Passports for Health

On Monday the Department of Health’s most senior civil servant suggested that patients for scheduled surgeries in hospitals could be asked to provide their passport in order to prove they shouldn’t be charged.

This is in response to a possible total of around £200 million (the figures seem to be intentionally vague) which has been unclaimed by the NHS for treating foreigners. It seems quite an impressive amount of money, until you realise that the total budget for the NHS is currently around £107 billion, over 500 times as much. The £200 million wasn’t even 10% of the NHS deficit for 2015/16, let alone the higher projected figure for 2016/17.

Supposedly around 30% of the British population do not have passports, and a large proportion of those do not have driving licences either. Many of those will be elderly, who no longer travel or drive, and many others will be poor – the very populations who are most likely to require scheduled surgery.

Department of Health statistics indicate that around 713,000 scheduled admissions happened in the month of September. Let’s investigate the procedural cost required to verify that passports (or any other documentation) have been provided. Even just a couple of minutes per admission generates around 1.5 million minutes per month – you’d need well over 450 full-time employees just to process this, costing well over half a million pounds per month, not to mention the paper work and design of systems. And bear in mind that 30% of admissions (and possibly much more) would generate even more administration, as would forgotten or mislaid documentation.

The cynic in me wonders two things. Firstly, is this an attempt to raise revenue from around 20 million people – at £72.50 a pop? Secondly, is this an attempt to cut demand from those who cannot prove their identity, who will probably be the most needy?

If this proposal is implemented, a message will go out that you need to prove your entitlement to access the NHS – not just elective surgeries. And that will mean that people who may have all sorts of infectious diseases decide that it’s not worth the hassle of seeking medical attention. The implications for public health are profound. Indeed, such a proposal may well cost the NHS much more because of the epidemics that would need treating.

The more fundamental issue is the amount of money charged to the NHS because people cannot be discharged from hospitals due to the lack of social care. Council budgets have been slashed in recent years, and most council-provided social care now has a number of restrictions imposed. Bed blocking, as it is known, is estimated to cost around £820 million a year – over four times as much as we are losing in unclaimed operation costs – and those were last year’s figures. Bed-blocking has increased in 2016.

It’s also worth noting that passports are used to prove identity. Thefts from within hospitals are sadly not unknown. So if an individual is expected to take in such proof, then hospitals will need to have far tighter security in order to reduce thefts. It might not be unreasonable to refuse to take such a document in if it is possible, likely even, for it to be stolen while you’re under anaesthetic or recovering.

It doesn’t make sense from either an economic or a public health point of view. But the final aspect is the decline in humanity that it demonstrates. Most scheduled surgeries are not vanity projects. They are joint replacements, or solving other life restricting problems. The message given out is that Britons now only care for themselves. As Tim Farron said in his recent speech to the Liberal Democrat conference, Britain is now seen as “mean and not pulling its weight”. That is not the Britain that I want to be associated with.

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