Decision details

Committee to receive a report on health tourism.   

The Chairman introduced the report which had been provided by Barnet CCG. The report covered the local implementation of Overseas Visitor Hospital Charging regulations published by the Department of Health in 2015 with specific reference to:

·         How local hospitals (ie Barnet, Chase Farm and the Royal Free) ensure that patients from abroad who use services are billed appropriately and that payment is received.

·         What checks are made to establish the nationality of patients and if, for example, they are E.U citizens.

·         How hospitals and GPs are following the guidance if non-British patients request treatment. 

Mr William Redlin remained at the table.  He emphasised that the rules for charging for NHS treatment were complex, but essentially based on the concept of the patient being “ordinarily resident” in the UK and not on their nationality.

The Chairman questioned if it was possible to be provided with data showing the total amount invoiced to non-British patients and that the data be broken down into:

1.     What had been invoiced;

2.     What had been paid;

3.     If the payment had been received, was it i) on the spot or ii) afterwards. 

Mr Redlin informed the Committee that a fee would apply to non-UK patients for hospital care but that for most other forms of care, including primary care, there is no charge.  He emphasised that the charging regime applies to hospital care only. The Committee noted that it would not normally be possible for a GP to refuse to see a patient purely on the grounds of their overseas status.  Mr Redlin informed the Committee that individuals not necessarily entitled to free secondary care, would be able to access free primary care. 

The Committee noted that rules relating to the use of the European Health Insurance Card (EHIC) mean that, in some circumstances, European citizens could access free NHS care. He also noted that there were circumstances where British Nationals may not be able to access free NHS care e.g. where they were living abroad in a country without a reciprocal agreement.  The Committee noted that in the case of planned care the expectation was that the hospital or NHS Trust would seek to secure payment prior to carrying out treatment but, if treatment was required immediately, they may need to proceed without first securing payment.  The Committee noted that there was clear guidance not to delay care in these circumstances even if the patient made it clear that they were unable to pay. 

Mr Redlin informed the Committee that the Royal Free London NHS Trust had provided the following information in respect of invoices for the nine month period April 2015 – December 2015:

Total Number of invoices raised:      357

Total Value of invoices raised:          £1,539,000

Total Value of Invoices Paid:             £398,000

Members of the Committee expressed their shock that the figure for outstanding care was well over £1 million.  Mr. Redlin informed the Committee that the Royal Free London NHS Foundation Trust had also been surprised that such a huge amount was still outstanding.  

The Chairman noted that assuming there was one invoice per patient, the figures broke down to a mean average cost of approximately £4,300 per patient. 

Responding to a question from a Member, Mr Redlin informed the Committee that the Royal Free had been unable to break the figures down by department, but that it would be fair to assume that most elective care is paid for and that he therefore expected the outstanding money to relate to emergency care. 

The Chairman suggested that the Committee should receive a further report on the matter and requested that the CCG work with the Royal Free London NHS Foundation Trust to produce a more detailed report on the matter. 

RESOLVED that:-

1.    The Committee notes the report.

2.    The Committee requests to be provided with data showing what the Royal Free had invoiced out to non-British patients as set out above.

3.    The Committee requests to be provided with a further report from Barnet CCG and The Royal Free London NHS Foundation Trust.