Preparing the slides for the recent cost recovery webinar really made me think about how best to describe what the financial rewards are for individual trusts in delivering the Visitor and Migrant NHS Cost Recovery Programme. For some trusts who have a high visitor population there clearly are benefits in ensuring that you have invested in putting the right processes in place to identify potentially chargeable patients and to recover the costs of their care where appropriate. For trusts still trying to work out how much to invest against the potential financial gain, working out the cost-benefit can be a complex calculation because what you gain in financial incentives (see figure below) is dependent on the cost of the care that you are providing. For instance, if we consider the European Health Insurance Care (EHIC) incentive for visitors from EEA countries (and Switzerland) who are able to provide an EHIC card. For every treatment reported on the Overseas Visitor Treatment Portal (OVT Portal) by a trust, as well as receiving back the cost of care from their commissioner, an incentive of 25% national tariff is also paid to the trust by the Department of Health. The annual income received from this financial incentive is dependent on the type of care provided to overseas visitors (and the cost of that care) as well as the number of chargeable patients you are able to identify (the volume of treatments). So in some years a trust might identify a greater number of overseas visitors who are able to provide an EHIC card but paradoxically the income received by the trust is lower because the treatments were of lower cost than in previous years. Some years will be more rewarding than others so you have to take a long term view that overall the trust will be better off. Quite a difficult message for an Overseas Visitor Manager (OVM) to get across to their trust board.
But I think that implementing the cost recovery programme at trust level is more than just about considering what is financially achievable for the trust. For me the message we are trying to get across to trusts is a bit like the message we try to get across to parents about the importance of getting your child immunised (I spent eight years working on the National Immunisation Programme in a previous DH role). The Cost Recovery Programme works like herd immunity – you get the biggest benefit if everyone is doing it. As an individual trust it may not appear cost effective to invest time and resources into improving your cost recovery rate but if across the NHS we are all sticking to the same message, that NHS treatment is not free for everyone, then in the long term there will be a better understanding among NHS staff and those visiting the UK that the healthcare you receive might be directly chargeable to you (or you might need to apply for an EHIC before you travel). This will surely make the programme easier to implement and the monies saved centrally will be put back into NHS services across the country in addition to the financial incentives collected by each trust. So every trust benefits. Of course making change happen within trusts is not just about making the financial case, it’s about winning over the hearts and minds of everyone working in the NHS that this is the right way to run the NHS if we want it to be sustainable.
So back to the webinar. If you missed it, it is still available at www.hfma.org.uk/hfma-tv/webinars/webinar-detail.html?id=137&pageSection=2. I hope that the series of webinars we have produced are a useful reminder of how the new charging rules work and that the package of e-learning materials we have produced with e-Learning for Health are useful tools in getting the message across to colleagues in your trust that its everyone’s responsibility to understand the rules and correctly apply them. That way we will all see the financial benefit from the Cost Recovery Programme.