Passport checks considered for pregnant NHS patients

[LurkingHusband]

www.bbc.co.uk/news/health-37621239

Pregnant patients could have to prove they are eligible for free NHS treatment by showing ID such as a valid passport, under plans being considered by one London hospital.
St George's says the checks would help tackle health tourism and would only be for non-urgent patients - emergency cases would get automatic care.
^It says such a move is in line with what guidelines recommend.
But critics say the checks could be potentially dangerous.^
St George's says it has a duty to use resources wisely, as well as provide care and treatment to patients requiring the hospital's services. The hospital has a high number of patients from overseas who are not eligible for NHS treatment.
The government said a pilot was a good idea and it would be keen to see the results.

(contd)

It is possible to precis the story as "The only thing worse than a foreigner, is a poor foreigner".

Most foreigners (non EU) on residence visas, (EU people don't need visas) have ID cards issued by the Home Office anyway. When I became British I had to send mine back to the Home Office or I would be fined.
The rules are all there in place. None of them are enforced. There is no point having more restrictive laws if you don't efficiently enforce the ones in place. UKBA for the most part is an inefficient mess.

As an Australian citizen I was asked how long I'd lived in the U.K. For when I was pregnant with DTDs, as it was over 12 months I was entitled to NHS care (this was in 2011)

Why can't British citizens register their kids as British? That's what getting a passport effectively is...

I had to prove my eligibility for NHS treatment at the booking appointment with both my children (I'm an immigrant). So passport and visa (within passport) showing right to remain. This might be new at George's but certainly not new to the NHS.

One reason this is opposed by the way is that once an internal system is in place to bill correctly then it paves the way for charges to start being made for services. The logistics of coding everything to put that in place are huge and it's politically easier to do it in response to something like this because of justified public anger.

Just a thought.

What I don't think has been mentioned above is that many women were flying from Nigeria and they were paying fraudsters here to use the NHS. www.standard.co.uk/news/health/pregnant-women-will-have-to-show-id-to-give-birth-at-london-hospital-a3365906.html
The hospital in question is viewed as an 'easy target' apparently. The same might be said of many areas of the NHS, I suspect. There are rules about who can use the NHS but they don't seem to be enforced.

Well thehubbles I think we'll have to do that anyway. The nhs has gone way beyond what it was originally conceived as. People getting tattoo removals, for example, could surely pay for that rather than have it provided?
I realise the actual demarcation of what is classed as non-essential is a sisyphean task.

Luchi you don't "register" as a citizen of you have a British parent. You just are one.

Instantly - actually this NHS employee knows exactly what to do with you and your details and if you crossed my path I would ensure you are sent the bill you should receive. Please stop boasting about stealing nhs services you aren't entitled to. The go surgery staff may not have realised you're non resident but you know perfectly well that you are claiming NHS services fraudulently.

Boasting?? Pardon me?

What a ridiculous post Northern. I'm simply pointing out the problems I see with the system and the fact that I don't have a problem with users being asked to prove entitlement.

I suggest you grind your axe elsewhere.

I had antenatal care at a major teaching hospital in central London and I had to show my passport when I started there. So this isn't new as a concept.

The article says SGH have lost £4.6m this.

That's a lot.

We moved to this area 11 years ago. We took DS2 to the hospital for an outpatient appointment, after being referred by the GP, and we had to prove he was a British Citizen and we had lived in the UK for the previous 2 years.

We had to do it again when we took DS1 and when I attended. Everytime we've been treated by a new dept, as a non-emergency, in that trust we've had to prove it.

I can't see the issue.

When I had all my scans for DS1 I had to sign to say we were planning to permanently reside in the uk as we had only recently moved back from abroad. When I had ds2 the signs about care being free only for those entitled to it were very clear.

Also, the EHIC only covers you for urgent treatments, not routine appointments such as antenatal care. So residents of other EU states can't just pop over here for routine care, nor could we pop over to Europe. Only those resident in the U.K. are entitled to use the full range of NHS services.

Sensible in theory but not sure how this would work in practice. In order to qualify for free NHS care you need to be: 1) here legally; 2) here voluntarily (bit weird that one) and 3) be ordinarily resident here.

So eligibility for free care is not a static right - it may change over the course of treatment depending on whether a patient remains 'ordinarily resident'. So if this idea is rolled out, then with every contact with non-emergency secondary care EVERYONE would need to be re-assessed (by frontline staff?) and treatment will be withheld (from EVERYONE - including UK passport holders) until there is proof of eligibility.

Bearing in mind the DH guidance states 'A person is not ordinarily resident in the UK simply because they have British nationality; hold a British passport; are registered with a GP; have an NHS number; own property in the UK; or have paid (or are currently paying) National Insurance contributions and taxes in the U.K.' - it's not clear what simple document we would present that would enable a frontline member of staff to make an assessment of eligibility prior to treatment (and is it appropriate for them to have to make that assessment anyway?). It can take overseas managers a considerable amount of time to determine residency and legibility to free care.

Taking it to the extreme......When a patient rushes to hospital having been told he finally has a donor heart but alas in the anxiety and stress of the situation he's forgotten to bring any proof that he is ordinarily resident in the UK.....what are we going to do? Are we going to give him the transplant or not? I can't see that it would result in anything other than discriminatory practice whereby someone who 'looks' British and has a UK passport will be treated whereas others won't.

For those comparing this to the US please understand they have a completely different system. Everyone has to prove they can pay prior to treatment which is the system we'd need to move to here for this to work.

Northern charges only apply to non emergency secondary care so instantly is not defrauding the NHS, intentionally or otherwise:

^GPs have discretion to accept any person, including overseas visitors, to be either fully registered as a measure of an NHS patient, or as a temporary resident if they are to be in an area for between 24 hours and three months. No registration application can be refused on the grounds of race, gender, class, age, religion, sexual orientation, appearance, diversity
or medical condition. In reality, this means that the practice’s discretion to refuse a patient is limited. There is no minimum period that a person needs to have been in the UK before a GP can register them. Furthermore, GPs have a duty to provide free of charge treatment which they consider to be immediately necessary or an emergency, regardless of whether that person is an overseas visitor or registered with that practice.^

You might need a hand down from that horse.....I presume you are not an NHS employee in primary care.

When a patient rushes to hospital having been told he finally has a donor heart but alas in the anxiety and stress of the situation he's forgotten to bring any proof that he is ordinarily resident in the UK.....what are we going to do? Are we going to give him the transplant or not?

Very dramatic, but highly unlikely. For someone to be waiting for a donor heart they would have been a patient of the hospital for quite some time and to have had lots of tests so any checks can be done prior to the op.

What do you want, Overrun? The NHS to treat everybody for everything at anytime?

You can read all 131 pages of the guidance here. Who wouldn't want to, hey .

www.gov.uk/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf

No chardonnay, just pointing out in practice how hard this would be.

Whilst you are right that someone requiring a transplant will have had ongoing care that is not to say they will always have remained resident since their last contact. Hence why it would have to be checked every time and treatment withheld if proof can't be provided.

The guidance linked to above specifically states:

There are clear Directions in the UK on the allocation of organs from deceased donors. The NHS Blood and Transplant Directions 2005 place patients into two categories – Group 1 and Group 2. The Directions make it clear that a person in Group 2 cannot receive an organ if there is a clinically suitable person in Group 1. Group 1 includes, amongst others, persons ordinarily resident in the UK

So if we switch to this system of EVERYONE having to prove residency at each contact, then if someone cannot prove that they remain in group 1 they cannot receive that organ ahead of someone who can prove it.

I'm just pointing out the dilemma healthcare professionals will find themselves in and what a difference it would be for all of us. It would be a switch akin to 'guilty until proved innocent' rather than 'innocent until proved guilty'. That doesn't mean I don't think it should be done.

Yes thehubbles, that would make more sense

I'm pregnant now (not in London).

When I had my first hospital appointment, I had to fill in a form asking questions about my eligibility for NHS treatment - stuff about citizenship, length of residency, had I been living out of the UK within the last however long, etc. They already had my NHS number from the midwife referral.

They didn't ask for any proof to back up my (true) claims of being a British citizen normally resident in the U.K.

But it's not something I remember them asking about at all when I was pregnant with DC2 3 years ago at the same hospital, so it might be something the NHS is tightening up on generally.

Thanks overrun I am well aware of the regulations. I can also read instantly's first post where she describes that she's received treatment despite not being an emergency. She also describes attending ooh or a&e despite not being an emergency. Which is another way to misuse resources of course.

Hospitals like st Georges which are specialised in treating high risk pregnancies have always been targeted by overseas patients with complicated pregnancies which the services in their own countries may not be able to cope with. At our trust there are plenty of EEuropen families to purposely move to the UK because the medical care for chronic conditions in this country is so much more advanced and free. Obviously these EE patients are entitled to free NHS treatment as part of the EU.

Seems perfectly sensible to me.