswood. Follow Chris on Twitter.
How we should tackle the issue of "health tourism" is one which has recently been raised on ConservativeHome, while stories of foreign nationals, ineligible for free NHS care still obtaining operations and treatment appear frequently in newspapers and the media? The background to the issue is straightforward: too many of those visitors required to pay for NHS treatment do not, and too many people are being registered by GPs who are not eligible for free NHS care.
It was not until 1989 that a British government began to require certain overseas visitors to pay for hospital treatment, and 2004 that these charges were extended to cover refused asylum seekers. The current guidance places “a legal obligation on the trust providing treatment to identify those patients who are not ordinarily resident in the United Kingdom; establish if they are exempt from charges by virtue of the Charging Regulations; and, if they are not exempt, make and recover a charge from them to cover the full cost of their treatment.”
However, there is no guarantee that the requisite money will be recouped. My own investigation, using Freedom of Information requests to every NHS foundation trust, revealed that over £40 million pounds had either been written off or was still uncollected – considering that only two thirds of trusts were able to provide practical data the true figure is likely to be much higher.
Reading the official NHS guidance on overseas visitors charging regulations is instructive, especially when compared to how they operate in practice. There are trusts which take seriously their obligation to charge foreign nationals ineligible for treatment – the most effective to date being the "stabilise and discharge" system operated by West Middlesex University Hospital. When a foreign national is admitted to hospital, a doctor establishes whether or not they are in need of urgent, life-saving treatment. If this is not the case, they are then told what treatment is required, the cost of it, and if unwilling to pay are asked to leave. The policy saved the hospital £700,000 in one year. Yet its practice seems an exception to what is currently taking place elsewhere: despite the obligation to ensure that those required to pay for care do, one 2008 poll of NHS managers gave the startling fact that a third did not even bother to ask patients about their eligibility for free treatment.
In primary care, GPs have discretion to register foreign nationals as a NHS patient, which does not in itself give a person automatic entitlement to free hospital treatment. However, once registered, it becomes increasingly unlikely that they will ever be asked about their residency status or indeed nationality, if they are referred for further medical care. The regulations make this abundantly clear: “It is the relevant NHS body’s duty, not the GP’s, to establish entitlement for free hospital treatment. Furthermore, neither relevant NHS bodies nor anyone acting on their behalf, should imply that a particular patient should not be registered with a GP practice as that is exclusively a matter for that GP.”
Effectively, this is an area where GPs – the gatekeepers of the National Health Service – are being encouraged to abdicate responsibility. We should not be asking GPs to play the role of immigration officers, of course, but such a lax attitude to registering patients undermines the principle of that the charging regulations are built on. The regulations in place provide GPs with the means to check on the liability of individuals- and make it very clear that provided everyone attempting to register is treated the same way, there is no question of discrimination.
The Department of Health has an ongoing review into access to the NHS for foreign nationals. Announced last year, it has looked at the various aspects of charging policy, including the qualifying criteria for free hospital treatment. This review should take up the issue of GP registration by ensuring that Primary Care is included in the rules and practices around charging overseas visitors, together with how Hospital Trusts can best ensure that debts incurred by foreign nationals ineligible for free care do not escalate in the way they have done. One thing is certain- even with a ring-fenced, increased budget, the NHS cannot afford to be lax on this issue.
Ultimately, this comes down to a question of fairness. Tackling this problem cuts across all levels of the NHS- both hospitals and GPs have a role to play in ensuring the proper registration of overseas patients. And politicians have a responsibility to show leadership on this issue- to decide where rights and responsibilities meet, and to ensure that our health service reflects this. The demand for healthcare will always outstrip the supply- the government has a duty to ensure that the NHS recoups the maximum possible amount of payment from those not eligible for free care.