Hospital - BBC2

[NHSfangirl]

Anyone else been watching this? Really great show. Some tough issues covered quite sensitively - NHS overseas chanrging, bed pressures, cancelled operations...

I saw it. It is always thought provoking

I don't think that there is much chance of them ever getting those bills paid from the overseas patients, but it isn't as simple as just saying don't treat them if they fall ill on British soil.

I really felt for the Nigerian lady with the three premature babies in the neonatal unit. A bill of £331,000. She had only been a transit passenger at Heathrow on her way back to Nigeria from Chicago too when she went into labour.

I thought it did illustrate very well the importance of having appropriate medical insurance when travelling abroad.

Most of these people, while deserving and in need of emergency treatment which they would have died without, did not have that and couldn't pay their bills.

I didn't see it, but surely that woman had travel insurance, especially if she went to the US? Did they discuss that?

I don't know how they solve that problem. Not allow people visa's if they don't pay? Make travel insurance compulsory? It would interesting to know how the US deals with it, i doubt they let people run away from their debts

The US dealt with it by not allowing her to enter the country when she arrived there from Nigeria.
She was going to US for management of her high risk pregnancy though how this was going to be funded when she got there wasn't clear (or I missed it).
She was on her way home, via UK, when she became unwell and was found to be in labour - hence, she was taken to hospital for assessment and treatment.

She never mentioned having any travel insurance. She was pregnant with quads and I understand had travelled to Chicago with a view to giving birth there but didn't have the right papers. It wasn't clear how she planned to fund treatment there.

So she was returning to Nigeria. She was a transit passenger getting a connecting flight at Heathrow and went into labour there at 24 weeks pregnant. It was a case of either treat her or she and her babies would all have died (I think two of the babies did die).

It didn't come across as health tourism to me. Most of them weren't and seemed genuinely people who just happened to have fallen ill during a visit here, but they will never be able to pay their bills.

Apparently in the last financial year the trust was owed around £4 million from treating overseas patients, of which it has recovered £1.6 million, and holds out little hope of seeing the rest.

Hard to know what the realistic answer is. We can't just leave them to die, but clearly the financial issue cannot be ignored.

There's no way this particular case really teaches us anything is there? We couldn't have stopped her getting on a plane to the USA or from there back to Nigeria. Once she was in labour whilst in transit, we couldn't not have given her and the babies all the care they needed. What really bothers me about the whole debate ( I don't mean on here, but in general) is that it has taken on a rather unpleasant tone - a tinge of xenophobia? Of course all travellers should have travel insurance ( not that I think for one minute she'd have got cover with such a complex pregnancy) but then all drivers should have car insurance and a huge number don't and we all pay for that don't we? No silver bullet here, no easy solution

I do think there is an argument to be made for compulsory travel insurance.
If you do not have it, you shouldn't be allowed to board a flight in the first place and if you do arrive in a country without it, the airline that brought you should be heavily fined.
It wouldn't solve all cases such as this one (eg. someone's insurance may expire during their trip) but it would hopefully reduce the number of cases, some of which, result in a heavy financial loss to the NHS.
In this particular case, I would assume that this lady and her babies may be considered vulnerable patients and the Secretary of State for Health may determine that there were "exceptional humanitarian reasons to provide a free course of treatment" given that she wasn't intending to travel here but was trying to get back to Nigeria.

Compulsory insurance wouldn't work. People could buy the cheapest policy, not declaring existing conditions that nulified their cover because full disclosure and therefore cover was prohibitively expensive.
There would be no way of checking this unless each airline is going to cross reference the policy with the travellers GP.

I work in Primary care in the NHs and it is well known that Nigerian ladies with high risk pregnancies travel to the UK to have their babies as they are rarely asked for the money. Never heard of them going to the US though.

Given the level of deficits faced by trusts, I'm not sure how health tourism will plug the gap, which is the implication.

Yes we should be recovering the money. I think the NHS isn't naturally set up that way so adjustments are needed.

There is a bigger issue though. As the number of older people grows along with increased obesity and associated illnesses, the pressure intensifies.

That really needs tackling and chasing overseas tourism will be but a drop in the ocean. Especially as I suspect, it is more of an issue for london/urban hospital trusts.

I was surprised that they do try and get the money tbh and he has a tough job but it has to be done. They get more that I thought!

It's a brilliant series really thought provoking

My understanding is she went to the US with the intention of having her children there. She has family there. She was refused entry into the country because she had no way of funding her medical bills.

It's unfortunate she went into labour in transit and definitely needed the help.

But why was she allowed to travel with a high-risk pregnancy? and why was she going to have children in a foreign country with no money?

It is a brilliant series and gives a fantastic insight into the reality of the NHS today.

To be honest, I found last night's programme really frustrating. The patients were given bills for their treatment but clearly had no intention/ability to pay. Surely the message being given is still that you can come to the UK and receive free medical treatment. Yes you'll get a bill but don't worry about it. If the patient can't/won't pay the bill should be sent to their embassy for payment.

The Nigerian lady last night said that her Dr had advised her to travel to another country for medical care. She chose to go to the US so how did she plan to pay for her treatment there? Her bill from the NHS was in the region of £300,000 and she couldn't pay that. I'm quite sure it would have been much higher in the US.

Again, the lady from the Philippines admitted that she could not afford the treatment at home and that basically she would be left to die. She then came here for a "holiday" without any travel insurance and then suddenly needed a quadruple heart bypass while she was here.

I honestly do not know the answer to this. I could not accept that people were turned away from our hospitals because they couldn't afford the care but I do think that a message needs to be sent out that we are not such an easy touch. Don't come here for free treatment. At the very least you will be banned from coming here again until your bill s paid and we will present your bill to your embassy with the expectation that they pay.

I don't think the lady who had the quads should have to pay any bills. She didn't intend to have her babies here. Also as the babies were born here, are they not classed as UK citizens so therefore entitled to NHS care?

I could not accept that people were turned away from our hospitals because they couldn't afford the care but I do think that a message needs to be sent out that we are not such an easy touch. Don't come here for free treatment.

I agree with this. Obviously it would be inhumane to refuse to treat people who are in need of immediate urgent care but we have to find a way of making it clear that you can't travel to Britain to take advantage of our free at the point of use system.

The £4million a year spent by a single health trust on treating overseas visitors may be a small percentage of the total NHS budget but it is still four million pounds and I think the NHS should be saving costs whenever possible.

I would think there is a strong case for compulsory insurance before you are allowed onto the aeroplane. And not just any old insurance, fully comprehensive cover that is not invalidated by pre-existing conditions.

It can take months for hospitals to claim money back from Embassy's. They try and find any route possible not to pay.

I don't think the babies are entitled to NHS care, even though they were born here. I'm sure that's right but can't remember.

I love this programme, as a nurse I think it's brilliant and everyone should be made to watch it. This is the normal pressure we are all under. I deal a lot with bed management and there is no slack. It's constant juggling.

We'd all do the same though, wouldn't we.
I think the health insurance tied to the flight ticket is an excellent idea though.

I do like the idea of compulsory insurance before boarding a flight, but would already pregnant women be able to get cover? Especiallly if, as in this case, it is known to be a particularly complex pregnancy (it was quads, resulting from IVF treatment in Nigeria).

PolkaDot raises an interesting question regarding the nationality of the babies, but actually I think the bill still goes to the mother (and it did). The babies, those that survive, are unlikely to be brought up in the UK, and the family have never been taxpayers here. She was a health care professional in Nigeria if I remember rightly. She will never earn anything remotely approaching enough to make a dent in that bill, if she ever attempts to pay anyway.

The program is an excellent portrayal of the NHS currently, fantastic people like Kevin O'Neil performing amazing work and working in his own time etc but the chaos of cancellations lack of beds etc.

Only last week my DH was admitted to the CX, admitted at 0700 only to be cancelled at 3.30pm, a bed wasted for the day, been trying to get appointment since August.

jamieXeed which insurance company do you honestly think would provide that type of insurance cover?

You are not automatically a British citizen if born in the UK, a parent mush be a British national.

When I worked in the NHS in London, we frequently saw people who had just arrived in the U.K, and then presented at A and E with what turned out to be major health issues.Many were cardiac or pregnancy related. I've no doubt some of these were sudden onset,but I believe many weren't and in any case, how can you prove this?

When people know they have serious conditions, but if they can get to the UK they won't be made to pay for the treatment they need,they will come.
Other countries seem to deal with this. It's an abuse of our system.

Compulsory insurance wouldn't work. People could buy the cheapest policy, not declaring existing conditions that nulified their cover because full disclosure and therefore cover was prohibitively expensive.

A policy could be written to unconditionally insure the UK against their medical costs. So it wouldn't matter if they've lied to the insurance company, the insurance company would still have to pay. We could choose to only accept travel insurance that says this, from companies we trust will pay. It's up to us what we accept.

In other words, it's like 3rd party car insurance. If you hit a pedestrian with your car, your insurance company can't refuse to pay compensation if it turns out you lied to get your insurance. (At least, I assume they can't?)

jamieXeed which insurance company do you honestly think would provide that type of insurance cover?

Does it matter? If they can't get it, they don't travel.