Page last updated at 23:10 GMT, Saturday, 3 May 2008 00:10 UK

Eligibility checks 'are not done'

By Phil Kemp
BBC News

Health tourists can cost the NHS huge sums

About a third of hospitals in England and Wales are ignoring government advice to charge foreign visitors for NHS treatment.

Guidance published in 2004 stipulates hospitals should check whether foreign nationals are entitled to free care.

But a third of overseas visitor managers polled by their association admitted patients were not routinely asked about their entitlement.

The Department of Health said those not entitled to free care should pay.

A lot of my friends, they are in the UK and they tell me if I come there, I will get the best treatment

Tunde, not his real name, lives in Lagos in Nigeria and has been suffering with heart trouble for the past three years.

But, instead of paying for treatment at home, he travels to the UK for free care on the NHS.

"I have an NHS card. I registered it through the GP. I book an appointment with a GP and I am referred to the hospital," he said.

Tunde has been making the trip as a health tourist twice a year for the last three years and says that he will continue doing it until he is better.

"A lot of my friends, they are in the UK and they tell me if I come there I will get the best treatment."

For most non-EU nationals, treatment on the NHS which is not urgently necessary is chargeable.

Staff uncomfortable

Delivery of premature baby needing intensive neonatal care. Hospital says it has exhausted all attempts to recover the debt: 208,259
Female patient spent four months in intensive care unit before she died. Her son says he doesn't have the means to pay her debt: 206,368
Cardiology patient who absconded from hospital after he was identified as a non-UK resident: 13,819

The government was so concerned about reports of foreign nationals receiving free treatment when they should be paying that it introduced tough new guidelines in 2004, designed to ensure that all hospitals checked the status of patients being admitted.

But, four years on, the Donal MacIntyre programme on Radio 5 Live has learned the rules are widely ignored.

Some overseas visitor managers in hospitals told the BBC that they found the guidelines confusing and described how some staff are uncomfortable checking patients' immigration status.

One told the programme: "Staff are anxious of possible abuse not only by overseas visitors but also from people who feel it is unjust to be asked."

A confidential report for the Department of Health released under the Freedom of Information Act last year estimated that 30m was lost in un-recovered debts from foreign visitors in 2004.

Huge costs

The BBC has learned that one hospital spent 208,000 on the delivery of a premature baby needing intensive neo-natal care last year.

The Trust said it has now exhausted all attempts to recover the debt, so that money will now be lost.

The Department of Health is currently reviewing access to primary and secondary care for all foreign nationals and several hospitals are running pilot schemes where patients who are not eligible for free treatment have to pay at their bedside.

Andy Finlay is the income generation manager at West Middlesex University Hospital, which is one of the hospitals involved in the scheme.

He explained that one particularly blatant example of a health tourist prompted their involvement.

"He said 'you have to treat me until I'm well and I'm not paying and there's nothing you can do about it'.

"He came with a pre-existing heart condition and he knew it's free at the point of delivery in the UK. He abused us - he was a 100% bona fide health tourist."

Patients leave

Since introducing their new policy, 20% of all patients admitted to A&E self-discharge before they are asked to pay for treatment, whereas before no patients left of their own accord.

The hospital says they now recover 75% of debt from foreign visitors paying all fees, a much higher proportion that most other hospitals.

Andy Finlay is hoping that the Department of Health will extend his idea across all hospitals.

In a statement, the Department of Health said: "It important that those who are not entitled to NHS services pay for any they receive.

"The government is currently reviewing access to primary and secondary care for all foreign nationals."

The Radio 5 Live investigation into health tourism can be heard on the Donal MacIntyre programme at 1900BST on Sunday 5 May or get the podcast at the Donal MacIntyre programme website.



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