Concerns raised over nurses' role in charging overseas patients for NHS care

Nurses have voiced concerns over what role, if any, they should play in deciding whether overseas patients should be charged for NHS care.


Nurses have voiced concerns over what role, if any, they should play in deciding whether overseas patients should be charged for NHS care.

A new report from the National Audit Office (NAO) said nurses have an ‘important role’ in deciding whether overseas patients should be charged, and if they need care immediately.

health payments
Picture: Alamy

But the spending watchdog conceded clinicians are concerned that the programme to tackle so-called health tourism could deter people from seeking much-needed care. 

The NAO’s analysis found hospital trusts in England are failing to meet government targets on recovering costs from foreign visitors not entitled to free treatment.

Nurses have responded to the report by raising concerns that their priority is caring for patients rather than pressing them for payment details. 

Vicki Cheney wrote on Nursing Standard’s Facebook page: ‘My role is to report and document overseas patients but the cost implications are the responsibility of the higher management and accountants. My sole responsibility is the well-being of my patients in my care.’

Many responses questioned why securing payment information is not the responsibility of finance or administrative staff. Sue Young wrote: ‘We are nurses and doctors, not accountants or police. Can't believe we're being blamed for this too!'

The NAO report, called Recovering the cost of NHS treatment for overseas patients, acknowledged that clinicians are worried about the impact that collecting costs can have on their ability to care for patients. 

‘Some staff have expressed concerns that the programme may, for example, discourage people from seeking necessary treatment, increase public health risks and undermine trust between clinical staff and patients,’ the report stated.

‘There is insufficient evidence to assess whether, or to what extent, these concerns are justified.’

Who to charge?

More than half of nurses are unaware that certain people can be charged for care, the NAO found.

Unison head of nursing Gail Adams said she could understand nurses’ concerns and is worried that the policy will deter people from seeking care, particularly pregnant women. She recently intervened in a case where an overseas patient had been billed for £15,000 for treatment received after a violent attack. The trust involved waived the payment. 

‘Our responsibility as registrants is to care for people and I worry that the inquisitive nature of the process could inadvertently undermine the therapeutic relationship,’ she said.

NAO estimates suggest that of the £500 million the Government aspires to recover annually by 2017-18, only around £295 million is likely to be brought in from charges of £346 million.

Recovering costs

This, the report said, is ‘significantly less’ than the NHS is capable of recovering from the cost of treating patients from overseas.
It showed attempts to reclaim costs to the health service have been hindered by the failure to identify and charge foreigners from the European Economic Area (EEA) who receive treatment and ‘particular challenges’ in pursuing patients outside of the continent.
The ‘ambitious’ target for reducing the cost of treating overseas patients was announced by the Department of Health in 2014 in a drive to cut the deficit trusts face while countering claims the NHS was being ‘overly generous’.
Of the money charged to overseas visitors in the last year, half the total has come from 10 acute and specialists trusts in London, the NAO said.

Further information

Recovering the cost of NHS treatment for overseas patients report

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