COMMENT CSJ THE CLINICAL SERVICES JOURNAL Editor


Louise Frampton louiseframpton@stepcomms.com


Technical Editor Kate Woodhead


Business Manager


Gerry Boniface gerryboniface@stepcomms.com


Sales Executive Peter Moon


petermoon@stepcomms.com


Journal Administration Katy Cockle


katycockle@stepcomms.com


Design Steven Dillon


Publisher Geoff King geoffking@stepcomms.com


Publishing Director


Trevor Moon trevormoon@stepcomms.com


Upfront charges: are we missing the point?


On 1 February 2017, a report from the Public Accounts Committee concluded that health chiefs “must take urgent action to recover more money from NHS patients visiting from overseas.” It stated: “If the NHS does not recover the cost of treating patients who are not entitled to free care, then there is less money available to treat other people and even more pressure on NHS finances.”


Some treatments, including GP appointments and accident and emergency care, are currently free to all patients; and some patients, such as refugees and those applying for asylum, are exempt from charges. In other cases, statutory regulations require hospital Trusts to make and recover charges in respect of the cost of treating overseas visitors. Most hospital care is chargeable.


The Committee said it is “not confident the


THE CLINICAL SERVICES JOURNAL is published in January, February, March, April, May, June, August, September, October and November by Step Communications Ltd, Step House, North Farm Road, Tunbridge Wells, Kent TN2 3DR, UK. Tel: +44 (0)1892 779999 Fax: +44 (0)1892 616177 Email: csj@stepcomms.com Web: www.clinicalservicesjournal.com


© Step Communications Ltd, 2017 Single copy: £19.00 per issue. Annual journal subscription: UK £114.00 Overseas: £150.00


ISSN NO. 1478-5641


The Publisher is unable to take any responsibility for views expressed by contributors. Editorial views are not necessarily shared by the journal. Readers are expressly advised that while the contents of this publication are believed to be accurate, correct and complete, no reliance should be placed upon its contents as being applicable to any particular circumstances.


This publication is copyright under the Berne Convention and the International Copyright Convention. All rights reserved, apart from any copying under the UK Copyright Act 1956, part 1, section 7. Multiple copies of the contents of the publication without permission is always illegal.


Department is taking effective action to recover more of the costs of treating overseas visitors” and concluded progress “is hampered because the NHS is not effectively identifying chargeable patients”. The Government responded announcing new regulations requiring all hospitals to check upfront whether patients are eligible for free NHS treatment will be put in place – legal changes will require all hospitals to establish whether patients are eligible for free treatment, and to charge upfront those who are not eligible, for any non-urgent, planned care. The BMA’s Dr Mark Porter commented that it is hard to see how these new proposals will operate in practice: “There is no detail as to how upfront charging will be introduced from scratch in just three months in an NHS already unable to cope with normal operations. We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS. Doctors and nurses cannot be expected to arbitrarily decide whether a patient gets treatment or not. “There is patchy evidence that this kind of system will achieve £500 million in savings and, even if it did, this would not in any way solve the enormous funding crisis in our health service that the government has for too long ignored. Ministers should not mislead the public into thinking this will result in a cash


Louise Frampton l Editor louiseframpton@stepcomms.com


MARCH 2017


windfall for the NHS, but must address the wider funding shortfall in the NHS, which has left it understaffed and struggling to care for its patients.” Recovering such costs is one way of adding to the NHS coffers, but I cannot help but think that it is the equivalent of ‘looking down the back of one’s sofa for lost change’, given the scale of the financial pressures facing the NHS. Is this simply deflecting from the real issue of underfunding? How will staff on the frontline manage such difficult conversations? What happens when the lines become blurred between what constitutes ‘emergency care’ and what constitutes ‘planned care’? Furthermore, without planned care, when will these patients return to the door as emergency admissions?


In the scramble for the ‘coins at the back of the sofa’, who will pay the ultimate price? It seems compassion, in a funding crisis, is the first casualty.


As I write this comment, I am currently watching a spokesperson on the news highlight the case of a mother who had arrived from overseas and gave birth prematurely to quadruplets in hospital. The cost to the NHS of providing intensive care to these vulnerable infants, as they clung precariously to life, was fully detailed (£500,000+) and much was made of the fact that these infants were ‘taking beds’ that could have been used by ‘British citizens’. Where is our humanity when we put a price on saving four tiny lives? One newspaper report added that ‘only two of the babies survived’ – the implication being that it had been ‘a waste of resources’. In the scramble for the ‘coins at the back of the sofa’, who will pay the ultimate price? It seems compassion, in a funding crisis, is the first casualty.


Follow us on twitter: @csjmagazine


WWW.CLINICALSERVICESJOURNAL.COM I 5


CSJ


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72