'Chaotic' recovery of NHS costs is adding to pressure on finances

1 Feb 2017 01:43 PM

The Public Accounts Committee report says that health chiefs must take urgent action to recover more money from NHS patients visiting from overseas.

Public must be confident that money due is being recovered

In their report, the Committee calls on the Department of Health to improve systems for cost recovery and "do more to promote public confidence that the money due to the NHS is being recovered, and that the system is fair to taxpayers and to patients who are entitled to free care".

The report states: "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."

Whether patients are supposed to pay for NHS treatment depends on whether they are resident in the UK and on the type of treatment.

Committee not confident that effective action is being taken to recover costs

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 is not confident the Department is taking effective action to recover more of the costs of treating overseas visitors and concludes progress "is hampered because the NHS is not effectively identifying chargeable patients".

The extent of unexplained variation between hospital trusts suggests that some have scope to make substantial improvement, says the Committee.

Bodies other than the department have a role and are not doing enough

However, it concludes other parts of the health system—such as NHS England and clinical commissioning groups—have an important role to play and are not yet doing enough to support cost recovery.

Among its recommendations the Committee urges the Department to publish by June an action plan "setting out specific actions, milestones and performance measures for increasing the amount recovered from overseas visitors."

This should name senior individuals in the Department and NHS Improvement whom the Committee can hold to account.

Chair's comment

Meg Hillier MP, Chair of the PAC, said:

"The Government's failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds.

Our Committee has reported extensively on the financial pressures facing the health service and it is simply unacceptable that so much money owed should continue to go uncollected.

This is a problem for the health service as a whole and work to put it right must be driven by central government.

We are concerned that financial progress to date does not reflect meaningful progress with implementing the rules and the Department for Health and NHS have much to do if they are to meet their target for cost recovery.

That is why we are calling on the Department to set out a detailed action plan now. It must make clear what it will do to increase the amount recovered from overseas visitors, and who will be accountable for achieving this.

The public rightly expects the Government to enforce the rules and more can and should be done to recover money where it is due."

Report summary

The NHS will always provide immediately necessary and urgent care to any patient who needs it. However, hospital trusts have had a statutory duty for over 30 years to recover the cost of treating overseas visitors who are not eligible for free care.

It is clear that the NHS has been recovering much less than it should, and only in the last few years has the cost of treating overseas visitors become a priority for the Department of Health (the Department).

Since the Department launched its overseas visitor and migrant cost recovery programme in 2014, the amount charged has increased—from £97 million in 2013–14 to £289 million in 2015–16—but most of that progress has resulted from changes in the charging rules, rather than from trusts implementing the existing rules more effectively.

The Department and the NHS are still a long way from meeting the target to recover up to £500 million a year by 2017–18.

Cost recovery systems appear "chaotic"

The systems for cost recovery appear chaotic. The Department told us it was planning further changes relating to policy and regulation, good practice and IT, but we are not convinced that enough is being done to identify and charge overseas patients.

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.

The Department and the NHS need to do more to promote public confidence that the money due to the NHS is being recovered, and that the system is fair to taxpayers and to patients who are entitled to free care.