Hospital - BBC2

[NHSfangirl]

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

The Priscilla case is a bit irrelevant to the debate as she didn't mean to give birth here. However I was really upset with the other two patients who couldn't even make a token gesture towards their care, even a donation to the hospital to say thanks.

I too have found it very interesting and a real eye opener.

I do think that sometimes we should all get a bill for our treatment (even if we don't have to pay it) because it might make us think very carefully about what we've had done and all the costs involved. I certainly think we should know how much each consultation costs and how much a missed appointment would cost.

Last night's programme also made me think about the fact that travel insurance should be compulsory and I, for one, won't be travelling abroad without it even if I did in my youth.

I've read that Priscilla was advised in Nigeria that the care there wasn't adequate for IVF quads. She went to Chicago but was turned away because she could not show she had the resources to pay what they knew, was going to be a huge bill.
IF correct, that suggests she was looking for free care?
That said, I don't think we had any choice but to help her once she was in London.
I agree with the suggestions people have made re obligatory health insurance .

All I felt watching this last night is just that the NHS just isn't sustainable anymore. It was so painfully clear that all of those people had travelled here to get free healthcare, and on another post today, it was claimed that the Nigerian woman had had IVF treatment and had the money for flights to the US and here. Sorry but why should the UK taxpayer fund her to the tune of £1/2 million when she put herself in that situation. Yes there were babies involved but she should never have been allowed to travel OUT of Nigeria in the first place. If the Nigerian Embassy had been made to cough up for her treatment, they may have taken more care over issuing her visas. We have to make people have travel insurance before they even get on a flight that is bound towards the UK. No exceptions. And it says it all that she was refused entry to the US................

@Man10
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

I'm pretty sure they can. I would think the Motor Insurance Bureau would pay the compensation and then pursue the driver for it, as in the case of an uninsured driver.

Fair enough, if I'm wrong about that.

We could nevertheless construct insurance so that the insurer is liable for a given person, even if they've lied to get the insurance. Then it's up to the insurance company to decide who they'll believe.

I gave birth to DD at a hospital in Harrow - I wasn't supposed to, but my local hospital shut its lovely birth centre down days before I went in to labour. The Harrow hospital had had some terrible press with 2 recent postnatal mortalities, I was (as you can imagine) worried, and spoke to my midwife. Turns out that both deaths were of women who had arrived in the UK very close to birth and had little to no documented antenatal care - the deaths were connected to this (i.e. lack of care in home country and limited to no information about the women's history available to the medical teams here).

This, apparently, wasn't an uncommon occurrence - well, the deaths were but not the circumstances regarding the arrival of the women.

I get why they came here, and many others do when in need of good medical care at a small to no fee - morals go out of the window when you or your loved one is in dire need of help. You do what you need to do.

But if the NHS continues along the same path - funding/privatisation/bed blocking/free for all at point of delivery (which it is for all intents and purposes) - it will be at incredible risk of collapse.

Just to be clear, after a bit more googling, I accept I am wrong about the third party thing. A BBC story about someone who didn't declare car modification, insurance refused to pay third party, and Motor Insurers Bureau got the bill.

I have worked in this area for a London trust so I know quite a lot about the system! Just to answer a few questions and make a couple of points:

• the babies would not be entitled to citizenship or free NHS care if the mother is not entitled, i.e. Is not legally and ordinarily resident in the U.K. (Interestingly, babies born in the US are entitled to citizenship, which is why it is an attractive destination for rich Chinese and Russians to give birth as private patients, the UK less so)

• the one big issue that this programme didn't really address is the extent to which the NHS is expected to care for non-entitled patients and when it is expected to draw the line. Basically the NHS will always provide any immediately necessary care, to prevent immediate threat to life, and will stabilise patients to the extent they can be discharged. They would not, and should not, provide elective care where the patient reasonably has time to travel to their hind country (and regardless of whether or not the treatment in question is available there). So for instance, in the case of cardiac arrest and the need for surgical intervention, that would probably all have to be done straight away and then worry about the money later. On the other hand, a patient who arrives in the uk with stomach cancer and presents through A&E would ordinarily only receive the minimum care required to discharged them (which may involve a lot, e.g. A spell in ITU, or perhaps nothing immediately, just diagnosis - i.e. they can be discharged for now even though they would ideally need planned treatment). According to the regulations such patients should not go on to have elective surgery, or chemo, or similar, because they would have the time to travel home. Another very common example is people with kidney failure - a number come to the uk every year. If they present as very unwell they would be dialysed but they would not, for instance, be offered a kidney transplant. In theory they have time to travel home between dialysis session; in reality there is no agency that actually enforces that on behalf of the NHS (uk border agency generally has a backlog and doesn't have a 48 hr turnaround, so inevitably the patients cond back through the emergency route).

One consequence of this is that patients dont (well, shouldn't) get life-saving treatment if it is not immediately necessary to save their life but this can be very hard for the clinical teams to come to terms with. In the case of a patient with stomach cancer from Nigeria, they probably don't have the same treatment options at home and so not giving them elective treatment here means they will certainly die, though not immediately. In my experience such cases can lead to quite a big debate and some clinicians really pushing the boundaries of what is truly necessary, because at the end of the day many find it very hard not to do the humanitarian thing. It would have been good for the programme to show an example of where the NGD says 'you are very ill but we can patch you up enough to leave today; you need to go home'

• as a pp said up thread, the Secretary of State can make exceptions on humanitarian grounds but that would be exceedingly rare. In many years of overseeing this at a senior level i never referred a case to SoS. Usually they were fairly clear cut: immediately necessary = do and charge (and by definition no time to ask SOS anyway!); or elective care = should not do. Unavailability of equivalent treatment would not be an exceptional circumstance for SoS because that would apply to hundreds of cases!

• the DH does update its regulations on this periodically, and have certainly proposed compulsory health insurance before. I imagine that's something they have to consult on with the travel industry as to how it could be implemented, and it would be a fairly big change. speaking as a traveller, i seem to remember going somewhere where I had to prove I had travel insurance but I can't think where that was! But it's definitely not usually required, and not for the US. It is definitely something they need to pursue, in my view, but I don't think it will be a quick fix

• a big issue I encountered was illegal immigrants who needed care. They wouldn't be covered by a compulsory travel insurance scheme anyway. They are not entitled to free NHS care if not a registered asylum seeker, and it can be very difficult to discharge them and not have them come back into the system repeatedly. For this I think UKBA would have to have a rapid response team that actually deported people, even straight from discharge, but that would be difficult and probably politically sensitive.

• embassies don't pay for overseas patients unless they have agreed prospectively to do so (and usually sponsored the patient to travel to the uk for elective treatment as a private patient). Mostly middle eastern patients. It is very slow for trusts to get payment but they do get it, that would not counted in the overseas income the programme was talking about last night as it would be private patient income.

With respect to the Priscilla, with the quads, what really irked me about that was that Nigeria would allow its IVF operators to implant 4 embryos, in a country that does not have the facilities to manage quadruple births! In the uk I think clinics are now only allowed to implant up to two embryos at a time (someone may correct me) so it seems very irresponsible that IVF providers can do what they like over there and not have to pick up the pieces. But that is probably true in many countries.

The uk does get a fair few people coming over for free maternity services. The only thing that stops this being a flood is restrictions on flying while pregnant - if women could fly 2 weeks before their due date I am sure we'd have a bigger problem but they effectively have to be here for a couple of months after their last flying date. Which is a cost /logistical problem unless they can stay with family.

Anyway, I have gone on far too long!

Thanks Christmas that's interesting to hear.

Thanks ChristmasSeacow, insightful information.

Was also irked by the ivf that Priscilla received in Nigeria, incredibly irresponsible and unprofessional - so, unless she had either one or two sets of identical twins (there was no suggestion of that on the programme) she had a minimum of 4 embryos transferred, that is a hell of a lot in any country, never mind one without the neonatal facilities to care for them.

Goodness knows what the prognosis is for those little babies. I have to say I do feel sorry for her all by herself in a foreign country. I had ds1 abroad and had to stay longer as he had to go into NICU because his jaundice was too bad. I was lonely staying by myself in the hospital room and just wanted to cuddle my baby! The hospital cleaner found me crying by myself and comforted me! I feel like an idiot now but it was shit at the time. This poor lady has had months of worry and was very poorly herself. I wish I knew how to help her.

Bestthingever, they said at the end of the programme that Priscilla is currently being housed in the UK by a charity, so hopefully they will be providing her with some support during this difficult time for her. I really feel for her, she's all alone in a foreign country and has lost two of her babies :(

I wonder how she is going to afford the plane fair to travel back home with the babies once they are discharged?

Yes I heard that too. It's good to know.

Unfortunately I have seen abuse of the system too. I have told a person entitled to care to go home as no bed whilst the person here needing a bed but not entitled to it get it.
I think we should harden up. I don't think we should provide emergency care without insurance.
There are another group of offenders. Those who reside abroad but are from the UK but return for treatment.
I think every attendance should be checked as a matter of course.
We need to husband our resources wisely.

Bestthing it would be truly awful. i think in these circumstances, especially given the length of her stay the staff would have been very supportive and they would have probably got to know each other pretty well. It's no substitute for husband and family but not 'just' nursing, iyswim.

And you definitely shouldn't feel an idiot now for having a cry! Entirely reasonable and I am glad the cleaner was kind. Most people are, really. It must have been very scary and stressful for you

Headofthehive you are right about that group of offenders. I have turned down British passport holders who were expats abroad because they were not eligible. One got a (not-very-clued-up) solicitor onto me but it didn't change anything, they had no demonstrable ties to the uk at that time, so no free treatment. I think a lot of people in that group know how to lie their way in though (and I do mean lie ) .

Also, to be fair, many don't actually realise that when they retire to Spain and sell their home in the uk etc that they will ultimately relinquish their right to NHS care. It can be a huge shock. I was talking to a British dcoatblast head when I was on holiday in Cyprus - he said he loved the weather etc but wish he'd never moved there because they couldn't afford to come back now (relative property values) and he really feared a serious health problem in a country where he did have some entitlement to care but where they do not have the full services of the NHS. And he just didn't realise that before they relocated.

Yes I was relieved to hear that Priscilla was being supported by a charity - what an awful situation for her, and so incredibly sad that 2 of the little ones didn't make it.

The only thing I can think of to alleviate the issue is the compulsory travel insurance suggestion, but I'm under no illusion that implementing that would be an easy task.

Huh? Talking to a British expat!

While I feel sorry for Priscilla...

If you have money for IVF...and travel to the US...you can surely afford to pay your bill and get home.

Where is the line?

Not necessarily Moony, quite possible she used up most if not all her cash on IVF and the plane ticket to the US, hoping/assuming that she would be able to access free heslthcare when she got there (not that I understand why she thought she would get this).

Sadly, putting things right often costs a lot more than the original intervention. It's really common for people to have private surgery in the uk or abroad and then for the NHS to have to deal with the consequences.

Generally people have no idea of the true cost of services, and in any case just worry about paying for the immediate part without worrying about the 'what if' costs.

What irritated me was the Nigerian woman (and Philippine to a lesser extent) thanking god and saying she put her faith in god. It was the NHS and its staff who saved her and her 2 babies.

The other "hidden" impact on the NHS is from overseas students and their families: unlike other countries, the issuing of the visa isn't contingent on proving that adequate insurance exists. Students on student visas and their dependents use the NHS for no charge. (Also our school system, though that's another matter.) In my city, it's quite common to see overseas students presenting at A and E because they think they'll be charged by a GP.

I think the Phillipini family knew exactly what they were doing. They scammed the NHS. I do hope she isn't allowed back in Uk.
As for the Nigerian lady I suspect that was planned.
She said she had no money to buy husband a plane ticket, so how was she going to pay for treatment in the USA. ??