Passports for the NHS?

“Yesterday, we learned that pregnant women will be forced to hand over their passports at NHS hospitals. No ultrasound without photographic ID—heavily pregnant women sent home on icy roads to get a passport. Are these really the actions of a country where it doesn’t matter where you were born?”

Jeremy Corbyn, 12 October 2016

This refers to one hospital in particular rather than to all NHS hospitals, although the government is looking into rolling out identity checks more widely.

It was announced on 11 October that all non-emergency maternity patients at St George’s Hospital in London will be asked to provide proof of ID or right to reside in the UK before being treated, as part of a pilot.

The hospital said that “Hospitals are required to check patients for their eligibility when accessing non-emergency NHS treatment. We are not doing this effectively enough at present, and are looking at ways in which we can improve this.” It also said that patients without ID will be referred to the “Overseas Patient Team for specialist document screening”.

Anyone who is not “ordinarily resident in the UK” can be charged for the use of NHS hospital services in England and Wales, except for emergency services such as A&E. There are one or two exceptions to this, such as refugees and asylum seekers.

It has been (roughly) estimated that the NHS spends around £2 billion a year treating patients who aren’t ordinarily resident.

EU citizens don’t have to pay. There are arrangements in place by which the UK can charge their home government for the care they receive.

Department of Health guidelines say that “all relevant NHS bodies will need to have systems in place to support charging of overseas visitors…[Staff should] identify, without discrimination, all patients who may be liable to charges.” The guidelines suggest that this should be done by interviewing patients to find out whether or not they should be charged.

The guidelines also say that “booking-in staff, ward clerks etc. will need to be prepared to ask for basic supporting evidence. Being unable to provide evidence does not mean that someone should be refused treatment, only that they should be referred to the OVM for further investigation.” This seems to be exactly what St George’s Hospital has proposed to do.

What about the rest of the NHS?

The government is looking at whether or not patients should be required to bring identification when using non-emergency NHS England services. As with St George’s Hospital, the focus is on finding more effective ways of identifying patients eligible to be charged—which in theory should be happening already.

Chris Wormald, the Permanent Secretary for the Department of Health, told a committee of MPs that “for the majority of free healthcare, hospitals do not routinely either check identity or charge, so we are trying to introduce this system”. He also mentioned that some hospitals are trialling a system of asking patients for two forms of identification, their passport and proof of address.

The Department of Health told us that "The NHS is a national—not an international—health service and we are determined to stamp out abuse of the system to ensure it remains free at the point of need in this country. We consulted earlier this year on extending the charging of migrants and visitors using the NHS. We will set out further steps in due course to ensure we deliver on our objective to recover up to £500 million a year by the middle of this Parliament.”

Update 22 November 2016

We updated this piece to include information on what the government has said about the future use of identification and charging those eligible across the NHS.