Hospital - BBC2

[NHSfangirl]

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

hefzi does the NHS surcharge not apply to student visas? I know that most visa categories charge £250 a year now for the duration of the visa. Its payable upfront.
I came to the UK on an ancestry visa 10 years ago and there was no charge then but I know now there is, in adittion to paying into the system through tax.

Well certainly something needs to be done. It was pretty obvious that the man from turkey and the lady from the Philippines knew they had health problems before they came here and knew that they would be treated for free

I wonder if Pricilla will go back to Nigeria. When the surviving babies are discharged, they are likely to have additional needs that the healthcare system in Nigeria will be unlikely to be able to meet.

Can I just say that the first time I had to use an OOH doctor in the UK I was pretty shocked at how easy it was to get seen.
All I had to do was give my name and the name and address of the surgery I was registered at.

In the country I was born and raised in (Canada if anyone is wondering) we also have a "free" health system. We ALL have cards with our name,dob,and healthcare number on them. They also have pictures and expire every few years. If you are not entilted to one then you can not get one. They look just like a driving license.

I am no longer resident there so I buy travel insurance every time I visit.

When you present at the hospital they ask for your card. They also ask at every GP appt. If you don't have your card they will still generally treat you but you will be charged unless you can present one within a certain amount of days.

Why doesn't the NHS have a system like this? I couldn't believe the man had to look every A&E patient up to see if they had an NHS number.

If you express concerns about entitlement to health care here on the NHS you often get accused of being racist or xenophobic.

IME it's nothing to do with what colour you are, it's about receiving a 'service' that you're not entitled to. Of course we should treat people in acute situations in order to preserve life but there has to be a line drawn. I work in primary care and saw a Brit who had retired to Spain (permanently) who had 'popped back' staying with his daughter to get an ECG, BP check and BP meds. I referred his case to our practice manager as I wasn't sure if he was entitled to treatment by us, and didn't want to do the wrong thing. I believe his NHS entitlement had ceased and he was outraged that he wasn't able to get 6 months of meds to take back home to Spain.

Students (on properly accredited courses - not, say, a summer language programme) are actually counted as ordinarily resident, ie they are entitled to NHS care like everyone else, as long as they are legally resident. Some will be on student visas, some will just have the right to travel (Eu citizen, dual nationality, British passport or whatever). As long as you have a valid visa to be in the country and are here for the settled purpose of your life (so a tourist visa wouldn't count, by its nature) then you may be entitled. As long as you can also demonstrate that you do live in the U.K. for the normal settled purpose of your life. And doing a properly accredited course would count.

People who are not ordinarily resident can still register with a Gp because some primary health services are free to all for public health reasons (sexual health services, for example). I am not sure what the requirements are in gps to check but in my experience of acute care, loads of patients who are not entitled to acute elective services get referred by primary care, probably because they are registered like any other patient. That's why acute trusts cannot take a gp referral (or having an NHS number) as evidence of entitlement. The DH makes each part of the system responsible for carrying out its own checks. They are supposed to ask every patient where they have lived for the last 6 months and take it from there if necessary, but that is a difficult task given the volumes concerned. And especially for trusts with an A&E.

Unfortunately the problem Is not helped by frontline staff being unable or unwilling to make the checks necessary. They see themselves as compassionate healthcare workers, not gatekeepers. And people just think oh they can be squeezed in rather than it actually affecting someone else's treatment.

I do think compulsory insurance is the way to go, for overseas visitors.

Lots of patients are aware of the six month rule and if you were to ask where have you been living they just say u.k.
Nothng to stop them lying.

Like other posters on this thread, I think it was wrong for the Nigerian clinic to implant 4 embryos when that country can't manage high risk multiple pregnancies.

It seems pretty clear too that Pricilla had no means to pay for treatment, wherever she ended up, and set off with no travel insurance and no financial means, to a country where medical care is very expensive - the treatment she got in the UK would have cost a lot more in the US - and the UK is picking up the bill for her poor decisions and the poor decision of the Nigerian ivf clinic.

On a personal level, I have every sympathy for her current situation and for her tragic loss.

Miss yes, you're correct for non-EEA people - it was about 2015 this changed, I think: it's £150, I think (or one consultation with a specialist )

My SIL was telling me recently how shocked she was that she could get a GP without showing she'd paid the NHS levy: she took all the info with her, but they didn't want to see it even though she tried to insist. She's non EEA and she thinks as a nation, we're a push over: she's currently doing GCSE English and Maths and can't believe she's entitled, as the spouse of a British citizen, to get this without payment too!

I think frontline checks are not really tenable. It worked in one of my trusts because we didn't have an A&E and could effectively screen each new referral. And this could be fine by the core outpatirnt admin team who managed all new first appointments for new referrals so a finite number of people to train. And while people can always lie, we could actually check passports /visas to check legal status and that weeded out a lot of people (if not the British expats in Spain). We need addresses and if it's a hotel or whatever that would prompt more questions.

In a trust like imperial that simply can't work - there are 4 separate A&E departments and other acute points of entry (e.g. Cardiac centre) - and people are not always even conscious when they pitch up! It's fair enough to expect clinical staff to highlight concerns if they find out incidentally, but not realistic to expect them to do the primary screening of every single patient. Effectively. Especially as the regulations are actually not completely simple.

The only thing that would really work is an NHS ID card, as the Canadian poster above describes, AND compulsory insurance.

I am not sure why cards are not implemented but for some reason in the uk there is condiderable opposition to the idea of a national ID card and I think this is a corollary of that.

I think the ID card is good but it should be automatically updated with border control - to flag up those who leave for more than 6 months. Surely that would be a reasonable thing?
Something must be done. Its good they highlight it. For every one they showed getting treatment they should show someone denied it who was entitled to it but not enough money etc to highlight it does affect care of others.

which insurance company do you honestly think would provide that type of insurance cover?
One that has verified you have the appropriate health checks and Doctors certifications about history. When we get car insurance we have to prove a valid MOT, and license, which seems a lot more rigorous than the tick box travel insurance you get when booking a holiday.

The Priscilla case is very relevant to the debate as she obviously went to America as a health tourist, probably hoping to have her children there where they would automatically become citizens.

Foreign students NHS bills should be paid for by the University that has issued them the visa. The consequently would be that universities will make sure students have health insurance.

The UK driver license could be used to prove entitlement to health care. Non drivers could just get provisional licenses issues.

It's good that the NHS is beginning to take steps to stop people from using a service to which they are not entitled.

I've been living abroad for several years and I took my son to a walk in centre. I put my correct address down and made it clear that he was not entitled to free care as a non resident. I was prepared to pay and had health insurance who would reimburse it.

They said they didn't have the ability to input a non uk address and to refill in the form with the address of where I was staying. They had no facility to pay, and obviously no ability to send me a bill afterwards.

My inlaws live abroad and had to access GP services, they also made it clear they were non residents and again no suggestion of charges etc. They are very reluctant to access the NHS and have to be forced to while they visit the uk. They have never attempted to hide where they live.

Where I lived was a private healthcare system. Employers had to provide health insurance but if often would not cover maternity. It was very common for people to get pregnant and then head back to the UK to stay with family and give birth there for free.

It didn't occur to me to tell my GP that I had left the country, and many other people don't think about it either. So as far as the NHS is concerned, I probably don't show as ever having been non resident.

There needs to be a joined up system between council tax/income tax etc and the healthcare system. So it's clear when people become non resident.

I thought it was great that people can be debarred from reentry if they had an outstanding NHS bill, but it doesn't solve the majority of problems.

There will need to be a requirement to prove health insurance before entry to the UK, at least that is something in place before the NHS is accessed and not after.

There should also be a move towards agreement with other countries about reimbursing healthcare costs for their nationals if they cannot pay.

It won't fix everything but it will help.

There appeared to be no concern about the bills by those patients and family members, and it's really annoying that no one even paid a token amount.

The NHS is not a bottomless pit and the line needs to be drawn somewhere.

It is one reason I would support ID cards for uk residents, and having to present ID to access healthcare.

I was wondering too about ongoing care for Priscilla's babies. And if her husband can't afford to come here, how are they going to get back? I agree it was incredibly irresponsible of the Nigerian IVF clinic.

Interestingly, she almost seemed to imply that she was in early labour as she was being put on a plane in the US. I may well have misinterpreted this, but I could also sort of imagine the US being determined to get her off their soil.

I can't see compulsory health insurance working, but maybe I'm not thinking outside the box enough! What level of cover would you require? What would happen if your treatment costs exceeded that? What about people with existing conditions who can't get insurance? Would they be barred? What about people who overstay and their insurance expires?

It is a tricky issue. I've come across a terminally ill man who travelled to the UK, apparently to say goodbye to his family while he was still able. Of course he deteriorated and ended up in A&E, but then had the awkward issue of whether he remained an inpatient for MRI (potentially might need urgent treatment). It was interesting what ChristmasSeacow said about not having to provide care if he could travel back to his country for it. I'm not sure we were aware of this. It would have been an awkward call though, because even if he had been medically well enough to return home, he couldn't have sat in a standard plane seat, and medical repatriation is not cheap!

We did know he would be charged once he was admitted, despite the ED consultant insisting he wouldn't if he remained under her care. I'm not sure what the outcome was, but I'd be surprised if the trust ever saw any money from it. I did wonder if perhaps he had travelled to the UK to die here, or whether he was genuinely expecting to say goodbye to family and go home again.

If you can't get insurance then you can't come. I couldn't take my DD to some countries as unable to get insurance.
We do check with border control in my hospital, if we suspect people have been in and out of the country. It's quite illuminating.

TarragonChicken, yes insurance would not solve all the issues but it would be a major help.

What level of cover would you require? Car insurance companies manage it by covering ALL third party expenses.

What about people with existing conditions who can't get insurance
Pre-existing conditions make insurance a bit more expensive but if they dont have proper insurance they dont gain entry to the UK.

What about people who overstay and their insurance expires?
They become a criminal and deported if caught.

Sensible suggestions from Jamie.
I think we have got to get tougher on this.
Not one of the people on the program last night paid anything and it was clear they had no intention of doing so.

Tarragon in the situation you describe it's not so much that the trust has the option of not treating, it's that the regulations say you actually should not do so unless it is immediately necessary. The issue of 'able to travel' is tricky and comes down to clinical judgment... if the patient doesn't have a medical repat option through insurance then you would have to get them to the point they could travel just with a family escort.... and for someone who is terminally ill you may never get to that point.

I don't think the insurance thing is so difficult because it's how it works in almost every other country. Usually you have to declare pre-existing conditions but if nothing remarkable it is fairly straightforward risk pooling. It's what we all buy when we go to the US or wherever. We pay fairly generic sums (because it isn't worth them over complicating it) to get pretty comprehensive insurance, often including repatriation costs (though you are older or have a preexisting condition it gets pricey).

That said, it's not always a great experience. My dad took out generous travel insurance to go on a walking holiday in Vietnam about 8 years ago. While he was there he was taken seriously ill and ended up in hospital in BAngkok (the nearest major acute hospital with international standard facilities). They thought he had had a stroke. The hospital kept him in a bed but didn't send him for an MRI for 3 whole days because the insurance company (a major one) wouldn't commit to paying for it because they believed that at 60 he must have had an undeclared preexisting condition which would invalidate his insurance. So they all waited over the weekend until his GP surgery opened on the Monday morning, for the insurer to speak to the GP and be told that dad was fine, GP had hardly ever seen him in the last 10 years. only then did they authorise payment for, and do, the critical scan. In the end he was in hospital for about 10 days and then flown back to the UK first class with a medical escort. All covered, it wasn't a stroke and he was okay in the end. I (thankfully) don't think the nhs would have waited for confirmation of funding in the same situation for a patient in a potentially life-threatening situation, who had appropriate insurance but whose company was being an arse .