NHS charging regime ‘incentivises racial profiling’

An investigation into the operation and impacts of the NHS England system of charging people for healthcare who are not ‘ordinarily resident’ in the UK has revealed that the system is ‘unfit for purpose’.

The IPPR think tank warns that the system of NHS charging, which has become increasingly stringent as part of the government’s ‘hostile environment’, is a threat to individual and public health.

According to the group’s report, the system was found to have delayed people receiving treatment and had a deterrent effect, dissuading both people liable for charging and those who mistakenly fear they might be charged from seeking urgent medical attention.

Under the current rules, anyone not ‘ordinarily resident’ in the UK is charged 150 per cent of the NHS national tariff for any secondary healthcare they receive, with some exemptions. ‘Ordinary residence’ is generally understood as residing in the UK legally and voluntarily for a settled purpose. To qualify, migrants typically need indefinite leave to remain or status under the EU settlement scheme.

Additionally, the current charging system was found to be significantly costly to administer in itself, and only a fraction of the amounts invoiced are recovered. This was especially true when chasing up patients who were destitute or in low-paid work, and so who were unlikely to be able to pay the charges.

The most recent NHS consolidated provider accounts suggest that only £39 million in cash payments were received by NHS providers in the year 2019-20, despite them issuing invoices of £93 million.

Marley Morris, IPPR associate director, said: “The current system for NHS charging in England is unfit for purpose. Under these rules, many long-term residents are left facing extortionate bills for receiving critical treatment. These rules are debilitating for patients, stressful to enforce for doctors and nurses, and harmful to public health.

“Our proposals would ensure that all residents, regardless of their immigration status, would be able to access free secondary healthcare at the point of use, provided they were not a short-term visitor. This would allow for a fair system which protects the founding principles of the NHS – to treat people on the basis of clinical need, not the ability to pay.”