NHS hospitals should charge foreign patients “upfront” unless the case is an emergency, the government has said – as a damning report warns Britain is failing to recoup hundreds of millions of pounds.
MPs said “chaotic” systems and a lack of sanctions for hospitals which failed to recover debts meant legitimate patients were being starved of vital resources.
It comes as a BBC documentary revealed one of the largest hospitals in the country is owed an estimated £500,000 by a Nigerian woman, after she went into labour with quadruplets three months early after landing at London Heathrow in November.
The 43-year-old, named only as Priscilla, has said she is unable to pay the bill and was expecting to give birth in the US, where she has family.
The health service is supposed to reclaim the costs of treating patients who come to this country from elsewhere in Europe, under reciprocal European Union (EU) arrangements.
But a report by the Commons Public Accounts Committee (PAC) says the UK is getting back less than £50m back for the costs of treating European patients – while paying out £675m for care of Britons in Europe.
While Poland claimed £4.3 million from the UK for care of Brits staying there annually, the UK claimed just £1.5 million from Poland, the committee found.
MPs urged ministers to “get a grip” on the problem – warning that Brexit could cause “further uncertainty” in a system riddled with “unacceptable” failings.
The commitee said it was not confident that the Government was taking effective action – and suggested the NHS had shown little desire to tackle the problem.
The damning report sets out a host of failings against policies to recover NHS funds, warning:
- Forecasts to recover £200m from European patients have been rewritten, after the Department of Health admitted just £72m is likely to be clawed back;
- Just one in five NHS trusts anticipate any significant increase in recouped funds, with MPs suggesting that few have the “will” to chase debts;
- A target to reclaim £500m a year from all overseas patients by 2017/18 is set to be missed by more than £150m;
- GPs are failing to identify overseas patients, with no systematic arrangements in place to ensure patients are billed;
Meg Hillier, PAC chairman said: “The Government’s failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds.
“Our committee has reported extensively on the financial pressures facing the health service and it is simply unacceptable that so much money owed should continue to go uncollected.”
“The systems for cost recovery appear chaotic,” the report says. “The Department told us it was planning further changes relating to policy and regulation, good practice and IT, but we are not convinced that enough is being done to identify and charge overseas patients”.
In evidence to the committee, the DoH said all trusts would now be encouraged to tell patients the likely cost of treatment in advance, with payment secured “up front” wherever possible.
The report said the failure to collect payment from patients who were not eligible free care, was limiting resources for those who were entitled to it.
“If the NHS does not recover the cost of treating patients who are not entitled to free care, then there is less money available to treat other people and even more pressure on NHS finances,” the report states.
Some trusts were found to be collecting as little as 15 per cent of debts owed.
The committee also suggested the NHS had shown a limited appetite to tackle the issue.
“Increasing the amount recovered depends on action by hospital trusts, but only 11 of 50 trusts that responded to a consultation thought that their income from overseas patients would increase significantly in future,” the report said.
Just 10 hospital trusts accounted for half of the charges to visitors from beyond the European Economic Area.
The report suggests trusts should follow St George’s Hospital in London, in introducing stringent tests of eligiblity for maternity care, after it became the victim of a health tourism scam.
“This suggests it may be possible to take effective action when there is the will to do so. However, there are no clear, consistently applied, sanctions when trusts do badly,” the report warns.
It also calls on GPs to do more to help identify those patients who should be charged for NHS care.
And it said the current rules are hard to enforce. MPs said the NHS should expand identity checks to establish entitlement to free care, because pilot schemes demanding passports and utilities bills do not prove eligibility, while penalising those who struggle to provide them.
Last year a London trust was revealed to be running a Home Office pilot scheme, which demands that women hand over passports before they give birth.
St George’s Hospital in south London drew up the scheme, which may form the basis of the national plan, after uncovering a scam which saw con-men charging Nigerian women who flew to the NHS to give birth.
Officials said the unit was used by around 900 pregnant health tourists last year — with deliveries from non-EU mums accounted for a fifth of all births.
The hospital sector last year admitted to a deficit of more than £2.45 billion – the largest in its history.