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In Focus Collections

The NHS: credit management at its most raw?

Political demands that the the UK’s health services should obtain payment from foreign citizens may flounder in practical reality

David Thornley

Group credit controller, Fort Vale Engineering

Credit management, at any level, has its challenges; generating payment from clients who are reluctant to part with the money they owe is not always easy. But, for most of us, we at least start from the point of dealing with customers who are aware of the debt owed, and who entered into a contractual obligation freely and with full knowledge of the transaction.

Also, in the general course of our daily work it is unlikely that we encounter clients for whom their very existence is at stake.

Extreme credit management The other day, I watched a fly-on-the-wall documentary which featured a member of staff at a London hospital whose job it was to obtain payment from those patients who were not British nationals and who did not qualify for treatment on the NHS. Interestingly, the job title of this man did not include the words ‘credit, collections, ‘control’, or ‘management’; but it struck me that his job did, in fact, represent the practice of credit management at its most extreme. The programme centred around a pregnant woman who went into premature labour whilst on a stop-over at Heathrow Airport en route from the USA – where her entry visa had been cancelled – to her native Nigeria. The lady in question had received fertility treatment which resulted in her expecting quads.

Barely conscious, she was rushed into the hospital, where three out of the four babies were delivered by caesarean section, one baby sadly died at birth.

Due to the delivery being so premature, the surviving babies were kept in the intensive care unit, needing round-the-clock

March 2017 Invoices delivered

These invoices were presented to the mother once she had reached a reasonable level of recovery, but whilst her babies were still fighting for their lives; a heart-breaking situation, with the extra burden of the mounting debt adding to her worries. The staff member dealt with this and other issues with absolute professionalism and compassion. He was indeed a credit to the credit profession, despite the fact that he did not recognise himself as such. This struck me as ironic.

care, whilst the mother also required a considerable period of recovery. The member of staff concerned with collecting payments was now charged with the task of issuing invoices for the care of mother and babies, which would eventually total more than £300,000. A mind-blowing amount of money and one that the mother could have had no inclination would be due when she was first admitted. The medical urgency had precluded any conversation about the debt that was likely to be accrued, much less any hope of obtaining a consent signature on a contractual document.

However well-trained, qualified, and experienced so many of us are, having to deal with situations such as this one would place an enormous strain on even our own professionalism, as would, at the same time the acknowledgment that, in this – and no doubt many other – cases, it is unlikely that the invoices will ever be settled in full. Faced with a defaulting debtor, most of us have procedures to go through which involve collection strategies, legal action, and judgment enforcement.

But what sanctions would be open to our staff member, and indeed the NHS as a whole, which would not involve cold-hearted and callous treatment of this woman whilst at her most vulnerable?

The medical urgency had precluded any conversation about the debt that was likely to be accrued

The programme left me feeling empathy for both the NHS staff member and the mother. Both had been placed in impossible positions: the staff member for doing his job with little or no expectation of a successful outcome, and the mother for incurring an unsustainable debt of massive proportions through no fault of her own. I think it is fair to say: that is really credit management at its toughest. CCR


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