Farron attacks Government plans to make patients pay upfront for NHS treatment

Don’t make scapegoats out of foreigners for the crisis facing the NHS. That’s Tim Farron’s message to Jeremy Hunt as the Government says it is going to get hospitals to check upfront whether people are eligible for free NHS treatment and charge them before treatment Because NHS staff don’t have enough to do already. Tim said:

We all want to see the NHS recover money owed it to it, but this is a completely disproportionate response to what is a fairly minor problem. The Health Secretary is turning NHS staff into the Border Force, its unacceptable.

Asking people to show their ID before receiving treatment will mean longer waits for treatments and heap more pressure on already overstretched NHS staff.

The government must explain how much it expects the new system will cost to administer and what the impact on patients will be.

Instead of trying to blame foreigners for the crisis facing the NHS, Jeremy Hunt should take responsibility and give our health service the extra investment it needs.

If I were Tim, I would have taken an even stronger line. You know what annoys me a whole lot more than a few people getting treatment that they need but  technically should pay for?  Them not getting the treatment they need at all.  That’s what it boils down to. I don’t want us to end up like America where they want your credit card number before they’ll do anything. Doctors and nurses are there to treat people not act as quasi tax collectors or immigration officials.

Making scapegoats out of sick and vulnerable people is not a very nice thing to do. What the government needs to do is to give the NHS the resources it needs to function at its best. The Tories simply want to undermine it as they always have done.

What they are egging on the media to do is a bit like criticising someone for not hanging a picture straight as the house burns down around you. The NHS has bigger problems. And, you know what, if some of the tax I pay goes to treat people from abroad who desperately need medical help, then I am absolutely comfortable with it.

I was struck by an article on this written by Richard Flowers a few months ago when the Tories first mooted it on the Tower Hamlets Lib Dems website. He said:

This is an attack on two fundamental freedoms at once:

  • the NHS must be free at the point of need, without needing to prove entitlement;
  • and making people produce their papers is a step towards ID cards by the back door.

And we fear that this is yet another excuse for “racial profiling” – just who is more likely to be asked for their passports – giving more encouragement to those committing hate-crimes and making the post-Brexit fractures in our society even worse.

We all benefit from people in the UK – residents or visitors – being in good health. And everyone’s good health benefits from us working together to support the NHS.

Anecdotes, scaremongering and labelling people “health tourists” are not a basis of evidence-led policy making.

The NHS is in crisis because of Tory cuts not some unmeasurably tiny cost of visitors needing treatment, but this shambolic government once again is trying to put the blame on “foreigners”.

* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings

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43 Comments

  • It seems to be the Tories policy of choice; UKIP not so lite.

  • John Barrett 6th Feb '17 - 7:59am

    If we all have to show ID when we borrow a book from the library, or for people to get a free bus journey, is it really too much to ask everyone to show some from of ID before expecting access to the NHS?

  • John Barrett 6th Feb '17 - 8:19am

    Those who are genuinely concerned that the NHS is under extreme pressure to deliver the service we all want, free at the point of delivery, should be saying that everyone who is entitled that access should make lifestyle choices to reduce the demand on the NHS, such as stopping smoking, reducing alcohol intake, eating less sugar, taking more exercise etc. And those who are not entitled to that free access should have to pay – if not, it will be the UK tax payer who is paying for their care.

    I have seen the US system of healthcare close up. Nobody wants a US style healthcare system here, but asking people from home and abroad, who wish to use the service and to reduce abuse of the system, is a million miles away from what happens in the USA.

    We don’t let people attend the Lib-Dem conference without showing some form of ID.

  • What happens when someone’s in a coma or badly injured – And what about their hippocratic oath? ;

  • Little Jackie Paper 6th Feb '17 - 8:56am

    I think the best I can say on this is that when I worked in the NHS I found very, very mixed views on this one. I suspect that there might be very different views in different parts of the country. There was at the time general agreement that a better system of recharging was needed for patients not entitled to NHS care or who were entitled and subject to recharges and that was more important than an ID check. That argument makes sense, however I don’t know of a recharge system that wouldn’t involve an ID check at some point if that’s the particular problem here. There is also the wider argument about who exactly should be entitled, but let’s leave that can of worms alone.

    Certainly when I go to my wife’s country I need to show ID if I need healthcare – does anyone know how other European countries handle this? I believe at second hand that some German Lander work with health insurance and that normally needs some form of ID and payment from people not covered.

    I have to admit that I was never totally sure in my own mind exactly what the problem with showing eligibility to receive a service was. This stuff about so-called racial profiling just seems to be getting trotted out every time as a way to duck unpalatable questions. As much as we all wish it were otherwise every penny spent on people not eligible represents an opportunity cost for those who have paid into the system in good faith.

    And ultimately perhaps there is the nettle to grasp about why be so squeamish about ID cards? Most of Europe has them in some form.

    Anyway, I’ll let everyone shout at me now.

  • What John Barrett said. Yes, of course, we should treat people in comas or life-threatening situations that arise, unforeseeably, after arrival here. To raise such cases is obfuscation: we all know what kind of cases are at the heart of this matter. There is nothing ‘liberal’ about allowing those flying here specifically by choice to have birthing or cancer treatment to leave without payment. Even if the sum raised is token, it is important ‘to send out a signal’ (and *boy* do we as a Party like doing that when it suits us!) that we are not prepared to be guileless dupes who will be ripped off helplessly when our NHS needs every penny. That’s an important ‘signal’ internally and externally.

    I don’t know who Tim thinks his stance is impressing, apart, probably, for a few people on here. I’d love to see some polling on this, with a by-Party breakdown.

  • It’s a Tory distraction policy, it saddens me some people fall for it. The real problem with the NHS is lack of money, blaming health tourists won’t solve that. Even if every health tourist paid the NHs would still be struggling, but then who could the Tories blame, the fat, the unemployed, the old; I guess we will wait to see.

  • Nonconformistradical 6th Feb '17 - 9:33am

    @David Raw
    “What happens when someone’s in a coma or badly injured”

    This is about payment for non-urgent treatment – not emergency treatment.

  • nigel hunter 6th Feb '17 - 9:55am

    I have seen Hunts smiling face in front of the Independant article. Is this the crack in the wall? Get foriegners to pay up front, continue wrecking the NHS till British Citizens have to pay before treatment, eventual privatisation.

  • I’d say that was mission achieved by Hunt. Instead of discussing the real issue, even here there is debate about something inconsequential. It should be an operational matter as to how hospitals collect payments as it would be in any other business. Don’t see the same discussion about how libraries should collect fines. We view that as up to the local authority to manage. Same should apply to the NHS. While we’re drawn in by this operational nonsense, the NHS is falling apart.

  • Nonconformistradical 6th Feb '17 - 10:25am

    @nigel hunter

    Given that the UK does not have reciprocal health care arrangements with many countries – so that someone from the UK would have to pay for treatment in any of those countries – why should the UK be expected to fund non-urgent treatment here for people from countries with which we do not have reciprocal health care arrangements?

    For a list of non-EEA countries where we do have such agreements see http://www.nhs.uk/NHSEngland/Healthcareabroad/countryguide/NonEEAcountries/Pages/Non-EEAcountries.aspx – it isn’t a very big list. Note also that after the list of countries where reciprocal agreements have been terminated in 2016 – mostly Russian area of influence – note that it states:

    “You will need to ensure you have adequate travel and health insurance to cover your stay. “

  • Nicholas Cunningham 6th Feb '17 - 10:32am

    The BBC and their programme ‘hospital’ which is currently being aired on Wednesday nights, it gives an excellent insight on the situation in our NHS. Last week it dealt with this issue of foreigners and their treatment under the NHS and has David Raw points out, there are times when it’s not clear cut and where people find themselves in very difficult situations concerning medical assistance. The NHS has a very difficult call to make and this programme cast light on the those decisions. It’s worth a look if you have not seen it, the cost of medical treatment is quite staggering.

  • Little Jackie Paper 6th Feb '17 - 10:43am

    Emma – ‘It should be an operational matter as to how hospitals collect payments as it would be in any other business.’

    The problem there (as I understand it) is that there will be huge variations on that from one place to another. As tempting as it is to see this as akin to a library fine, the complexity here is huge and the range varies from one place to another. The needs of, say, a hospital by Heathrow will be very different to a small rural unit even if the end-point is the same.

    As I said in my earlier post I am open to the idea that the effort being put into this initiative would be better put into establishing some sort of better system of recharge which, I believe, is the sort of thing they have around Europe, albeit at a cost. However if the objection here is about the principle of ID checks per se (which is how I read the article) then I fail to see how a more effective recharge system wouldn’t involve ID checking. If you do know a system of cost recharge with no ID then I’d be interested to hear about it?

    And ultimately if I go abroad I need to show ID for health purposes and it’s not clear to me why the UK should work differently.

    nonconformistradical – On that list you put up. My wife’s country is on that list and I can confirm that country did indeed enforce the requirement that I show my passport and the details were taken.

  • Emma observes that : “Don’t see the same discussion about how libraries should collect fines. We view that as up to the local authority to manage. Same should apply to the NHS. While we’re drawn in by this operational nonsense, the NHS is falling apart.”

    But the point is that the NHS is not managing it and is not collecting the money for whatever reason – but then expects the Government to hand over large extra sums, some of which are undoubtedly needed and others of which are occasioned by our complete failure to have any kind of sensible debate about: the value of preserving life at various stages of health, value-for-money of therapies and medicines, desirable-versus-essential, willingness/ability to pay and the health/social care interstice – and about the legitimate expectations of State/family of each other in old age care. sadly, I don’t expect that sensible debate to start in our Party: too many vested interests, as there are in the others.

    But simply as good politics, can’t the NHS see that if they DON’T collect this money, Hunt has an easy ‘poor-housekeeping’ shot that they don’t need to give him.

  • As John Barrett and others have said, is asking for ID before an elective operation really a big issue? I’m far more worried about requiring ID to vote, as there’s far less incentive to make sure you have suitable ID if it’s an issue.

    £500m is not a rounding error, even in the scale of the NHS budget, and we shouldn’t sniff at it. Caron says “And, you know what, if some of the tax I pay goes to treat people from abroad who desperately need medical help, then I am absolutely comfortable with it.” I for one am most uncomfortable with this, as it would lead to people flocking here reducing capacity for UK residents, and I imagine that position would be poison electorally, quite rightly.

    I’d have thought the smoothest approach would be bilateral agreements with governments. The only time I’ve injured myself and needed urgent hospital treatment was when I lived in Poland (before in the EU) – however one look at my passport was enough for them to treat under a reciprocal rights arrangement. All these pesky Brits though, sponging off the Polish health service!

  • Nonconformistradical 6th Feb '17 - 11:05am

    “Caron says “And, you know what, if some of the tax I pay goes to treat people from abroad who desperately need medical help, then I am absolutely comfortable with it.” I for one am most uncomfortable with this…”

    Likewise in respect of payment up-front for non-urgent treatment.

    “I’d have thought the smoothest approach would be bilateral agreements with governments. The only time I’ve injured myself and needed urgent hospital treatment was when I lived in Poland (before in the EU) – however one look at my passport was enough for them to treat under a reciprocal rights arrangement.”

    Exactly

  • David Evershed 6th Feb '17 - 11:13am

    If the local hospital/GP were allowed to keep the charges they would be incentivised to collect the fees due from those who don’t qualify for free health care.

    If Lib Dems believe in fairness then we should support the Government proposal.

  • Nicholas Cunningham 6th Feb '17 - 11:30am

    Ethically, what does a hospital do when an individual has no ID and needs urgent medical assistance? No doctor in this Country is going to say no, thank goodness for that. Why even consider putting a doctor in that position, it would be an intolerable position for them. Hospitals are already by law have to seek payment for those who are not entitled to free treatment under the NHS and the programme which I referred to above shows how difficult and the real complexity the issue is for them.

  • Nonconformistradical 6th Feb '17 - 11:43am

    @NIcholas Cunningham

    “Ethically, what does a hospital do when an individual has no ID and needs urgent medical assistance?”

    The proposal is NOT about urgent treatment – it is about charging for non-urgent treatment!

  • So the nub of the issue is that some people from overseas, are choosing to access health aid, at the point of our NHS, which it is estimated to cost the NHS £500 million per year.

    It seems perfectly logical then, to transfer £500 million, annually, from the overseas aid budget into the NHS. It still counts as overseas aid money, but the logic is that it is being allocated to foreigners in-situ, within the NHS.?

  • @ nonconformistnotsoradical.

    And who defines what’s urgent ? And still no answer about the Hippocratic oath which knows no boundaries. Of course at the moment we have a reciprocal arrangement with the EU. Will it be a medical decision to decide or will more clerical staff to be employed by, for example, Virgin who now have a vast profit making chunk of NHS clerical work before passing on the profits to an offshore tax haven ?

  • Are the Lib Dems primarily for British people or for those overseas? I only ask because it seems to be becoming a `project can’t` party representing the interests, either economic or ideological, of an extreme wing of public opinion that doesn’t believe in borders, would like us to be part of a European superstate and couldn’t care less about aspirational British people who want to get on the employment ladder. It goes against your preamble to your constitution.

  • From the ‘Times’ piece

    “…The measures, which come into force in April, will apply to all non-urgent care. Emergency treatment will continue to be provided irrespective of the patient’s citizenship…In 2012-13 the NHS charged only 65 per cent of what it was entitled to demand from visitors who lived outside the European Economic Area and 16 per cent of what it was entitled to from visitors within the EEA, recovering £89 million in total….
    The move comes after a week in which NHS bosses have faced criticism over health tourism. MPs on the public accounts committee said in a report that attempts to combat the problem were “chaotic”, and depriving the NHS of vital funds….a pilot scheme at Peterborough City and Stamford hospitals (w)as an example of best practice. …The hospitals said that chargeable patients paid about £350,000 a year and the scheme had not had any effect on the number of non-British residents coming through the doors.”

    And Tim is opposed to this, why?

  • Nicholas Cunningham 6th Feb '17 - 12:27pm

    Nonconformistradical
    Answer the question regarding ‘Ethically’ and doctors work. Do I want politicians making such assumptions regarding what is non-urgent, NO. What I see is the NHS, which has a budget of over 100 million and the foreigners who for whatever reason fail to pay amounts to less than 0.5% of the budget. What you are seeing is the Health Secretary seeking to make political capital on the back of today increasingly mindset, blame others.

    James, humanity.

  • Philip Rolle 6th Feb '17 - 1:17pm

    J Dunn’s suggestion is a neat one.

    I can’t help think though that all the fuss about “foreigners coming over here using our NHS” is a deflection from the immeasurably greater problems of social care provision and bed availability in the NHS.

    As I said on another thread the whole thing has become unsustainable without a fresh income stream. We must have a third deduction from earnings called a social insurance premium, which would fund the NHS and some aspects of social care.

    People insure their dogs, they can insure themselves. The government will have to be in charge of the system though, providing a subsidy to ensure that all adults of the same age pay the same premium, regardless of health conditions. They would also meet most of the premium of those unable to pay, though I suggest that there should be few 100% exemptions.

  • Lorenzo Cherin 6th Feb '17 - 1:40pm

    There is the pragmatic and the patriotic in this and anything else is hyperbole.

    It is essential that those in emergencies be treated. It is immoral if that is not the case.

    It is easy to register someone at a gp surgery based on id and the presentation of paperwork. When you get to see a specialist in this country everything is referred by a gp. Why should it be different in practical ways here for foreign nationals. Answer, it isn’t.

    No one can get treatment at a hospital for non emergencies unless via a gp.

    Therefore why can a foreign national who is entitled to treatment not present the necessary documentation to an administrative department at the national level of a national health service which employs more people than any organisation in this country?!

    Why should every country in the EU successfully claim back the money but not this one?! A reason other EU countries like the EU is they make it work for them.

    We make it work for them too , which is why so many want to leave it and why I want to reform it for us !

  • Martin Clarke 6th Feb '17 - 4:01pm

    It is the National Health Service, not the World Health Service. It is not free, it is paid for by UK taxpayers.
    My solution would be to have a strict no health insurance, no entry rule for non EU nationals.

  • Patriotic is hyperbole.

    I see the Little Englanders are out in force today. Nice bit of distraction from the real issues by Jeremy Hunt. Thank goodness I live in Scotland.

  • Nonconformistradical 6th Feb '17 - 6:06pm

    @Nicholas Cunningham
    “Answer the question regarding ‘Ethically’ and doctors work. Do I want politicians making such assumptions regarding what is non-urgent, NO.”

    It would appear, from the increasing waiting times for elective surgery for hip replacements etc. that doctors are having to make decisions about what is urgent and what isn’t all the time – without politicians having to get involved.

  • Lorenzo Cherin 6th Feb '17 - 10:13pm

    David Raw

    Why you refer to little Englanders in this thread goodness knows, the patriotic I refer to, unknown to the left is love of country and in love of country loving it enough to want to change it for the better including its health care !

    We could react to Hunt with common sense and explaining how simple it is to collect money via proper systems, like other countries , or not, but instead knee jerk liberalism of a bleeding heart unpragmatic nature all round, except from some really sensible people here.

    I suggest above, there is no access to hospitals for the residents and citizens of this country but via a gp, so how do any non entitled get to be seen in non emergency appointments no other patients can make ?

    Tim needs to be more measured on some things, more sardonic on others. Incredulous too!

  • John Barrett 7th Feb '17 - 8:16am

    J Dunn “It seems perfectly logical then, to transfer £500 million, annually, from the overseas aid budget into the NHS. It still counts as overseas aid money, but the logic is that it is being allocated to foreigners in-situ, within the NHS.?”

    No, no, no. The point of overseas aid it that it is targeted at the poorest, the most needy and vulnerable. Those who have jetted in from New York or Lagos to access the NHS are not those who should be receiving our aid or taxpayers money via free access to the NHS.

    This is why, when Caron says, “if some of the tax I pay goes to treat people from abroad who desperately need medical help, then I am absolutely comfortable with it.” that I can agree that is why we have a very substantial overseas aid budget doing just that. We do pay tax for exactly that purpose.

    Our NHS budget, which most people agree is stretched to the limit, should not be used in a round-about way to top up the aid budget.

    Having visited some of the most desperate people in Africa, many who were ill and benefit from our aid budget through organisations such as MSF, the last thing they would want is for their wealthy (or elite, including their own politicians) to be receiving that money.

    Some years ago I tackled a couple of Nigerian MP about a report which said that despite receiving substantial salaries they paid no tax. (They also brought their wives to London to shop while they visited Westminster). I asked why poor taxpayers here should pay tax to send aid to Nigeria, when their rich, including MPs paid nothing, or next to nothing in tax. They smiled and effectively said that that was “the system” in their country and they were not about to change it.

  • Everyone, except Hunt, suggests the NHS needs more funding. 1p on Income tax and showing some ID for elective (non-emergency) procedures doesn’t seem too much to ask. Needing ID to borrow library books and paying a fine for late-return puts this in perspective!

  • “the NHS must be free at the point of need, without needing to prove entitlement;
    and making people produce their papers is a step towards ID cards by the back door.” Why should we not have proof of entitlement. This is necessary in most other countries of the world. The NHS was always designed for the residents of the UK who finance it through tax contributions. For those who are not UK residents, we have EHIC for the EU but the NHS must seek reimbursement from the EU country concerned. All others should have health insurance.

    Although I am a Lib Dem, why is our party so against ID cards? Almost every other country I have lived in has them – and they become an important part of life conferring access to many benefits.

  • Nonconformistradical 7th Feb '17 - 9:35am

    @John Barrett
    “No, no, no. The point of overseas aid it that it is targeted at the poorest, the most needy and vulnerable. Those who have jetted in from New York or Lagos to access the NHS are not those who should be receiving our aid or taxpayers money via free access to the NHS. ”

    I agree. However that might not be what is happening – e.g. https://www.theguardian.com/global-development/2017/feb/07/trade-not-poverty-could-become-focus-of-13bn-uk-aid-pot-watchdog-icai-warns

  • Richard Underhill 18th Jul '17 - 1:24pm

    The Daily Politics is talking about money, including the new £10 note and the Australian $10 note. https://en.wikipedia.org/wiki/Banjo_Paterson

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