Review into denial of NHS care to overseas patients kept secret by government

Exclusive: Study appears to expose care being wrongly denied – with confusion over when it ‘should be safely withheld if payment is not provided’

Thousands of people have been told to pay upfront for their treatment, including hundreds for serious health problems (PA)

Ministers are keeping secret a review that appears to expose how overseas patients are being wrongly denied NHS treatment after being told to pay upfront charges, The Independent can reveal.

Care has not been “safely withheld” when payment is not provided in some cases, after the controversial rules were introduced last year, a brief statement on the report’s conclusions suggests.

The Department of Health and Social Care admitted some NHS trusts are failing to “ensure some groups of vulnerable overseas visitors understand their entitlements and treatment options”.

And trusts will be told to improve decisions on “when a patient can be reasonably expected to leave the UK before deciding if treatment should be safely withheld if payment is not provided” – implying care is being wrongly refused.

Thousands of people have been told to pay upfront for their treatment since the crackdown began in October last year, including hundreds for serious health problems such as cancer and heart conditions.

The Royal College of General Practitioners (RCGP), the British Medical Association (BMA) and Labour all attacked the highly unusual decision to keep the study under wraps.

“What are ministers hiding about these controversial charging regulations?” asked Jonathan Ashworth, Labour’s shadow health secretary.

“These charges were imposed as part of Theresa May’s obnoxious hostile environment agenda. We have long had concerns they mean seriously ill and vulnerable people could go without the medical care they need.”

A BMA spokesperson said: “If the government is to make such claims about the effect of these regulations, it needs to be able to substantiate them with evidence.

“We strongly would urge the Department of Health and Social Care to publish the findings of this year’s review without delay.”

And Professor Martin Marshall, the RCGP’s vice chair, said: “We are concerned about the risk of ill patients not seeking medical care because they cannot afford treatment – something that has the potential to affect some of the most vulnerable in society.

“We fed these concerns into the Department of Health’s consultation on this issue, and it would be helpful to see the outcome of this exercise.”

Under the rules, patients from outside the EU are charged 50 per cent more than cost to the NHS, which means up to £15,000 for certain operations.

Hospitals were ordered to demand utility bills, bank statements or payslips from patients, in order to prove their entitlement to free healthcare.

Staff were given a list of 32 questions to establish likely residency, alongside guidance warning trusts could fall foul of discrimination law if they target non-white patients.

Figures released last month, to The Guardian, under freedom of information law, revealed that 2,279 patients were charged upfront between October 2017 and June 2018.

Of these, 341 patients did not go ahead with their intended treatments or appointments after being told to pay. Many returned to their countries of origin, but some said they could not afford the charge.

They included a patient in Essex with arrhythmia, a disorder affecting the heart rate, and three in Hampshire who needed radiology, andrology and breast treatment respectively.

The true figure for the number of patients told to pay is certain to be higher, because 64 of England’s 148 acute hospital trusts did not reply to information requests.

The Department of Health and Social Care defended the decision not to publish the review into the policy, which was introduced after protests about so-called health tourism.

“All evidence was submitted in confidence by stakeholders and was considered thoroughly before a summary of the findings was published earlier this week,” a spokesperson said. “It was never the intention to produce a formal review document.

“British taxpayers support the NHS, and so it is only right that overseas visitors also make a contribution to our health service.

“The money recovered is reinvested back into frontline services, meaning that we can continue to protect the most vulnerable in society and ensure everyone receives urgent care when they need it.”

In the statement, released to MPs, health minister Stephen Hammond said: “The evidence received demonstrated that there is no significant evidence that the 2017 amendment regulations have led to overseas visitors being deterred from treatment or that the changes have had an impact on public health.

But he added: “Some case studies presented did reveal that there is more to do to ensure some groups of vulnerable overseas visitors understand their entitlements and treatment options, and that providers of NHS care consider fully when a patient can be reasonably expected to leave the UK before deciding if treatment should be safely withheld if payment is not provided.

“We will continue to work to ensure that these issues are addressed, so that the charging regulations are implemented in as fair a way as possible.”