UKC

Surely all this latest fuss in the news is just smoke and mirrors to hide government underfunding of the NHS.

https://www.kingsfund.org.uk/projects/verdict/what-do-we-know-about-impact-...

"The total gross cost at the top end of the estimate is £2 billion per year, of which a relatively small amount was recouped through charges and other arrangements. However, this total includes the use of the NHS by nationals of countries with which the United Kingdom has a reciprocal agreement. Within this total, ‘health tourism’, where people come to the United Kingdom with the express intent of using health services to which they were not entitled, was estimated to cost between £60 million and £80 million per year. This compares to the annual NHS budget of £113 billion."

The current annual funding difference on a GDP expenditure basis between the UK and the average of the "EU 15" is over £40 billion and growing.

https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-hea...

In reply to Offwidth:

Yes, and yet on some other thread on here people are trotting out all this sort of stuff pushed by the government and media. The fact that only half the consultant posts in my wife's specialty are filled in the South West and it's worse in other specialities, will not be fixed by refusing care for some poor soul who's desperate for treatment. Nursing numbers are way down since the government cut the small bursary they get while training. They also cut I think 1 billion off the NHS repair budget and have offered up another 500 million to private healthcare firms.

At least we've got out of Europe, that will sort the NHS out.

Toby

In reply to Offwidth:

Two points:

1) it may seem like a small amount of money but as you, and any businessperson knows, those "small" amounts add up.

2) The NHS and the welfare State in general won't survive if people think it is "unfair". People on ordinary incomes and paying tax lose faith in a system lose faith in that system if they think that it is "unfair", in this case because they perceive that people are freeriding on the back of their taxes.
There was a spokesman on Newsnight the other day saying that about 800 births per year at St.Georges hospital (out of 1800 I think-maybe wrong) were "unpaid for". That's quite a lot.

In reply to Offwidth:

I don't think it's the amount that matters it's more to do with a principle and good management practices. I'm all for giving the NHS more funding but it really needs to get it's house in order. There's an old saying "Take care of the pennies and the pounds will take care of themselves" and there is some truth to that.

Al

In reply to Postmanpat:


You're right.

And that's exactly why the right-wing press and government keep hanging on about how 'unfair' it is. They don't want either to survive.

As for the 'small amounts add up', yes, that's true. But how much would it cost to add up all those small amounts, and administer a system to recover them?

How much is spent on useless 'management consultants' by the NHS each year?

How much on the litany of pointless initiatives, and fragmented 'marketplace' funding streams?

There are many inefficiencies in the NHS, most due to political meddling with the system. Identify the big wastages, and address those first, before you tackle the 0.05% 'wastage' from 'health tourists'.

Sod 'looking after the pennies'; look after £20 notes that you are using to light the cooker.

In reply to Postmanpat:
Of course they add up and I don't see anyone saying accepting such fraud is a good thing. My point is why are we discussing an £80 million problem and not the £40 billion one.

As for chasing it the extra costs will lead to savings more likely in the £10 million range in an NHS that needs new beurocracy like a hole in the head.

As for the unfair bit ... give me evidence. Changing the NHS is like steering an oil tanker and the only choice on offer is insurance based health at a funding level well below the success of such sytems across Northern Europe. My tendancy is to beleive the exact opposite... propaganda and underfunding being used to slowly force ideological based change in the face of evidence of how effective the system is on a value for money basis and against the will of the British public.

In reply to Offwidth:


But it's not an £80mn problem. It's a £2bn problem. Many of the users (EU citizens mainly) have a perfect right to use the NHS but the NHS fails to recoup the costs because it has no system to do so. I think Newsnight reckoned there is several £100mn that could be charged or recouped but is not.

It would cost several hundred million to put charging/recouping system in place but it would pay for itself, on the face of it, in a couple of years.

In reply to Offwidth:

I think a total number of patients or patient hours would better represent how small a problem it is. Some folk will always just think millions and billions are both big numbers. But if you said for example 1 in every 100000 overseas patients didn't pay for their treatment and the average cost was £450.87. It would seem pretty obvious there is no point in paying someone a few hundred pounds a day to individually chase down this money internationally. (No idea of real figures).

In reply to Postmanpat:
Show me where the Kingsfund is wrong. They gave the number taking into account brits getting health cover at reduced cost in countries that have reciprocal agreements. Ive never seen any estimates anywhere from health analysts even close to a billion.

Its like the 350 million all over again... blatantly untrue and being spent multiple times over in the rhetoric we hear about the difference it will make.

In reply to Postmanpat:



Or build a small specialist team, taking on all the cases from trusts nationally that value over £10k ?

In reply to summo:

Something like that is bound to happen. We do love to chase the small cheats... keep counting those british value pennies while the pounds get ignored.

In reply to Offwidth:

Yes.

In reply to Postmanpat:


Actually, you are wrong there. The biggest group of 'health tourists" are British expats who live abroad and come here to use the NHS.

In reply to Postmanpat:

Oh and on an EU comparison... lets look at the health demographics... similar numbers on both sides (non UK EU citizens in the UK versus UK citizens in the the rest of the EU) with the Brits generally a good bit older and who has calculated how much these countries fail to charge back to the UK?

Looking at non EU citizens with expensive proceedures would be a lot more likely to save some money (health tourists must have assets if they can afford to fly here) even if the saving is a drop in the ocean compared to what is needed just to keep struggling on (let alone close the gap).

In reply to Offwidth:


>
The King's Fund isn't wrong, but your link focuses only on a very specific element within the report: deliberate health tourism, or fraud.
The report covers a lot of other categories which are not properly charged or the costs recouped. I've only skimmed the report, but the Newsnight summary was that of the total £2bn gross costs of these categories there were several hundred million in costs not being recouped where they should be. I don't have time to confirm Newsnight's summary at this moment!

In reply to Postmanpat:
It's obvious you have only skimmed. Its the total cost not the fraud cost. Also there is no possible EU fraud, just failure to claim back in a system that has little chance of identifying who needs claiming for. I'm aware others have come up with higher estimates but I tend to trust the independance of The Kings fund more... I clearly said this above... hundreds of millions isnt 2 billion.

In reply to Mr Lopez:


Expats account for about 15% of EEA resident NHS costs and about 3.5% of non EEA NHS costs. Source.The King's Fund.

In reply to Postmanpat:


That is what sells in the emotional world of the Right; "Lazy Johnny foreigner freeloading on the backs of hardworking British people. We must be sops to allow them to do this." etc...

In reply to Postmanpat:

Likely the biggest group of health tourists for any country or are we talking Daily Fail style Brits vs the World. Most of the EU 'tourists' are living, working and paying taxes here.

In reply to Postmanpat:

But we are talking about health tourism. " where people come to the United Kingdom with the express intent of using health services to which they were not entitled"

In reply to Offwidth:

No, we are talking at cross purposes. You are talking only about deliberate fraud. I am talking about unrecovered costs. As I said in my OP, the gross cost is estimated at £2bn and the next "loss" ie. unrecovered costs, at several £100mn. I was pretty clear on that and you seem to have ignored it.

The other problem, as the the King's Fund report notes, is that actually this is all based on top down estimates because the NHS doesn't have an effective way of monitoring usage by category.

In reply to Offwidth:

Took me a little while to find this, but here we go:
From Nye Bevan's essay "In Place of Fear A National Health Service" published in 1952

" One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of ... the total cost of the Health Service.
<snip>

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine. "

As true now as it was then.
Full text here: https://www.sochealth.co.uk/national-health-service/the-sma-and-the-foundat...

In reply to deepsoup:



The number of visitors to and temporary residents in the UK in 1952 was negligible compared to 2017. There was no way he could envisage the NHS as it is now or the demographics of the UK as they are now.

In reply to Postmanpat:


So minuscule in terms of the overall budget. So, regarding you point 2) above, harping on about this would be self-fulfilling scaremongering. In fact it would appear the NHS by whatever means is doing an excellent job of preventing "heath tourism"

In reply to Offwidth:
There are 10 million UK citizens without a passport and a passport costs £70 but lasts for 10 years.

It would cost the somebody (taxpayer or patients) £70M per year for the passport office to issue the required million passports or NHS equivalents.

The NHS exceeded a hundred million appointments in 2013.

The cost of checking ID to detect or prevent £80M of health tourism has to be less than 10p per appointment to make any economic sense.

10p is £80M saving minus £70M cost divided by 100 million appointments

I suspect the cost of checking ID at airports & ferry ports is more than 10p and not all of the £80M health tourism would be prevented/detected/recovered so it makes even less economic sense.

Those are rough numbers from Google.

In reply to Postmanpat:
Really? The Kingsfund report is clear enough (they dont talk fraud which would be exploiting non entitlement with deliberate criminal intent) and you say you've only skimmed that report. So what exactly does Newsnight think and why... maybe you need to find this and share it if you want to get on that high horse (their research, like the Kingsfund, not just the news which seems to me to get less reliable by the year).

Also, and not for the first time, you are arguing about the mouse and steadfastly ignoring the 40 billion elephant.

In reply to MG:

I repeat my first two points. It seems to me that when budgets are stretched every penny counts, and that collectivism works if the inputs and outcomes are perceived as "fair".

Surely, therefore, if you believe in such collectivism you should prioritise this fairness. You wouldn't tell examinees that because only on or two people in their class cheat at A-levels it should be ignored

In reply to Postmanpat:

No one serious has ever said ignore it... the immensely difficult question is how to deal with it practically in an already overstretched system. So back to my first post why isn't the elephant in the news?

In reply to Postmanpat:

Indeed, or he'd be up to about 3000rpm in his grave by now. Nevertheless, he's still right.

The last paragraph I quoted there particularly resonates with me: I'd like to rejoice at the 'opportunity to practice a civilized principle'. The whole agitation does indeed leave a nasty taste, the exploitation of the most disreputable emotions to rally decent people around the idea of being so mean to achieve so little.

From those who urge patriotism, especially, those who berate 'snowflakes' like myself for a perceived lack of national pride - it would help a bit if you weren't seeking to systematically dismantle everything we have in this country that we can all be proud of!

Edit to add:
"The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities"
I don't suppose he could have envisaged VAT at 20% either.

In reply to Postmanpat:


Of course not but it would hardly be a sensible focus of efforts to improve the exam system if less than 0.2% of students cheat.

In reply to Offwidth:
>
Yes really. The King's fund does have a category For "deliberate health tourism for urgent treatment" and another for "regular visitors taking advantage". Plausible additional cost £70-300mn. Most of this appears not be to be collected. (Table 7 for definitions). Some "health tourism" is of course legitiimate.
They summarise daily equivalent population of visitors and temporary migrants is around 2.5 million and the costs are about £1.8 billion for the normal use of the NHS
. We think that this probably in the range £1.5 billion to £1.9 billion. On top of this, there is a plausible range of around £100m to £300m attributable to health tourism. "

So, they have a total of around £2bn gross cost. What is very complicated (p28/9) is estimated how much of this is charged or recovered. For EEA citiizens only about 15% of that chargeable to the individuals is actually collected. In terms of EHIC reimbursements the UK pays out £173mn (for Brits treated overseas) and recovers £50mn but it's not clear what proportion of what should be recovered that £50mn represents (I think about 16% if I understand table 11 correctly) . The proportion recovered from non EEA citizens appears to be much lower.

Anyway, I think the Newsnight contributors concluded that the total not recovered was "several hundred million"

If you reach different conclusions from the Kings Fund report then let me know. I'll look at it more later.

In reply to Offwidth:


Because the gap is so large that politicians of all parties are frightened to raise the spectre of higher taxes or copayments to bridge the gap. I did see a cross party initiative to address the issue in the news the other day.

In reply to Postmanpat:

Help help! HMS Collectivism is sinking! She has been holed below the water line.

There's a mighty great gash on the port side, and the water is pouring in. The port watch are screaming to their shipmates of starboard watch to help them fix it.

Meanwhile the starboard watch has discovered a small, jaggedy hole. This hole is so small that HMS Collectivism could easily make it to a harbour to fix it if this was the only problem she faced. But the starboard watch find this particular hole amazingly irritating, it angers them so much that their constant calls for assistance drown out the screams of the port watch. This hole is so irritating to them that they are even prepared to cut a bigger hole of a more pleasing shape out of the hull to plug their jaggedy one.

In reply to Wicamoi:


What a weird response. For nearly four decades the collectivism has been in retreat in the UK and even in the great bastions of collectivism of Scandinavia it has come under pressure as people lose trust in it..
And you come out with this nonsense. It's a serious issue of which this NHS issue is just a minor example.

In reply to Wicamoi:



The starboard watch are also oddly welcoming to USS Insurance that is sailing nearby and repeatedly sending boarding parties to HMS Collectivism. At the same time they are firing cannons at the EUShip that they regarded as an ally for 50 years before abruptly trying to sink it.

In reply to Postmanpat:
Of course it's a serious issue, which is why people obsessing on minor aspects is unfortunate, particularly when it is clear this is done for political ends. Like Republicans obsession with voter fraud in the US.

In reply to Postmanpat:
No thats fair enough at last (albeit spun a little to your line). I would point out the UK gross is an NHS up front cost, very different to the overall cost to the UK and if the NHS gross are of the order of a billion why are the collective EU up front health costs of looking after those older Brits abroad in less efficent sytems going to be so much smaller. On this subject, 173 million implies huge missing costs ... a more useful difference between the two EHIC recovery figures is back around the 100 million mark.

Finally, fraud remains different to non-entitlement, and the Newsnight alternative analysis remains opaque in evidence terms.

No one is mentioning Health tourism of a different type makes the UK money as rich people come to pay for treatments and have to live and travel while they are here (and I guess like most private health arrangements they know when things go wrong, and create an emergency, the NHS usually steps in for free)

In reply to Offwidth:

We in Europe are accustomed to having sufficient disposable income that we can set up contingencies like insurance and savings. In most of the world, people live hand to mouth and simply can't afford any kind of safety net, meaning that when they get seriously ill the safest solution is to jump on the first 'plane out. That said, the case of the Nigerian woman looked un-planned; it looked as if her relatives in the USA had been intending to pay for her treatment. Nobody knew that her babies would be so premature or so ill.

I have a Nigerian customer who went into labour on a flight to the USA; the 'plane diverted to Glasgow and she had the baby there. After three days she got up, took the baby and walked out owing the NHS a huge sum of money. Some years later she kicked up a fuss when the BHC in Lagos refused to give her another visa....

In reply to Offwidth:
The Hospital programme the other night said it was less than 0.5% of the NHS budget, while that not a small amount.

It is smoke and mirrors and what are those in charge suggesting we do; let people die on the street?

A woman turns up ill at your hospital and she's pregnant with quads, to you turn her away for them all to die?

Who would do that?

In reply to Rigid Raider:

Sure but in most of the world, planning and affording such things is only possible for the small proportion of the very richest with particular conditions and a lot of whom are often assited by private health companies. For accessing the NHS direct for free there is still great expense and luck needed to get past immigration in all but those emergencies that happen on the plane (Ive had ill first time overseas students sent back home on the next plane).

I guess the Nigerian woman who ran was fraud based on fear of huge costs due to not having proper insurance but she didn't set out to defraud the NHS in advance.

In reply to Offwidth:

I don't think the Newsnight analysis is an "alternative analysis". He bases it on "a government sponsored report in 2013" which I assume , given the numbers quoted seem the same, is the self same King's Fund report.

http://www.bbc.co.uk/iplayer/episode/b08d66fy/newsnight-01022017 The summary is between and 25 and 27 mins in.
He quotes some of those numbers from the KF report I quoted above (eg recouping only £50mn of £300mn owing for treatment of EEA nationals), but also a number I couldn't find; the amount not recouped from non EEA nationals . He says we only recoup £25mn out of a total chargeable of £1bn. On that basis (and it is not clear whether all that £1bn should be recouped) , the total number not being recovered would be over £1bn rather than "several £100mn".

In terms of the difference between EHIC recovery figures, I'm not sure that I get your pint. We have no figure for the percentage recovery by rest of the EU, although the £173mn number may imply they are probably better at it. The key figure is that we only recover £50mn of 300mn in the UK so we are clearly crap at it. As the later contributors point out, the NHS problem is that it seems to have no system for identifying or charging or recouping these costs. It doesn't really know what they are.That seems to me pretty scandalous.

In reply to Postmanpat: can you clarify your position - should Johnny foreigners, who is working, and contributing to with taxes, get health treatment , or not?

Actually for the point of clarity can you state if you believe there should be universal health care or not.

In reply to Postmanpat:

You keep to your moral mouse scandals, the real scandal is the elephant. Recovery of costs is hard, recovery of fraud is harder still

http://www.acfe.com/rttn-summary.aspx

In reply to wbo:


I don't think you should use racist terms like "johnny foreigner". I hope you are not a nasty racist. Or are you one of those racist hunters? Good on you. We can't be too careful.

I believe that there should be universal healthcare for UK citizens, or other citizens ordinarily resident and paying taxes in the UK (I'm not going to get into a squabble about precise definitions of elegibility. You get the gist). This should also be available to EEA citizens or citizens of other countries with which we have a reciprocal arrangement, on the basis that the NHS recoups the costs as agreed under those reciprocal arrangements.

Citizens of other countries not ordinarily resident or paying tax in the UK should have access to emergency care and charged later. Elective or longer term care should be charged for-just as it would be if a UK citizen visited eg. Canada. They would therefore be well advised to to take out appropriate travel or health insurance before coming to the UK.

In reply to Offwidth:


You are well aware that I have bored for Britain many times on the subject of the elephant. That is not a reason to ignore the mouse.

In reply to Postmanpat:
I was tempted to write a massive reply to this, but it's mostly been covered. I will say this:

Part of the problem is that the moment Trusts flag a patient as a visitor they don't get paid by NHS England for providing care. So if you were to set a system for recouping money you're expecting already broke Trusts to bear the up front costs of setting it up for no potential reward.

Of the costs, the largest chunk is owed by national governments. IMO the NHS, especially front line Trusts, has no business in collecting this; this should be handled by govt.

Given the UK has no legal jurisdiction abroad, identification of costs is no guarantee of recouping them.

It's nice to know that people acknowledge employing more managers would be a good thing (someone would have to run this service).

Any variation in 'free at the point of care' has repercussions. If you're scared you're going to get charged, under current law you can just go to A&E. If you're really nice you'll wait til you're a bit sicker before doing that. You're asking the NHS to bare both the system costs badly written legislation and the change in perception enforcing such practises would have.


I'm not against it in principle. In the same way that I'm not against charging for GP appointments in principle. We are also doing something about it. If you really care about this sort of stuff, https://www.nao.org.uk/wp-content/uploads/2016/10/Recovering-the-cost-of-NH... and https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3... give you more detail as to the problems (depressingly, I've read all three).

In reply to Postmanpat:
Indeed but hardly with much conviction in support of the NHS and with an equal amount of 'think of the children' logic (thats pretty much what this moral outrage on cheating amounts to) in the face of the figures and difficult practicalities and moralities of any improvements, and little more than ideology on the liklihood your proposed solutions could work. Sure the NHS was born of an unusual period of collectivism but its current support is despite a significant public decline in that ideology and more importantly now being clearly evidence based. Even you must acknowledge its at least close to par for nortern Europe on a GDP per capita expenditure vs outcomes basis, unlike say the dreadfully expensive US insurance based system.

As for you, yes of course I think your heart is in the right place and if the changes you proposed happened and went wrong I suspect you would grudgingly apologise. You do make a good foil and rarely talk complete shite, so making UKC more fun to visit. In contrast it is utterly depressing to watch yet another person on Question Time last night admit to changing her mind and voting for brexit over banana regulations...stupidity (and loutishness) is a growing infection on UKC.

In reply to BFG:

Havent read the links but essentially the gist seems to be (?) that it may cost more to put in than it recoups or so complicated as to be impractical or counterproductive. If the analysis is thorough and that is the outcome then so be it: don't proceed.

In reply to Postmanpat:

But, but, but... think of the childen.... with such lax morals the system will break.

In reply to Postmanpat:

Well, kinda. I don't want to be entirely negative, but it just strikes me that, given the above, asking 200-odd organisations to set up new departments to chase 0.5% of their individual budgets is just asking for duplication of costs and waste. If its a worthy activity, it should happen on the back of legislative change and run as a joint Department of Health / Home Office project.

In reply to Offwidth:

In contrast it is utterly depressing to watch yet another person on Question Time last night admit to changing her mind and voting for brexit over banana regulations...stupidity (and loutishness) is a growing infection on UKC.

It's not one sided though. I voted remain and some of the statements coming from other remainers is equally depressing.

In reply to FactorXXX:

Absolutely. My point wasn't about brexit it was about people believing pretty obvious lies.

Another absolute classic here from so called pre post-truth days:

http://www.bbc.co.uk/news/magazine-35962999

In reply to Postmanpat:


If the 'unfairness' accounts for a mere 0.05% of budget, frankly, I don't give a f*ck.

Sort out the crazy wastages I mentioned earlier, all of which are political meddling.

Above all, I want to see an efficient service. Pissing money away to enforce insignificant (0.05%, FFS) 'unfairnesses' is not efficient.

How much money was wasted on various NHS computer systems over recent years? Billions, that's how much. Here's 10billion for starters:

https://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn

That's 8.5% of annual budget, or 170x your 'unfairness'. Now, which do you think is the bigger problem and the sort of problem we should be tackling first?

Go on, take your time.

Is it still 'cheating, idle, Johnny Foreigner'?

ps. Don't fucking dare try to lecture me that it's a racist term; I'm using it with deliberate ironic intent, since that appears to be YOUR genuine mindset.

In reply to captain paranoia:



How about we don't spend them in the first place?

In reply to Big Ger:

Oh right, so the Nigerian woman mentioned above should not have been treated then?
She and/or her baby should have been left to die?

I don't think the NHS is currently staffed with people who are willing to do that, and I'd *really* prefer it if the management don't try to compel them to. Quite apart from the shocking immorality of it, it'd be a great way to drive the best of our doctors and nurses out of the service, perhaps out of the country, at a time when we're seriously short of them and only likely to become more so.

In reply to captain paranoia:










You appear to have have missed the bit where i pointed out that, on the figures available, the costs of instituting a charging system would cover themselves in a couple of years.
On the broader point, you appear to agree that the NHS is guilty of inefficiency eg. IT failures. Some are bigger than others. It seems odd to ignore any of them.

PS. Haha. When did u use the term "johnny foreigner"? Have u just given a game away? wbo apparently feels that he is so morally superior that he has a right to accuse anyone who disagrees as "racist" through his ironic use of the term "johnny foreigner" . Are you spitting the dummy on his behalf? It would appear that you pride yourself as the racistfinder general rather than the racist.
It's not complicated. The issue has nothing to do with race. Those who use the "racist" slur are substituting analysis and an attempt to understand the issues with unfounded and casual abuse. So don't start it or you might get an ironic response.

In reply to Postmanpat:

That's 8.5% of annual budget, or 170x your 'unfairness'. Now, which do you think is the bigger problem and the sort of problem we should be tackling first?

Go on, take your time.

In reply to captain paranoia:


It's a very simplistic approach. On the face of it certainly the relative budget shortfall is the major issue, but it is also a political minefield to address it. (see previous threads for discussion of this). Productivity, of which the failure to recoup costs is an integral part, is a less politically difficult fix and, so one reads, there is much "low hanging fruit" to be plucked.
So, the obvious strategy would be to make aggressive ongoing attempts to improve productivity whilst trying to build an understanding and consensus on the budget issue. I can understand, of course, why if somebody can't see beyond "racism" as the reason for wanting to address a productivity issue, they might not see it as a priority.

In reply to deepsoup:

The one who could afford to fly to the UK to give birth? The well to do woman from Lagos? This woman?

The Nigerian mother obtained a visitor’s visa soon after discovering she was pregnant in 2010, travelling to the UK to stay with her younger sister, Stella, early in her pregnancy. She gave birth to two boys and three identical girls at Homerton Hospital in Hackney, East London, in April 2011 – seven weeks premature. She had a complex caesarean and remained in hospital for almost two weeks after the birth at a cost of £145,000 to UK taxpayers. Despite having an expired visa, Miss Ayelabola continued living in her sister’s flat in Poplar, East London, after the births. She didn’t return home until February 2013. Miss Ayelabola has since returned to her home city of Lagos, where she is a successful make-up artist.



No, we should have murdered her and danced around on her grave singing "hallelujah", get a frigging grip.

Why is it that some seem to think; "if I can find one extraordinary, unique case, emotionalise it, and present it, then no change or practical solutions should be found to NHS problems, and we should continue give everything away for free to anyone who turns up in the UK"?

In reply to Big Ger:

Wrong woman (with the report cut and paste from the Daily Fail). Have you fully paid up your UK National Insurance as a matter of interest?

In reply to Big Ger:

The only way to "not spend the money in the first place" is to deny treatment to anyone who does not have the means to pay. Rant at me all you want, your suggestion would require NHS staff to allow people they could otherwise treat to suffer and in some cases die.

It doesn't require an "extraordinary, unique case", a perfectly ordinary case will do. One person in need of urgent treatment, who doesn't have the means to pay. You treat them anyway and spend the money, or you withhold treatment as you suggest and allow them to suffer and die. Get a frigging grip yourself.


Ironic then, that this is itself an emotive strawman.

I'm not suggesting anything of the kind, merely pointing out the obvious consequences of what you suggest. Forgetting about the morality of it for a moment, it also is not a practical solution. It might bring about a 0.5% financial saving, at what cost to the morale of the caring people who would be asked to withhold treatment? With a recruitment crisis already unfolding, and not nearly enough doctors and nurses currently being trained, what will it cost to lose some of the best of those people?

In reply to Offwidth:

A woman. Same idea.



Yes, to ensure I get my full pension at age 66. Have you ever worked for a living?

In reply to deepsoup:

No, the way to not spend the money in the first place is to ensure that only those who are eligible get treatment.


So anyone who can get themselves to the UK should be treated on the NHS?




So anyone who can get themselves to the UK should be treated on the NHS? Isn't that discriminating against people who cannot get here? Shouldn't we be trawling the world for people to treat on the NHS, otherwise your just treating the well to do, rich, and resourceful.

Highly discriminating is that!




But if you have your way, and anybody who wants free treatment just has to make their way to the UK and present at a hospital, then soon that 0.5% will become 50% and then 150%.

In reply to Big Ger:

Ah bless, the old reductio ad absurdum argument! Haven't seen that old chestnut for a while!

Healthcare tourism is an issue, but all the stats indicate that it isn't a very big one. We can do better at recouping costs from rich people but other than that? I'm not sure that it is a problem for the foreseeable future.

But you keep worrying about 'what ifs...' and we'll still take you in and treat you for depression, heart attacks or whatever. Happy to do so.

In reply to Big Ger:

And how exactly is that is different to denying treatment to those who can't pay, are uninsured, or otherwise as you say are not 'eligible'?


Anyone who turns up in A&E in need of urgent treatment should be treated, yes, obviously.

You're insisting that I've got you all wrong, but without saying what you do mean.
What *do* you mean?

A hypothetical Nigerian woman is on a flight, travelling home to Nigeria from the USA via Heathrow. She's pregnant, and goes into labour prematurely on the first leg of the flight. The captain radios for an ambulance, and as soon as the plane lands she is rushed to hospital. Without treatment she, her child, or both will die.
She has no health insurance that will cover her treatment, hasn't the means to pay for it.

I'm saying she should be treated. You're refusing to say that she shouldn't, but you are saying the costs of treating her should not be incurred. How is that not the same thing as withholding treatment? And in the case of urgent treatment, how is that not the same thing as leaving her to die?

On a more practical level, as it stands now the staff at an NHS A&E department will take her in and treat her regardless. You do not become a doctor or a nurse in an A&E department if you're the kind of person who's willing to leave someone to die on the doorstep.

If it's policy that she should not have been treated what then? Sack them? At a time when we are increasingly short of doctors and nurses, and failing dismally to recruit and train enough even to maintain current numbers in to the future?


Strawman.


Also a strawman.
I do have my way. Have done for many years - the essay I quoted above was written in 1952.
The 0.5% remains 0.5%.

In reply to Offwidth:

I believe that in an emergency medical treatment SHOULD be given. I also believe if you can afford travel
arrangements then insurance should be MANDATORY too. Any medical issues etc. won't exist then.

How do you control that? Same way as requiring a passport to travel. Try getting on a plane without one.

In reply to brianjcooper:

If you apply for a Russian visa they ask for your medical insurance details.

I think it my be the same for India.

In reply to brianjcooper:

I would broadly agree with this. With regards to the Nigerian woman above, under the law as it is atm the NHS does not seek to reclaim costs related to giving birth (from non EEA citizens), so it's not an NHS issue; it's a central govt issue.

It broadly strikes me that the NHS is a healthcare provider, not a debt collector. I don't see a good way for this to be managed at the front lines. Fundamentally, you're either going to have to deny care (no A&E til I see some ID) which would have huge practical (and moral) consequences, or you have to chase after provision. The NHS has no right to detain people so it's not like you can lock em to a gurney til the cough up a credit card.

Remember that since the internal market / purchaser-provider reforms of the early 1990s each trust operates as its own 'business' (kinda). So you'd be asking 200-odd companies to institute their own depts / new practises. Given the volume of cases you'd be dealing with you'd be throwing money away.


Basically, 'free at the point of care' is predicated on being a citizen of the country. Fine. But that doesn't mean the NHS is in the best place to be checking that when someone comes through the doors. Health tourism is an immigration (have insurance) / national govt / The Home Office.

If you want an overview of the structure of the NHS this is a good start (though a little out of date now): youtube.com/watch?v=8CSp6HsQVtw&

In reply to BFG:

Ah, now *there* is something a bit more significant than the 0.5% we've been wrangling over. Reforms of the early 1990s, continued through Blair/Brown's enthusiasm for various PFI schemes and greatly accelerated after the Tories returned to power in 2010. Especially after the 2012 'Health and Social Care' act effectively abolishing the National Health Service by removing the Secretary of State's overall responsibility for the health of the nation for the first time since 1946.

Money is already being thrown away (from the taxpayers' point of view). There is one area where the American model (which spends more taxpayers money per capita than we do, yet leaves many without cover) really is the envy of the world - transforming taxpayers' money directly into corporate profits.


Is it though, really? When did it become so? The founder of the NHS certainly didn't see it that way, and clearly explains why in the essay I posted above.

In reply to deepsoup:
Well, as you've just said, what we have now isn't what was originally envisaged, and if we were to redesign the system from the ground up to meet today's / tomorrow's needs we probably wouldn't end up with either. So whilst Nye Bevan's ideals are worthy, that alone doesn't make them correct.

Regardless, I do agree with him, as I clearly said just before the line you quoted. What I meant was more "if you think that 'Free at the point of care' should be predicated on citizenship then Fine. That's not the crux of the issue".

Partially, that's because there's ideological scope here. Free at the point of care doesn't prevent the NHS from chasing the occasional private citizen for payment *at the moment*. We also cross charge governments for care provided to their citizens.There is no contradiction in saying 'free at the point of care to everyone who turns up, but if you're not a citizen we might try and reclaim that'.

Given that's what it's actually like this is a practical issue: are we managing this payment system well? Realistically the answer is no, mainly because the internal structure of the NHS and the legislation that applies to doing it is a mess. the short of it is: this is not an issue for Trusts, but govt.

I would also disagree that the NHS stopped being 'national' in the 2012 reforms; it's just a bit reductive.

In reply to BFG:

Not really. As the Russian visa comment above mentions, to have been able to travel in the first place you would have needed insurance. If we adopt the same, then A&E wouldn't need to check for documentation.

In reply to deepsoup:

Anyone requiring emergency treatment should receive it.

Anyone making their way on from another country to get treatment should pay for it.

In reply to Offwidth:

NHS hospitals in England will have a legal duty to charge overseas patients upfront for non-urgent care if they are not eligible for free treatment. From April this year, so-called health tourists could be refused operations unless they agree to cover their costs in advance. NHS Improvement, which oversees the trusts, said hospitals would no longer have to chase money they are owed. Emergency treatment will continue to be provided and invoiced later.

There you go, sensible enough.

In reply to brianjcooper:

Sorry, clearly my previous comment wasn't well written. The reason I was saying I agree with you is those are the only two options if you want Trusts, frontline providers, to charge. For the reasons given in my previous two posts that would be a bad idea. If you want to manage it you need to look to national solutions, such as the visa one you mention.

In reply to Big Ger:

Not really, the vast majority of the £500mil figure routinely used is neither deliberate health tourism or chargeable under that, given that it's within the current rule structure (so doesn't cover EEA, emergency, maternity etc). That duty already exists, I'm not entirely sure what they're using the justify it as 'news'.

It's not working at the moment and this won't make a difference. If you want the UK to be better at reclaiming this then the changes that are needed should happen 'up stream'.

In reply to BFG:

Well that all sounds very convincing, now, care to back it up?

In reply to BFG:
The idiots win again. Ill informed outrage leads to more impractical and very likley loss making activities for the NHS (I failed to see the funding boost and structured advice to solve the problem on the ground) that simply, cant be supported on a local basis by many of its professionals (there is no way most doctors will currently refuse to treat ill people before payment is made). I guess the government are delighted as its a fresh smokescreen for their underfunding and red meat to their fans. This was always a home office issue and the problems there are all down to St Teresa.

Ipsos say 50 % dont want to pay more tax for the NHS.. these days we get our cake and can eat it.

In reply to Offwidth:

This may be of interest.





http://www.privatehealth.gov.au/healthinsurance/overseas/

In reply to Big Ger:

The total incompetence of governments who think that making a policy a 'legal obligation' automatically removes any practical or operational difficulties implementing it beggars the imagination.

Truly they are not fit to run a whelk stall; and if they were asked to they would probably sub-contract it out to Capita and consider it job done.

In reply to Rob Exile Ward:


Is that what they've done? Really?


As opposed to Corbyn et al who shouldn't be allowed a pet welk.

In reply to Big Ger:


See my previous two messages. If you want the evidence for what I'm saying see the National Audit Office Report into the DH's policies and their own Impact Assessment, both linked at the end of my first post.

In reply to Rob Exile Ward:

A consultant has just been on the BBC morning news accusing Hunt of a smokescreen.. he agrees there is a problem but he says the initiative is unworkable. As an example there is only one manager currently tasked to recover money from 3 London hospitals and his job is now clearly impossible. He thinks compulsory insurance at immigration is the only practical solution... but hey he is probably just obsessed with pesky evidence and facts?

In reply to Offwidth:

Have you read BFG's links, which provide an outline of the costs, benefits, an alternative mechanisms to charge or recoup costs. One of them estimates a net present costs (over 10 years) of implementing a system at £33mn and a net present value of benefits at £1.658bn. On the face of it this appears to be a no brainer. BFG seems to think that these mechanisms are unworkable. I'm not clear whether your BBC consultant is saying "there is no mechanism" or the budgets don't allow for a mechanism, or is unaware of the details of the proposals.

Either way, it doesn't seem that the evidence and facts are lacking on the part of those proposing change, simply that others believe that the estimates and proposals are not necessarily reliable or workable.

Aren't you the one guilty of politicising the issue by creating a false choice between improving productivity and increasing spending when in reality both are important, and seeing conspiracies behind straightforward good housekeeping?

In reply to Postmanpat:


How much would that cost to check the immigration status and entitlement of every patient ? How the NHS is supposed to deal with the millions of British citizens who don't have a passport ? It's possible but that would probably mean effectively bringing a form of centralised ID database (many people are opposed to it) and the costs are likely to outweigh the benefits.




And that's why the debate should shift from perceptions to realities.

In reply to Postmanpat:

To be clear, the solution I think is unworkable is the idea of Trusts recouping the money. I would agree with the Consultant (broadly) that, if it is decided that this is a worthwhile pursuit, the approach should be around ensuring the health insurance of visitors and the mechanisms of recompense are only really enforceable at the national level.

This also needs to be backed up by changes in the law as, despite the legal obligation, in practical terms Trusts are financially disadvantaged if they try and pursue these funds and the situation in general is really complex. Complexity is a cost.

In reply to RomTheBear:


Well, I suggest that you start by reading my post of 10.12 and then read BFG's links which analyse the options available.
If it's not cost efficient then so be it.

In reply to Big Ger:



So if I need emergency treatment in the USA I will get it for free if I'm uninsured, and also have no way of paying for it later?

In reply to Postmanpat:

Of course I am guilty of politicising... its my clear intent here. The problem I am concerned with isn't your 'whatifery' (I'm pretty sure we would agree systems could be improved and more money recovered), it is what is currently possible in the face of this initiative and what it will cost trusts up front (who are in many cases barely able to cope financially as it is) and how it will effect the current systems (delays for everyone and putting off people who need treatment) and what the front line staff think about it in moral terms (very little support). As I see it, the only way to stop fraud in a serious way is an identity card system (that old labour idea ... a very expensive white elephant in my view). Even with insurance there is an incentive to pretend you are British, giving a friend's address, false name, etc. I find it very odd that quite a few of the publicly highlighted cases of health tourism are nothing of the sort when you examine the details (odd really the Fail needs to bleat about this when its obviously not true: like the Nigerian who went into labour on a return journey from the US via Heathrow).

In reply to Offwidth:
>
What do you mean my "whatifery"? It's an officially sanctioned report and proposal.

It now seems that your objection is not to the idea of charging or recouping the costs. It is simply an argument with the legal requirement soon to be announced (which I agree with you on, although it actually seems to be a requirement already) and a discussion about how such a proposal should be phased in and funded (which is clearly matter for debate).

Do you accept that if a cost efficient way of recouping the costs can be designed then it should be pursued?

Quite possibly the initiative is being launched with the usual Hunt care and subtlety but that doesn't mean it is a purely political initiative as opposed to a possiby ham fisted way to address a cost problem.

In reply to Postmanpat:

'Do you accept that if a cost efficient way of recouping the costs can be designed then it should be pursued? '

If you'd said 'cost efficient, humane and workable way of recouping the costs can be designed then it should be pursued? ' then I would agree, no problem at all.

I *suspect* that a lot of so called health tourists would pay if they were given the opportunity to do so; and those that weren't prepared to pay could and should be banned from re-entry to the UK until they settle their outstanding bills.

In reply to Rob Exile Ward:

From an earlier poster:


Sorry it still sounds like slamming the gate after the horse has bolted. Surely prior to visiting insurance should be in place. However. I still believe emergency treatment should always be made when needed.

In reply to Postmanpat:

I did but it's completely unrealistic and incomplete.
The elephant in the room is that there is no way for the NHS to check the identity and immigration status of every patient who comes in with accuracy, unless we start giving ID cards to everybody.

In reply to Offwidth:
http://www.bbc.co.uk/news/election-2015-32167763

Government policy now. One London trust is owed just short of £5m from "health tourists".

In reply to Offwidth:

Sorry, haven't had time (inclination?) to read through all this, but I did hear it today admitted on a WatO interview that the amount of money all this fuss is about is 0.1% of the annual health budget, so we are getting our knickers in the proverbial (or at least The Mail is) over a sum of money which, although sounds huge in relation to a typical citizen's budget, would keep the NHS going for about 8 hours or so. I'm sure our time and efforts could be better spent picking the low-hanging fruit.

In reply to Rog Wilko:
It's a bit more complicated than that. Deliberate health tourism: at most about 0.08% of the budget. You've got the wider spend on those who aren't UK citizens. Depends on how you define it - but it's stuff that you might be able to charge for. At most that's about 1.7% of the budget, though I have just calculated those off the top of my head.

In reply to Postmanpat:


You should know that such simple cost/benefit analysis carries no weight with a Tory government. Just look at their policy towards HMRC and tax evasion. I seem to remember they slashed the number of people working on tax avoidance, whose efforts were estimated to produce over 20 times their salaries in the form of recovered tax.
But perhaps their hearts aren't really in tackling tax avoidance. Or the NHS, of course.

In reply to Offwidth:

Radio 4 on the Today prog this morning was good. A chap said that a more major issue was the overuse of limited resources. He cited Nigerians coming here following IVF treatment and having multiple births ie 3 and 4 children, and thus taking up intensive care peadeatric places, which are not available in Nigeria.
His solution was that to gain an entry Visa and person mus prove they have £30K worth of health insurance.
Worth a listen.

In reply to Rog Wilko:

>
Well it seems to in this case.

In reply to RomTheBear:


As the reports suggest,trying to find out might be a start.

In reply to Postmanpat:

I'm telling you what's going to happen: as soon as someone shows up with an odd accent or looking somewhat foreign they'll be ignored or placed the back of the queue.
The home office is asking various parts of society to do their job, it's already started with the immigration bill, asking for landlords to check the immigration status of their tenants, which of course in many cases is next to impossible unless you're an immigration lawyer.

I have a simpler solution : we ask the home office to do their job instead of asking doctors, banks and employers to do it for them, because we know very well it inevitably ends up in discrimination.

And it doesn't matter hue much restriction/barriers we put in place, those who want to complain that the system is unfair and abused by evil foreigners will still do.

In reply to RomTheBear:

>
But this isn't the Home Office's job because it's not about the right to enter or reside. It's about the right to free healthcare at the point of service . It's the NHS's job.

Anyway, never mind that, did you enjoy the Superbowl? Good game, eh?

In reply to Postmanpat:

The NHS job is to provide healthcare, it's not their job to find out who is entitled to what.
Either they come up with mandatory IDs for everyone and then it's simple, or they should check who is entitled to healthcare case by case themselves.

In reply to RomTheBear:


Well, it's one point of view. Others are available.

Didn't enjoy the game then, I guess.....

In reply to Mr Lopez:

It does not matter who they are or where they come from, if people come here ( on a non emergency ) who are not entitled to free care they should not be allowed to take up the place or the scarce resources that will then be denied to others who are entitled. The cost is not the only concern.

I just watched ' Hospital' dealing with this subject, a man from Turkey ' visiting' the uk, presented with a heart condition, he was informed of the charges, he received treatment costing £20,000 which he did not pay. Who else ( who was entitled for treatment) was denied treatment
That day.

Edit, the more I watch, there seems also to be people living here ,originally from abroad, who have sick relatives abroad , they invite their relatives come over on 'holiday' and they then present at the NHS with pre existing conditions that they are not entitled to for free.

In reply to BFG:


What's wrong with requiring medical insurance to enter the country?

In reply to brianjcooper:


Wut?

In reply to Rob Exile Ward:


Why not look to other countries for their solutions?

It's not a problem here.

In reply to Big Ger:


France ? They have IDs, carte vitale etc etc..
The far right still complains of the evil foreigners abusing the healthcare system anyway.
There is no real issue in the first place

In reply to RomTheBear:
IDs, not a bad idea.


Germany seems to have it sorted too;


Belgium too;

https://mobile.twitter.com/drbenwhite/status/828673591940112385
In reply to Offwidth:

Nice pie chart of the issue here

In reply to Big Ger:

But that's not the issue here, it's already largely the case that in the UK, unless you are resident and working you can't get access to the NHS for free.
The issue is that it's not enforceable because there are no IDs and the NHS is free at the point of use.

Just Gonna leave this here. As far as I can see, his answers are basically the same as mine:


"The Tinkerman has a busted budget, no parliamentary time to dismantle the Health and Social Care Act, so he can only 'tinker'. Yesterday his head was under the bonnet, fine-tuning Health Tourism.

Yup, we are a national health service not an international health service. I agree, every penny of the taxpayer's hard-earned should be spent wisely and well.

How much of our NHS is pinched by Johny Foreigner? Is it £200m or it could be £400m a year. I don't think we know. Might mean £50k per Trust?

The sums are small but the principle is big.

Can someone really run off with a free hip operation? Can they steal a new knee?

An ex-pat living in Spain might be able to wangle it, via their old GP, if they stay on-the-list and have an 'address' here. They might get expensive med's that way, too.

The pathway for elective procedures starts with the GP. To register with a practice is more difficult these days. Practice managers are a savvy lot and they will want a passport, driving license or some such and a lecky-bill.

Asylum seekers are exempt. Migrants can be muddled up with visitors; a bit of a challenge... you might be able to 'borrow' your second cousin's gas bill. But by and large primary care has it cracked.

Collapsing in the street; it might mean a visitor has a blue-light ride to A&E where the focus will be on saving a life.

Emergency care is provided, free, under international convention. As a rule of thumb; when a patient reaches a ward the meter starts running.

The Tinkerman's latest will oblige Trusts to make an estimate of the cost of additional care and charge up-front. If our heart attack patient needs major surgery and is unable or unwilling to pay, the best we can do is shove their stuff in a plastic bag and call a taxi.

How the doc's and the nurses are going to like doing that!

We have reciprocal agreements with our EU partners but I guess they will be torn-up. If they are, life might get tough for ex-pats. There are arrangements with some Commonwealth countries.

Maternity? Airlines have guidance and rules about carrying pregnant passengers. It varies but 28 weeks seems to be a consensus cut-off-no-fly-point. What to do if a pregnant visitor collapses in the shopping centre, an ambulance called and a little Fernando decides to arrive early? It's on the house. But...

... what happens if the birth goes horribly wrong and Mum ends up with a bill for a week's worth of paediatric intensive care? We issue an invoice, she goes home to South America and we never see Fernando again.

The more you think about this the more you realise it is not an issue for the NHS to resolve lone. They are as much the victims.

It's like penalising Marks and Sparks for shoplifters pinching a pair of their socks.

Answers?
• If it becomes impossible to determine who gets what, we will have to make everyone prove who they are before we open the medicine cabinet. That might mean Identity Cards for every one. Home Office, get busy.
• If you don't like that, make it a UK entry condition; proof of health insurance or the means to pay a bill of at least £50k. If someone slips through... send the bill to the Boarder Agency.
• If a visitor receives unexpected healthcare they cannot afford (a by-pass following a heart attack, say), send the bill to the embassy for the Foreign and Commonwealth Office to follow up. If they can't get paid, take it out of their budget.
• If somebody does find a way to pinch a new knee, it's theft and a job for the police.
I can't help thinking there is more to this than filling the £22bn black-hole in NHS finances.

It's much more likely to be about Brexit; immigration, talking tough, looking busy and playing the game at Cabinet."


-----------------------
Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.
Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.

In reply to BFG:

That.

In reply to Big Ger:

I was just being flippant!

In reply to RomTheBear:


Surely the issue is that you CAN get treatment free if you are not resident or working.


The issue is that it's not enforceable because there are no IDs and the NHS is free at the point of use.

Well there should be then.

In reply to brianjcooper:


Still doesn't make sense.

In reply to Big Ger:

You can't, theoretically, these are the rules. In practice they are not respected because the rules are stupid and unenforceable.


Well totally agree. But that's not what the gvt wants to do, they don't want to introduce any IDs, instead they put the burden of doing the identity /entitlement checking on the NHS

In reply to RomTheBear:



Well people do, and so the rules need to be tightened and / or changed.




Very nice to agree for a change.

In reply to Big Ger:

The estimate for the cost of ID introducing cards 10 years ago was about £5bn and that was almost certainly a big underestimate, so it would make no financial sense. Simple measures like demanding passports/visas/NI numbers/utility before issuing NHS numbers and allowing treatment, and demanding insurance from non EEA visitors would surely be a start and would both catch a lot of low hanging fruit and put off many misusers.

In reply to Postmanpat:

True, but a universal ID card, as used in other nations, may address more issues than just this one.

In reply to Offwidth:

"Give me your tired, your poor, your huddled masses yearning to breathe free.”


What if this became a trend? What with healthcare costs in the US.

In reply to Big Ger:


Well obviously the thing to do then would be to build a wall. And get the Americans to pay for it. Problem solved.

In reply to Postmanpat:

Funnily enough the Scots appear to be tackling - and solving - this problem. They have a thing called the CHI number - community health index - and increasingly you have to have one of these before receiving treatment. E.g. if you want a sight test an optician can look up your CHI number and check that you are eligible.

In reply to Postmanpat:
' and demanding insurance from non EEA visitors would surely be a start and would both catch a lot of low hanging fruit and put off many misusers.' That's not so easy in itself. If a Russian rocks up with an official looking Russian insurance document who on earth is going to be responsible for checking whether it is valid or not? And the idea of charging for treatment upfront isn't too clever either - how does anyone *know* how much it's going to cost?

It really isn't that difficult. 1) Ensure that any treatment provided FOC at the point of need is recorded reasonably accurately at the point of delivery, for any px not registered with a UK GP. 2) Present said px with itemised invoice on discharge, together with an easy means of paying i.e. PDQ machine. 3) Report any patient who doesn't pay to Immigration, and ensure they are excluded from further entry to the UK until they settle in full.

It wouldn't get everybody, but the rich would no doubt stump up so that they can continue to enjoy the dubious privilege of shopping in Harrods on future visits, and the poor would either have make sure they have insurance or be excluded from the UK indefinitely - but they probably couldn't have afforded to pay anyway, and you can't get blood out of a stone.

In reply to Postmanpat:


You're going round in circles.
What you are saying is that we need to ask anybody who seeks treatment to prove their identity. And there is no way we can do that without a form of ID.
So we end up where we started - everybody needs an ID then.

In reply to Rob Exile Ward:

>
Yup, no system is going to be foolproof, even an ID based system, but having no system is just mad. So introducing some practical checks at reasonable cost to disincentivise "fraud" and implement existing recharging guidelines seems like a sensible start.

In reply to Postmanpat:

"Practical checks" such as ... checking a person's identity. Back to square one everybody then needs to have a form of ID in one way or another.

In reply to Postmanpat:
Round we go again. There is an existing system in most hospitals... why not talking to some hospital managers some time. Its not very successful as its hard to spot who to charge and hard to follow up if people don't pay. None of that has changed with the government edict... just extra costs likely and longer queues and more arguments with the qualiifed medical staff (who won't refuse to treat). Its all a bit Stalinist excepting Stalin didnt have to deal with The Fail partly causing the pressure for such a daft solution that is bound to achieve little (if anything). In politics though such facts don't count: give out more red meat and keep bashing the system until it changes to suit your ideology.

The govermment could have chosen to insist on and check medical insurance at immigration but even then, as numerous expert commentators have pointed out, without verifable ID (like a very expensive ID card system) cheats will still prosper.

If you want to deal with the real low hanging fruit invest in more tax officers before hospital money chasers. If you want to deal with the real NHS problems invest more, preferably to the EU 15 average.

In reply to Offwidth:

>
Which don't work. Let's just give up then.

In reply to Postmanpat:

Oh no... a worse system that will work even less well is clearly good politics now, so its nothing to do with efficiency. As I said, you need to try a bit less internet theorising and a bit more contact with those involved. If health experts were playing whatifery with your job I'd be defending you.

In reply to Offwidth:

So, what actually is your answer to this dilemma?

To maintain the status quo?