Patients not Passports: ID Checks and Upfront Charges in the NHS

In recent months, the NHS has seen itself once again at the forefront of issues being commented upon and debated by the government. Earlier in the year there was widespread shock upon the memorandum of understanding signed between NHS Digital (the company which holds all NHS online information) and the Home Office. The memorandum would allow sharing of information between the two bodies to crack down on immigration. This is an affront to confidentiality of healthcare workers to their patients and raises concerns about the use of the NHS as a border enforcement agent.

Later in the year we heard Boris Johnson once again revive the Leave campaigns promise to fund £350million a week into the NHS, money saved from leaving the EU. This was once again hugely controversial over whether such funds even existed and how they could be incorporated into the NHS.

However, one story which has relatively gone unnoticed by the public in recent weeks is the checking of ID’s of patients and the enforcement of upfront charges before proceeding with treatment. From the 23^rd of October (today) all community health organisations in England receiving NHS funding will be legally required to check each patient’s immigration status and then subsequently charge those not deemed to be exempt, an exorbitant 150% of the cost of their treatment.

Currently regulations are set to affect all community health services including school nursing, community midwifery, community mental health services, abortion services and specialist services for homeless people and asylum seekers. Additionally, these regulations are expected to include charities receiving NHS funding, alongside NHS hospitals which will also commence upfront charging.

These proposals by the Department of Health are an affront to Universal Health Care, a cornerstone of the NHS and encompassed more widely in resolutions accepted and passed by previous British governments. It also raises three major questions and indeed problems with this resolution.

Firstly, these resolutions will unfairly target and deter some of the most vulnerable members of our communities from seeking healthcare advice such as homeless people and victims of human trafficking. This was highlighted by Leigh Daynes, the executive director of Doctors of the World UK who said, “At our clinics, we already see heavily pregnant women, cancer sufferers, and people with ill children who are too scared to see a doctor. Hospitals should be reducing the barriers these people face, not putting up more.”

Whilst I believe that people who can truly afford to pay for their healthcare should do so, hospitals as a whole, should not have rules that can shut out people in need. Many excluded people in the UK, such as asylum seekers and trafficking survivors, also do not have ID and address documents. This also applies to some British people such as the homeless, the destitute, and the elderly.

This also raises the question of how one defines Universal Health Care (UHC). The long-standing definition has been to ensure access to healthcare is the same for everyone regardless of someone’s background or their ability to pay. However, in political times like these it is interesting to consider where boundaries are drawn. By universal health care which group of people are we including and who are we restricting. Thus, can it be called universal health care if certain groups of people are excluded?

Secondly this proposal raises the question of which services are to be affected. At the minute, Accident and Emergency services and GP surgeries (thereby primary care) is exempt, but the UK government has been clear that charging could be extended to these services in the future. The question here arises from which services are considered essential and urgent. One can agree labour and childbirth or immediate treatment of a heart attack (MI) would be considered urgent. What about life saving heart surgery where the patient is stable. Who is it that decides a certain procedure is urgent and therefore can bypass the upfront charging, and how is this decided.

Finally, one clear issue in my mind is the use of healthcare professionals to monitor and enforce this policy. Adding to the wok of clinicians who are already struggling due to staffing shortages and reduced funding from the government is careless and disregards the main role of these professionals, which is to help all patients regardless of their background.

This policy has been criticized by various organizations in the UK with 4 charities; Doctors of the World, Asylum Matters, the National Aids Trust and Freedom from Torture, signing an open letter to Jeremy Hunt (UK Minister of Health) and the Department of Health to backtrack on this policy. Since then it has been signed by over 190 organizations including several UK Royal Colleges and Amnesty International UK. It is still to be seen what impact this policy will have once it has been enforced, and whether the government will backtrack on this controversial issue.