'New rules intended to cut the cost to the NHS of foreign nationals travelling to Britain to use the service mean patients could be asked to show their passport to prove they are UK residents before accessing treatment.
Guidance from the Department of Health (DoH) tells NHS trusts that “where there is uncertainty” about patients’ entitlement to free care they must ask to see credentials including passports, driving licences, bills and bank statements.
Treatment at A&E departments and GPs’ surgeries will remain free for all, the department said, and no one should be denied treatment if it is deemed to be “immediately necessary or urgent”, but patients will face questions from staff, where possible, before being admitted as an inpatient or being given an outpatient appointment.
People living in the UK for more than six months are entitled to free care, but there are fears over abuses of the system by foreign nationals travelling to the UK to use the NHS.
The rules, which came into effect on 6 April, are intended to save as much as £500m a year by 2017-18, with hospitals given the right to charge short-term visitors from outside Europe 150% of the cost of their treatment. Hospitals will also get an extra 25% in funding on top of the cost of every treatment given to a European Economic Area (EEA) migrant or visitor with a European health insurance card (EHIC).
They also face penalties for any failures to implement the rules, as the cost of caring for any patient not eligible for free treatment would be withheld, meaning the hospital would foot the bill.
According to figures provided by the DoH, costs for common procedures range from £2,188 for a “normal maternity birth” to £7,826 for a hip replacement operation. Women who are about to give birth will not have to fill in forms beforehand, but could be asked for documents and chased for payment once their baby has been delivered.
Foreign nationals’ use of the health service has become a burning issue in NHS funding, with some on the right claiming they contribute to a healthcare gap by taking up beds that could go to people who have paid into the system. This is despite an investigation by the Guardian last week that found that the cost of treating ill Britons in Europe was five times higher than the cost to the UK of treating sick visitors from other European countries.
The rules place a legal obligation on NHS bodies to establish whether a patient must pay for care, but also emphasises that they have a “human rights obligation” to give treatment a doctor judges “immediately necessary”, even if the patients indicate they are not able to pay.
Anticipating concerns about discrimination, the guidance instructs staff to make sure they do not simply give forms to patients on the basis of their skin colour or their ability to speak English. Requests for documentation would only be made after initial interviews with patients to establish whether they are ordinarily resident or exempt from charges.
“These in-depth interviews need to be handled sensitively and by staff who have been adequately trained to perform this task, including training on appropriate interview techniques and how to identify patients in a non-discriminatory manner [e.g. to avoid racial discrimination and harassment],” the guidance says.
The guidance applies only to NHS hospital care, but in February the DoH was reportedly set to introduce a pilot scheme to test the feasibility of GPs asking their patients for proof they are eligible for free NHS care, with family doctors asked to identify patients who should be paying for treatment.
Responding to the new rules, Roger Goss of Patient Concern told the Daily Mail: “It’s a worthwhile price to pay to attempt to recover the tens of millions owed by health tourists. If it is successful, the money recouped could be invested in better care for those patients who are entitled to it for free.”
Leigh Daynes, the executive director of the health charity Doctors of the World UK, raised concerns over the rules. “There should be no impediment on receiving immediately necessary medical care,” he said.
Doctors of the World UK runs a clinic in east London staffed by volunteers that provides medical care free to undocumented migrants. “The patients we treat are not health tourists,” Daynes said, adding that many were women trafficked into the UK or migrants in otherwise exploitative situations.
“One-fifth of them tell us they did not seek a doctor’s help because they are afraid they might be arrested, and in 2015 that’s unthinkable,” he said.
“Of course we all want a sustainable NHS that’s accessible to all’ Also it is right that those who can pay should pay if they are eligible for treatment. [But] our experience is that there are many, many bureaucratic and language barriers stop people accessing care even when entitled to that care.”
Don Flynn, the director of the Migrant Rights Network, said any potential extension to family doctors’ surgeries of checks on patients’ entitlement to NHS care would be a “very bad idea”.
“Staff at reception are unlikely to have the skills and experience needed to determine the immigration status of patients and this will be particularly testing at practices in areas with large ethnic minority and immigrant communities,” he said.
“We are also concerned that it will conflict with NHS duties to eliminate the present high level of health inequalities through proactive work with hard to reach communities. Registration with primary care services will become a more hostile experience for people whose residence status in the UK comes under more suspicion because of their skin colour or accent.”
An official study in 2013 estimated that £388m is spent each year on patients in England who should be paying for their care but are not charged. The report said only 16% of costs were being recovered. It added that the cost of people who come to England with the purpose of getting free treatment on the NHS could be anywhere between £70m and £300m.
Figures obtained by the Guardian last week under the Freedom of Information Act showed that European visitors using the NHS cost the service £30m in 2013-14, less than a fifth of the £155m other states in the European single market spent on treating ill Britons.'