Ensuring fair use of the NHS efficiently and effectively – DEMOS (October 2014)

Posted on Fri 31 Oct 2014

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Leander Neckles is a freelance equalities consultant and a Board member of Equanomics-UK

The Immigration Act 2014 and proposals to extend charging for healthcare

Last month, we reported our concerns about proposals for an NHS health care levy for migrants entering the UK and a separate raft of charges being considered by the Department of Health (DH) for migrants who wish to access primary and possibly secondary care. We remain concerned that the proposals will lead to widespread racial profiling and race discrimination. This month DEMOS, a leading cross party think tank, working with Doctors of the World published "Ensuring fair use of the NHS efficiently and effectively…” Do no harm. This report, commissioned by Doctors of the World supports the Government’s aim to ensure that NHS services are not misused but draws on consultations with experts in the field and raises serious concerns about the likely unintended and damaging consequences of the proposed charging regime. A separate report, Reforming the UK border and immigration system, published by the Public Accounts Committee also provides important evidence.

Charging and the announcements in July 2014 from the DH

The introduction of new charges for NHS services is currently being considered by the DH. In July, the Secretary of State announced that a scheme would be introduced this autumn to improve the recovery of existing NHS charges from EEA (migrants from the European Economic Area) nationals (the EEA incentive scheme). The Secretary of State also announced that a second scheme (the non-EEA incentive scheme) would begin in spring 2015. The DH published a detailed implementation plan and an impact assessment for the proposed charging regime for primary and secondary care in July 2014.

About the DEMOS report and the new report from the Public Accounts Committee

The report, from DEMOS and Doctors of the World, focuses on the introduction of proposed charges for primary and secondary NHS care. The report supports the Government’s aims to ‘protect the NHS from misuse and abuse’ whilst giving vulnerable people the care that they need. However the report identifies that the DH proposals present some problematic and, as yet, unresolved problems and challenges. These concerns are supported by the evidence provided by Parliament’s Public Accounts Committee’s new report on immigration and asylum. The Committee’s report identifies that IT failures (for the now defunct UK Borders Agency and the Home Office) cost £1bn, 50,000 asylum seekers are missing and a new immigration backlog is building up and newspaper reports refer to chaos in the immigration system. It is difficult to have confidence in the DH’s ability to develop a national IT system that addresses both immigration status and health care eligibility given the expensive IT failures of the Home Office and equally high profile, expensive and reported NHS  IT failures.

Key unresolved challenges identified in the DEMOS report

  • How to protect the NHS without adding unnecessary bureaucracy, creating threats to British public health and/or leaving innocent vulnerable people without care.
  • The cost and time required to develop the new IT infrastructure that the extended charging regime would require. As well as questions about the ability of government/the DH to develop the new IT infrastructure given the history of failed IT projects.
  • The impact on the ability of the NHS to plan services and allocate resources effectively  if new data gaps develop as individuals and families, eligible for services but fearful of the proposed charging regime, fail to access services.
  • Concerns that early diagnosis will be undermined if people fail to seek treatment early increasing the eventual costs of any treatment for both individuals and the NHS.
  • Missed opportunities to diagnose communicable diseases (e.g. and HIV) which will increase the cost of treatment for individuals, create new health challenges, pose threats to wellness and increase costs for the state. As well as, increased risks in relation to antibiotic resistant diseases, associated public health risks and increased costs risks for the NHS.
  • Risks to providing mental health treatment which would raise efficiency, security and ethical issues and leave vulnerable people without access to care at the right time.
  • Exposing pregnant women and newborn children to unnecessary risks.
  • Concerns about NHS information being available to the Home Office due to serious issues in relation to privacy and doctor-patient-confidentiality.

The recommendations from DEMOS

The report recommends that the Government should:

  • consider setting up a network of triage walk-in clinics, exempt from the charging regime, bringing together frontline NHS staff, CAB staff and other relevant support agencies;
  • completely exempt children who need NHS care from the charging regime;
  • establish a principle of one way information-sharing – which would mean that the Home Office would not be able to access NHS data;
  • educate NHS administrators;
  • introduce a rolling programme of impact assessments to ensure that the policy is having the intended impact and is not resulting in unintended adverse impacts.

The report’s authors make it clear that they hope that the DH will consider the report’s analysis and specific recommendations. It is hoped that voluntary and community organisations will urge the Government and DH to fully consider the report and its recommendations.