Campaigners call for local political declaration on NHS patient charging

Campaigners are calling political representatives from across north-east London to make a joint statement opposing the charging of overseas visitors by health trusts to NHS England and the government.

North East London Save Our NHS (NELSON) made its call with a focus on the practice at Barts Health NHS Trust at last night’s meeting of a committee scrutinising health matters across Hackney, Newham, Tower Hamlets and the City of London.

NELSON spokesperson Rosamund Mykura, underlining her organisation’s support for Barts and the wider NHS for its work on health inequality, argued for the opposition to NHS patient charging for both “moral and practical reasons,” adding that the imposition of the charges amounted to institutional racism.

All NHS trusts are legally required to charge patients who are not entitled to free care for their treatment, with national regulations currently stipulating that all patients must be ‘ordinarily resident,’ or living in the UK “lawfully, with a settled purpose, for the time being.”

Mykura said: “No-one is blaming Barts for this racism. It was not designed by them. As councillors and residents we know the moral and practical problems of charging patients remain.

“Morally, our residents, threatened with NHS charging, are fearful, of NHS debt, and of being reported to the Home Office. This can be life-changing for local families. They may delay them attending, or [make them] not attend, hospital.

“Practically, putting immigration enforcement into the NHS means health inequalities are deepened. This includes racialised health inequality. This means more ethnic minority people will die, especially in our boroughs with large ethnic minority populations.

“Despite the efforts at mitigation, that we support, the moral and practical issues continue, of denying free NHS treatment in our hospitals for some of our most vulnerable residents, and reporting them to the Home Office.”

Due to last night’s meeting being held on an informal basis, no decision was able to be taken on whether to release the statement called for by NELSON by the committee, though Health in Hackney scrutiny chair Cllr Ben Hayhurst said that he would support making such a declaration.

According to figures submitted to the meeting by Barts, the number of overseas visitors legally charged for treatment at Barts Health hospitals has more than halved in the last year, falling from 2,430 in 2018/19 to 997 in 2019/20, with the number of invoices issued also falling from 3,113 to 1,228. The payments received increased in the same period, from £1m to £1,429,000.

The hospital has also rejected all claims that implementation of the policy amounts to supporting institutional racism, adding: “Such claims are unjustified and do not help our staff or patients in implementing what is a national policy.

“We aim to offer an equitable service to everyone in the community we serve, whilst also being congruent to our legal obligations. Though it’s not the position of Barts Health NHS Trust to comment on the policy itself.”

In response, Mykura pointed to statements from NHS boss Sir Simon Stevens on the increase in action needed to deliver on the moral basis of the health service and statements on anti-racism and in solidarity with Black Lives Matter made by Barts itself.

Mykura added: “It seems Barts can and sometimes does address wider societal issues in relation to health. It is surprising that Barts feels that insitutional racism should not be discussed in relation to the government’s decision to put immigration enforcement into NHS hospitals.

“Barts Trust do not think it appropriate to comment on the government-imposed hostile environment affecting our residents. We hear that. We know it was not their decision to implement it.

“This committee, as political representatives of our residents, are however well-placed to do so. We suggest this committee should make a statement in order to further protect our residents.”

Hospitals will contact the Home Office when needing to confirm the immigration status of some patients to see if they are eligible for treatment, and are required to report outstanding debts meeting criteria outlined in the national regulations to the Department of Health, which information will then be shared also with the Home Office.

The figures on charging by Barts included payments made under reciprocal arrangements with the EU, under which hospitals can reclaim the costs of emergency treatment for EU citizens from local clinical commissioning groups and the government.

Quizzing Barts representatives, Cllr Hayhurst said: “One of the criticisms of overseas charging is the limited amount of money it may or may not bring in, and whether administrative costs are more than it does.

“I appreciate that these figures include the European health reciprocal arrangements. You would expect that to be paid back. What would be interesting would be to see the dataset with that stripped out, and then how much is billed and how much is then claimed.”

Addressing the meeting, Barts’ group chief medical officer Alistair Chesser reassured those listening that an equality impact assessment had been carried out on the policy, with the Trust “always open for further joint working and dialogue” with Save Our NHS.

Pointing to the improvements in the Trust’s processes and systems, such as the hospital engaging with patients earlier in order to reduce the number of invoices sent out as entitlement to treatment is established earlier, the Barts boss acknowledged that “further improvement” could take place.

Chesser said: “It is a legal obligation on all NHS trusts to establish if a person is an overseas visitor and therefore should be charged for NHS treatment. I should emphasise that we never turn anybody away if treatment is immediately necessary. That includes care in the emergency department and all maternity care as well.

“In order to fulfil our legal obligations we are adopting an approach of treating all patients in the same way when they present to the hospital of asking whether they have lived in the UK for the last twelve months. That is a screening question which allows us to focus on those patients who may not be ordinarily resident and who therefore need to be helped to understand the position they are in with respect to charging.

“We will continue to do all we can to implement our legal obligation equitably and fairly, with an emphasis on making sure that we treat all patients in the same way.”

Barts’ chief executive officer Alwen Williams added: “This is a legal requirement on NHS trusts to do this. What we are trying to do is do it fairly, equitably and justly.

“This is not something we choose to do, but this is a statutory requirement and therefore what we are trying to do is transact it in the best possible way, with a very clear sense of equity in terms of how we apply the procedures that we do within the organisation.”