Since last autumn, I have been working alongside a dedicated team in DH who are designing a programme to better recover costs from overseas visitors and migrants who aren’t eligible to receive free NHS care – the Visitor and Migrant NHS Cost Recovery Programme.
By agreeing to provide NHS leadership to the programme, I was acknowledging that the current guidance on cost recovery simply hadn't maintained pace with the increasing number of people who are now entering the country and using the NHS.
It was quickly evident to me that the overseas visitor managers working in many hospitals were doing their best to identify who should pay and who should not, but many needed more support and in particular, needed clearer information on who was eligible to receive free NHS care and who should be charged.
Recovery of any costs from non-UK residents who use the NHS is a highly emotive issue for some and I understand why. As a nation, we must protect those who are vulnerable and we must ensure that access to GPs remains free because we do not want to deter anyone who is unwell from seeking help. This message was consistently reinforced from organisations and individuals during the consultation period and is why it was brought forward in the Department’s consultation response. But we must also ensure that such access is not seen as conferring automatic and open access to free NHS care when the individual is not entitled to it.
However, identifying who is eligible and who is not has been fraught with problems, not the least being how we do this without asking everyone to prove their right to access free NHS care.
Over the past several months, I have been chairing an NHS Reference Group, made up of people from within the NHS, including overseas visitor managers, hospital chief executives, GPs, public health experts, representatives from the medical professions, experts who can advise on access for vulnerable groups and people with expert knowledge of how various NHS and other systems can better talk to each other. This group has been helping us to identify the issues and is helping to shape some of the proposed solutions that we are considering now.
We will soon be publishing an implementation plan setting out what changes the NHS can expect to take place during the next financial year and beyond. We have published some initial thoughts on progress reflecting the work we are doing jointly with our stakeholders and through the Reference group as a slidepack.
Without straying into political territory - something I will not do – I do want to echo what Secretary of State has said - the NHS is a national health service not an international health service. And as NHS employees, we must also acknowledge that we have a duty to ensure that we do recover all costs where an individual is not entitled to receive free NHS care.
This is the first of what I hope to be a series of blogs that will help everyone in the NHS understand the programme of work and also give you the opportunity to comment and ask questions.
6 comments
Comment by June Williams posted on
As an overseas manager I have been waiting 12 years for this to happen , I hope the decisions will benefit all involved who are trying so hard to protect our NHS ,It has not been an easy task ,it has taken to long to become recognised by the powers that be, albeit Overseas staff have been complaing for many years.
Comment by Jenny Norman posted on
I do not understand why GP's will remain free to all. Vulnerable Groups shall continue to remain free of charge, such as Asylum Seekers and Refugees. Immediately Necessary treatment or that of such which can not wait until the overseas visitor returns home will never be with held. However why should a person who is Visitng the UK and requires the assistance of a GP not be expected to pay or use their European Health Insurnace Card, as they do in most countries across the world.
Comment by Kate Dixon posted on
Thank you Jenny. Keeping GP and nurse consultations free of charge for all, is an important mitigation on public health grounds. This is for the wider benefit of the whole population.
Kate Dixon
Deputy Director of the Visitor and Migrant NHS Cost Recovery Programme
Comment by Elizabeth EDMUNDS posted on
I note that Sir Keith has been speaking to various NHS personnel about the challenges facing the NHS. Might I enquire whether his work has extended to talks with the Home Office? 1/11/11 saw a change in the Immigration Rules whereby a person owing the NHS more than £1,000 could potentially be refused permission to re-enter or remain in the UK; this new piece of legislation has been used to some effect in order to reduce NHS debt, but still needs to be taken much more seriously by all Trusts. In order to safeguard the NHS, the benefits system, the taxpayer, and the country in general, government departments need to liaise much more closely with each other for their mutual benefit. (I am a recently retired Immigration Officer whose remit has been furthering better liaison between UKBA and the NHS, including assisting with debt recovery for the latter.
Comment by Kate Dixon posted on
Yes - Sir Keith, and the wider cost recovery team have regular conversations with the Home Office, and we are working jointly on the issue you raise, amongst others.
Kate Dixon
Deputy Director of the Visitor and Migrant NHS Cost Recovery Programme
Comment by ed posted on
I do not understand why GP's will remain free to all”
This is not my experience where is the evidence that this is the case who did the reasch.
Gps are a private business that awards them selves nhs employment contracts, can be unionised business owners with dividends and public sector pensions. Amongst the highest paid Gps in Europe.
Unlike say McDonald’s franchises, Gps are given lot discretion.
NHS Gps have subsidies taxpayer funded pensions, can be dividends, often unionised private business owners are given freedom to choose there own criteria’s when it comes to asking for identification. They are also free to choose there own criteria as what patients choose to have in there practice.
Unlike bin men or indeed even sir Keith, sir Keith does not employee himself through private company then award him self public pension, then game whether he is paid privately or public sector or even refuse what work to do or not.
I have been refused treatment by GP as I did not have a current passport and I am uk citizen. The person in front of me in que at Gps was refused treatment as leave to remain stamp in his passport had expireed.
Like many things it would take research to determine what “rights” people actually have in practice as if GPs are given wide discretion, there is effectively no right if Gps are given discretion that allows them not to see people.
If council bin man refused to pick up bin can make a complaint. Gps are a private business that award them selves NHS contracts in effect.
Like the so called NHS dentists, that is a private business with state subsidized pensions.
I remember when unemployed, and had no dentist i complained to my MP who told me that nhs dentists are a private business and there is no entitlement to nhs dentist irrespective of income. That only emegery pain relief service is an entitlement free for unemployed.
The nhs provide no entitlement to a NHS dentist, and provide no subizdity for a private dentist. So in effect provide no entitlement to subizdies dentist of any type as there being no entitlement to nhs dentists other than emergency pain relief service these being a private business.
Even in some states in the US there is an entitlement for a dentist (like a private one that will see people for check ups and non emergency treatment) for single parents unemployed the UK does not offer this service, the UK government through rules only offered emegery pain relief as an enitlemnt irrespective of income. (unless in prison or asylum seekers , its an internationally and correctly so, that bad part not being they offer these services to asylum seeks but they do not offer it to citizens)
A friend of mine developed a condition while working illegally In north America on an expired visitor visa. Ran up a bill of 12k and returned to the uk and the bill was effectively written off, Its not a problem unique to the NHS.
From USA to Germany to New Zealand people are not left to die.
The GP service in my experience which of course is not representative does not allow everyone access.
May be this is Sir Keith’s experience that it does, but that also is not representative of course this may come looking at rules and asking some senior people etc but this does alone would not determine whether the UK gives allows access or not.
When someone is in GPs such as person in front of me in the que and refused by a private company the NHS employee a NHS GP then for all intends and purposes the government do not offer this service in this instant. Even as Uk citizen I get refused on quite spurious grounds, no current passport. Yet NHS has allowed Gps this discretion or my old GP who claimed because I now lived all of 4 miles from his practice I was outside catchment. This is allowed in effect by NHS.
To determine whether or every one is has access to GP would need to conduct research as organization is too lose.
Although could consider, what NHS rules are on this if there is discretion by NHS outsourced contracted GPs. And this discretion allows GPs not to treat then there is no entitlement, if there is technically entitlement but NHS makes no effort to enforce there contracts like with rogue NHS dentists then also no entitlement in effect.
Even if the GPs did not get given discretion flexibility and was more military approach, or even an approach such as Mc Donald’s or dominos pizzas, where its unheard of to be offered private of the menus offering, or to not offer core products in breach of Franchising agreement whether the offer of this product, maximises profit or not its part of a package. (Some things are discretionary some are not)
Unlike say NHS dentist who take the block payments, then refuse to offer some NHS work and sell there own services in breach in contracts yet NHS. What action has NHS taken against rogue operators? Fraud, well don’t know if it is, loss of contract finical penalties being that its government can always do this to an extent as can make the rules
These breaches of contracts are widespread and normal like police taking money in the 1970s almost regarded as perk of the job.
The problem that can get is that asked an approved yes man that gives answer what someone wants to hear.
I always think it’s a bit like someone that has watched business on TV can say of yes I am confident in my managers. But being confident in mangers, with no basis or acting that way with out reason is poor management. As would what rules says and how well are the rules followed.
“do not understand why GP's will remain free to all” where is the evidence to confirm that this is the case, its not my experience.