BARTS HEALTH NHS TRUST has defended itself for carrying out ID checks on patients – pointing out that it is only carrying out government policy and trying to claim back money from patients who are not entitled to free treatment.
Their statement comes after local NHS campaigners claimed that the ID checks would deter patients from seeking treatment – and could lead to a rise in emergency admissions as untreated conditions escalated unnecessarily.
The Trust’s position is set out in papers of its July Board meeting. These point out that patients must be “ordinarily resident” in the UK to receive free treatment. The Trust insists that it doesn’t turn patients away – but it will charge those who are eligible. The question, though, is how does it find out who is eligible?
The Board paper confirms that until recently it relied on staff happening to figure out that a patient might not be eligible for free treatment, and it has for some months been updating this casual, and potentially unfair, system. So far, so good – but the Board paper leaves many questions unanswered and some questions are not even asked.
•Emergency care (including maternity services) All patients being treated in an emergency department or maternity unit is asked where they have lived for the last twelve months. Depending on the answer, further checks may be carried out (looking back at NHS records, asking patients for documents, or checking with the Home Office).
It is fair that everyone is asked: but who decides, and how, whether the answer is acceptable and whether these further checks will be done?
•Identity checking pilot scheme The renal unit at the Royal London Hospital and the maternity department at Newham Hospital were part of a Department of Health pilot scheme to test out identity checks that ran between July and October last year. The Trust insists that no patients were turned away or had treatment delayed as a result of the scheme.
When patients were sent an appointment letter, they were asked to bring two forms of ID in with them, one with a photo and one with a home address. If they could not produce adequate documents, they were still treated but further investigations were carried out. The pilot produced some interesting figures.
In the Renal department, 552 out of 2,752 (20%)of patients could not produce adequate documentation as requested – but after further work, only two were found to be ineligible for free treatment. They were invoiced £2,500 (between them) for the cost of their treatment.
What is not revealed is the cost of the officer time needed to go through 550 investigations of patients who ultimately turned out to be eligible for treatment – and whether the cost was more than the £2,500 invoiced (or if the charges were recovered). Without this information, it is hard to work out if it would be better to reinstate the checking or abandon it for good.
In the maternity unit, 383 patients out of 1,497 were not able to produce adequate documents: 17 accepted they were not eligible for free treatment and have been invoiced £104,706 between them, while inquiries continue into a further 77. This suggests that 289 patients were investigated and found to be eligible for free treatment.
It is fair to say that even if £2,500 isn’t going to stem the deficit, £104,706 is not to be sneezed at (if it is all recovered), but there is still no data give to the Trust’s Board on the cost/benefit ratio of the identify checking scheme. Perhaps the Trust can reveal the net cost or gain from the scheme, taking cost of the work and total recovered (not invoiced) into account. But why was this information not given to the Board: it was supposed to be a pilot scheme, after all. Worse, why did no Board members ask for it?
•Recovering Costs The Board was told that in the financial year 2017/18 the Trust’s Cost Recovery Support team invoiced 1,929 patients a total of £13 million – less than 1% of all patient activity and less than 1% of the Trust’s annual turnover. The Board was also told that the Trust’s recovery rate is less than the national average (and the Team is trying to improve on this).
An income stream of £13 million is worth pursuing (we’d like one here in our office, if anyone has one to spare). However, again the Board is not told the net amount of potential gain. How much of the £13 million did it cost to identify chargeable patients (including all the checking on non-chargeable patients) and charge and chase them? The Trust is currently making up to 100 inquiries with the Home Office each week about patients’ immigration status, so the cost is not negligible.
The Trust is not the enemy here, but it could be accused of losing the plot. The clerical effort needed to identify and raise the charges is significant. The financial returns from that investment are tiny, and the human cost of worrying genuine patients to find acceptable documents – when they may be trying to come to terms with diagnosis and treatment – is considerable.
•Barts reply A spokesperson for Barts Health pointed out that all NHS Trusts have a responsibility to recover costs from those not eligible for free NHS care. The two pilot schemes were part of an initiative that involved up to 20 other NHS Trusts and was requested by the Department of Health.
She continued, “We made clear from the start that no patients would be turned away, and no patient visiting our hospitals had care delayed. We are now reviewing arrangements across the Trust to ensure all our patients are subject to appropriate processes and checks in a consistent way. In the meantime, we have stopped asking new maternity and renal patients at Newham and The Royal London to bring ID, and anyone who attends an appointment will not be expected to show it.”
•Campaigners reply Yes, the NHS was designed to be free at the point of need. But, which is said far less often, it was also designed to be paid for by means-tested taxation. Raise enough in taxes, and your health service can offer care to all who need it rather than just to residents.
Our Trust may be able to raise up to £13 million by invoicing non-UK resident patients, but how much is it spending on buying health related services from private companies, just because the Government requires it to do so – and how much of that spend is to pay for company profits, channelling taxpayers’ money into private hands for no return to the private sector?
The Government cannot claim to be neutral here. It is insisting that the identity of all patients is checked as part of the “hostile environment” towards immigrants – but covering up the cost of public subsidy to the private health sector. When are Trusts going to step up and denounce that discrimination?
•Read the Barts Health Trust Board document on ID checks here: Barts Trust on ID checks-4-July-2018
•Read what campaigners say and sign their Open Letter: Campaigners tackle Barts Trust on charging migrants
•Read more about it: Barts Health tackles waiting lists Campaigners explain opposition to GP at Hand