Tougher charging regime for “overseas” patients

NHS burden

Not all migrants and visitors are required to pay for their care even if they haven’t paid the surcharge. Staff will need to understand the full set of exemptions for vulnerable patients and those detained—10 full pages of the guidance. Healthcare staff, now including those in mental health trusts, will need to take steps to identify patients eligible for exemption. But we know that many staff lack the confidence and training to do so effectively, especially around exemptions for people who have been subject to human trafficking.6 This burden falls on a mental health service that already requires an additional 21 000 staff.7

Furthermore, a recent report from the National Audit Office identified some trusts are paying more to administer the system than they are recovering and cited ongoing objections by healthcare staff and their representative organisations to checking entitlements.8 Staff are concerned that involvement with immigration enforcement betrays the ethics of healthcare practice9 and about the additional workload in an already overburdened healthcare system. Such objections seem well founded, with even the government referring to the system as “chaotic.”41011

Published freedom of information requests suggest that many acute trusts still have no overseas patient management team and are making charging mistakes.12 Mental health trusts are likely to be equally unprepared, and mistakes in mental health may have dire consequences for adults and children who are already highly vulnerable. Many patients needing their care are extremely vulnerable and face formidable obstacles in obtaining that care. The new regulations add further complexity, and the government’s impact assessment is silent on people with mental illness.2

It is difficult to avoid the conclusion that these measures are not really about raising money for a beleaguered health service but rather about contributing to the government’s agenda to “create a hostile environment” for migrants.13 Importantly, the problems could increase rapidly if restrictions expand to cover everyone from the EEA after Brexit. Enforcing the charging of migrants in this way may also sensitise the public to charging in the healthcare system, while laying the groundwork for further privatisation in the future.

Research on the effect of collecting and sharing migrants’ data on their accessing of healthcare is still lacking even as the new procedures come into force. Charging provisions for migrants using the NHS in England aren’t “low impact,” as the government suggests—they will have serious consequences for staff and patients, particularly those in mental health services. The government has fundamentally misrepresented the nature of the changes. Alternatives should urgently be considered.