Agenda item

The Chairman introduced the report, which provided the Committee with an update from Barnet Clinical Commissioning Group on the issue of Health Tourism.  The Chairman invited Leigh Griffin, Director of Strategic Development, Barnet CCG, to the table.  Mr. Snee remained at the table.

Mr. Griffin noted that the report provided the outline approach for charging  patients from overseas.  The Committee noted that the CCG were pursuing further data from the Royal Free London NHS Foundation Trust and the Royal National Orthopaedic Hospital (RNOH) which would be provided to the Committee when it became available.

The Committee noted the following information in relation to the treatment of people not ordinarily resident in the UK:

Hospital Care:

NHS Trusts are required to invoice any patients who are not entitled to free NHS treatment. Where possible, the Overseas Visitor Team (OVT) takes payment prior to, but without delaying, treatment. Otherwise payment is requested immediately after treatment and before the patient leaves hospital. Both the Royal Free London NHS Foundation Trust and RNOH employ debt collectors to pursue outstanding debts.  Any debts which are deemed non-recoverable are transferred to the responsible CCG within whose boundaries the Trust is located. 

A Member noted the following statistics in relation to the Royal Free London NHS Foundation Trust as set out in the report:

Royal Free Hospital Overseas Visitors April 2016 – September 2016

The Member questioned if the figures provided in the paper were unusual. Mr Griffin informed the Committee that he did not consider the figures as set out above to be abnormal for London and the South East and noted that the issue of outstanding payments would be an issue for the whole NHS. 

The Member commented that the Royal National Orthopaedic Hospital (RNOH) was on the border with Harrow.  Mr. Griffin noted that whilst it was on the border, Barnet was the responsible CCG.  The Member questioned if all outstanding invoices would be re-paid by NHS England.  Mr. Griffin informed the Committee that some outstanding money would continue to be pursued. 

The Member requested to be provided with the following information from Barnet CCG:

·         How much outstanding debt is re-paid to the RNOH by NHS England (NHSE)

·         How many beds on average are occupied at the RNOH by patients not ordinarily resident in the UK

·         How much money Barnet CCG is currently owed as a result of unpaid invoices from overseas visitors treated at the RNOH

The CCG undertook to provide this information to the Committee.

Primary Care:

There is a duty on GPs to provide care to all patients who have been in the country for more than 24 hours. The Chairman invited Dr. Charlotte Benjamin to provide the Committee with her perspective as a local GP of treating those patients who are not ordinarily resident in the UK.  Dr. Benjamin informed the Committee that previously GPs were able to ask for people’s passports and visas to see if they were eligible for treatment and that receptionists had a list of reciprocal treatments provided to UK patients in other countries.  Dr. Benjamin informed the Committee that, since then, guidance had changed and that she had experienced an increase in patients not ordinarily resident in the UK who had required emergency treatment. Dr. Benjamin expressed concern about the issue of resourcing such treatment and commented that she felt demand was higher than appreciated.  The Committee noted that GPs were duty bound to register presenting patients and make necessary subsequent referrals as appropriate. 

The Chairman informed the Committee that Dr. Debbie Frost, Chair of Barnet CCG, had given her apologies for the meeting, but had provided the following statement to be read out at the Committee:

“GP Practices are required to see patients who are residing in their practice area for over 24 hours. So if, for example, an American is on holiday and stays in Mill Hill where I am a GP for more than 24 hours with family, then we would be expected to treat him/her as any other patient that we have as far as GP services are concerned (Consultations and prescriptions).  But, if they need to be seen in secondary care, then they need to pay. So even if someone has medical insurance and presumably is covered to pay for the service, we (GPs) should still see them on the NHS”

A Member expressed concerns about the pressure on resources that the treatment of those not ordinarily resident in the UK would put on General Practice and suggested that the Committee write to the Secretary of State for Health in order to outline their concern. 

The Chairman informed the Committee that she had once attended a Barnet Hospital Board Meeting and that a Gynaecologist had been in attendance who had been asked to inform the Board about the issue of health tourism in his department.  The Gynaecologist had advised that he had employed an officer who was responsible for ensuring receipt of payment from overseas visitors.  The Gynaecologist had noted that the officer was very effective, but was only employed during office hours and so was not on duty to collect payment from patients at other times. He also stated that maternity departments probably had one of the highest incidents of ‘health tourism’ in hospitals.

The Chairman questioned the cost and method of debt collection and Mr Griffin advised that he would contact the Royal Free in order to ask for an estimate of their collection costs. 

The Chairman noted that there are  around 1400 hospitals in the UK and expressed her concern at the huge cumulative amount for outstanding treatment costs across the UK. 

Mr. Snee informed the Committee that CCG Officers were public servants and were employed to implement national policy.

A Member advised that whilst he felt some treatments should be chargeable to people not ordinarily resident in the UK, the NHS had been set up so that it was free at the point of access.  The Member also expressed concerns about patients with particular medical conditions, such as heart attacks, maternity care, or infectious diseases, not receiving treatment.  He said he would prefer to have to pursue a debt rather than sending a patient in need away. 

The Chairman expressed concern about instances when pregnant women intentionally fly to the UK either to give birth or come into the country with pre-existing complex maternity conditions, such as foetal heart conditions, and deliberately leave the country afterwards without paying for the expensive treatment they have received. A Member commented that he felt that in the instance of a baby being born with a heart condition, there were two people needing treatment and that the cost was worth paying so that the principles of the health system were not lost.

A Member questioned if it would be possible to receive information on how much money the CCG charged back to European Union Countries.  Mr. Snee advised that he believed there was a reciprocal agreement and undertook to provide the Committee information on the cost of treatment of EU citizens coming into the country.

A Member of the Committee noted that the NHS was founded on the principle of compassion and advised that he had not enjoyed the debate on the issue.   The Chairman commented that most non-UK residents entering the country  would do so with travel insurance and therefore should be covered for any healthcare treatment.

The Chairman noted that the Committee had agreed to write to the Secretary of State for Health on the issues raised. She commented that the letter to the Secretary of State would be sent out in the name of the Chairman, but that a draft of the letter would be provided to Committee Members for comment prior to it being sent.  Councillor Arjun Mittra advised that he did not wish to have his name associated with the letter.  The Governance Officer in attendance advised the Committee that the letter would contain all Committee Members’ names, except for the one Member who had specifically requested to be disassociated from it. 

The Chairman MOVED to the recommendations as set out in the report.  Votes were recorded as follows:

RESOLVED that:

1.    The Committee noted the report.

2.    The Committee requested to be provided with information from Barnet CCG as set out above.

3.    That the Committee agreed, with the exception of Councillor Arjun Mittra, to write to the Secretary of State for Health.