Nurses must not be made to charge overseas patients for care, warns health unions

NHS trusts will be legally obliged from April to check if overseas patients are eligible for free care – but unions fear it will further stretch an already buckling health service and risks ‘demonising’ patients.

Plans to charge overseas patients for non-urgent NHS treatment are unworkable and nurses and healthcare workers must not be made to police them, health unions have warned.

NHS trusts are expected to charge overseas patients upfront from April. Photo: iStock

From April, NHS trusts will be legally obliged to check if patients are UK residents and so eligible for free care.

If not, trusts will be expected to charge these patients upfront, as part of plans the government hopes will save £500 million a year by 2017-18.

Nurse and doctor representatives have expressed deep concerns at the plans, which come amid NHS funding and staffing shortfalls.

‘Not main issue’ for NHS

RCN chief executive Janet Davies said: ‘Nurses and other frontline staff go to work to care for patients.

‘While we recognise the need to ensure people are entitled to NHS care, this is not the main issue facing the health service – the biggest concern is that the NHS is understaffed and underfunded.
‘It is unclear how these proposals will work – who will administer the charges? Any new system must not take overworked clinical staff away from the core job of treating patients.’

Ms Davies added that until the government addressed the ‘real problems’ – particularly the critical shortage of nurses – the health service would continue to struggle.

‘Demonising’ patients

British Medical Association council chair Mark Porter said it was right to ensure all patients are eligible for NHS care and to have a working system to recoup the cost of treatment from patients not ordinarily resident in the UK.

But he added: ‘It’s hard to see how these new proposals will operate in practice, especially as they are to be implemented by law. There is no detail as to how upfront charging will be introduced from scratch in just three months in an NHS already unable to cope with normal operations.

‘We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS. Doctors and nurses cannot be expected to arbitrarily decide whether a patient gets treatment or not.’

Trusts will be able to decide how to check eligibility. For example, by asking for two forms of identification such as a passport and a utility bill.

They can take payment at the time of treatment or ask patients to sign a form to agree to a longer-term payment plan.

Patients will also be able to choose not to have the treatment if they have no means of paying the bill.

Plans to recoup £500 million 

People needing urgent care will still be treated immediately on the NHS, but can be invoiced – as at present – if it is found they are not to be eligible for free care.

Announcing the plans, health secretary Jeremy Hunt said: ‘We have no problem with overseas visitors using our NHS – as long as they make a fair contribution, just as the British taxpayer does. We aim to recover up to £500 million a year by the middle of this parliament – money that can then be reinvested in patient care.’

Patients Association chief executive Katherine Murphy said the plans should not compromise patient care – if decisions regarding the urgency of treatment are assessed on clinical need, rather than patients’ ability to pay.

NHS trusts will also be obliged to flag up a patient’s chargeable status so that other parts of the NHS can more easily recoup costs.

Under the plans, anyone from outside the European Economic Area who is staying in the UK for longer than six months will also not be eligible for free fertility treatment on the NHS.

Some £289 million was charged to all overseas patients in 2015-16, though not all of this will be recovered. Currently, trusts collect only around half of the amounts they invoice.

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