‘Health tourists’ to be charged upfront for NHS care

Hospital staff will be told to routinely ask patients for utility bills, bank statements and proof of employment in a bid to identify those who should be paying for NHS treatment, under new laws.

Overseas patients will be charged “upfront” for NHS treatment, under the legislation which comes in force on Monday.

Ministers said the changes were an attempt to protect “a cherished national institution that is paid for by British taxpayers”.

From Monday, those resident outside Britain will need to pay for non-urgent care, in a bid to clamp down on “health tourism” which is estimated to cost the health service up to £2bn a year.

Guidance seen by The Telegraph reveals that NHS trusts have been instructed to ask patients for detailed evidence to establish their right to free healthcare, if there is any doubt about their entitlement.

Every NHS trust has been issued with guidance, with a list of questions to be asked, and documents to be required, if the residence status of a patient is not immediately clear.

Some hospitals - especially in urban areas with high ethnic populations are expected to ask questions of every patient, in a bid to reduce the risk of being accused of discrimation.

Following a backlash from doctors, Accident & Emergency departments and access to GPs will remain free for all, and asylum seekers will be exempt.

The move means anyone flying to the UK for non-urgent treatment such as a hip operation or cataract removal could now be turned away unless they agree to pay the NHS bill.

A small number of hospitals have introduced upfront charges for overseas patients already, with some requiring provision of a passport and utility bill, to help officials establish entitlement.

But the vast majority currently attempt to chase debts after patients have left the hospital - often fruitlessly.

The Department of Health guidance - called the “Ordinary Residence Tool” - instructs NHS staff to ask patients for evidence of a “settled home address in the UK”.

These could include utility bills, council tax records, bank statements, tenancy agreements, proof of property ownership or insurance policies, the guidances states.

Patients could also be asked to provide payslips, letters from their employers, or tax reference codes, the guidance states.  

The eight-page form lists 32 questions which could be asked of patients in a bid to establish their legal entitlement to care.

While staff are not told to ask the questions to every patient, separate guidance warns trusts that they could fall foul of discrimination law if they target non-white patients or those for whom English is not their first language.

The equality analysis suggests previous attempts to chase overseas patients for payment could have been open to such claims .

“There is evidence (anecdotal and qualitative research) that non-white people or people for whom English is not their first language are, on some occasions, targeted in the application of the 2011 regulations due to speculation or assumption that they are not resident in the UK.”

Trusts are told: “This is clearly unacceptable and longstanding guidance to the NHS has advised that each patient must be treated the same in assessing for charges.”

In order to reduce the risk of discrimination, all staff involved in assessing charges should receive training in discrimation laws, it adds.

Health Minister Lord O'Shaughnessy said: "The NHS is a cherished national institution that is paid for by British taxpayers.

"We have no problem with overseas visitors using our NHS as long as they make a fair financial contribution, just as the British taxpayer does. The new regulations simply require NHS bodies to make enquiries about, and then charge, those who aren't entitled to free NHS care. All the money raised goes back into funding and improving care for NHS patients.”

No one would be denied urgent treatment on cost grounds, he stressed.

"We are clear that some vulnerable groups are exempt from charging and the NHS will never withhold urgent and immediately necessary treatment."

Earlier this year a damning report by the Public Accounts Committee warned that the Department of Health was failing to recover hundreds of millions of pounds, amid “chaotic” cost recovery systems.

Some £289 million was charged to all overseas patients in 2015/16, with trusts collecting only around half of the amounts they invoice.

The plans aim to recover up to £500m a year, with funds reinvested in patient care.

Trusts are expected to check eligibility through asking people to produce identification - such as a passport and a utility bill with a UK address.

Patients will be told upfront that their care is chargeable before treatment begins, with administrators expected to present chip and pin machines to patients or collect cash payments before treatment can go ahead.

Those needing urgent care will still be treated immediately on the NHS.

In February a BBC documentary revealed the case of a Nigerian mother, Priscilla, who gave birth to quadruplets, two of whom died, and was left owing the NHS nearly £500,000.

Under the new plans, she would still have received urgent treatment as her life and those of her babies were at risk.

Last year NHS board papers revealed that one London hospital had provided care to around 900 pregnant women from overseas in a yaer.

Deliveries from mothers outside the EU accounted for a fifth of all births at St George’s in Tooting, South London, costing the taxpayer more than £4 million in unpaid medical bills.

The board papers said four in five overseas patients left without paying their bills, and that the trust was being “targeted” by agents from Nigeria as it then lacked robust eligibility checks.

The new measures will also require hospitals and NHS bodies to identify and flag a patient's chargeable status so that other parts of the health service can more easily recoup costs from overseas visitors when charges apply.

The Department of Health said the approach would mean NHS staff could devote more time to treating patients rather than chasing money the NHS is owed.