In a bid to crack down on so-called 'health tourism', 20 NHS trusts across the country have taken part in a government pilot scheme to trial identity checks for patients. The results of the pilots are due to be published later this year, but doctors, patients and health organisations have spoken to Politics.co.uk to raise serious concerns about the impact they have had.
"One of the worst cases involved a pregnant French woman who was of Asian descent," one doctor says. "She arrived for a routine scan and was asked by reception staff if she was eligible for free care. She told them that she was French and had never needed to provide ID before. The receptionist told her that she didn't 'seem French' and called the Paying Patients department to question her further.
"The woman was so upset by what was happening that she had a panic attack. I was called to check her over. I had to tell the Paying Patients department to leave the room because they had upset her so much."
A doctor from another hospital speaks about a man with tuberculosis (TB) who needed an operation. Because of his immigration status the hospital refused to carry it out.
"He was finally granted refugee status so they had to do it," she says. "But it could have been so different."
She says that another patient with TB was told that the hospital would treat him but that they would pass his details on to the Home Office to "deal" with him afterwards.
The government says the pilots involve asking all patients for two forms of ID to establish whether they are eligible for free care or not. But one doctor told Politics.co.uk that she didn't believe that all patients at her hospital were being asked, raising the possibility that staff were singling people out because of their race or accent. Indeed, she says that when she attended her own hospital A&E department as a patient, she was not asked to provide any documents.
"I couldn't help but wonder whether I wasn't asked because I'm white and an English speaker," she says.
The doctors say that the pilots seem to have been kept away from clinical staff as much as possible. Some say their colleagues weren't even aware it was happening. Instead, administration staff have been working alongside the Paying Patients and Overseas Patients departments to check ID documents and eligibility.
A form being sent to patients by one of the hospitals involved in the pilot has been passed to Politics.co.uk. It says:
"NHS hospital treatment is not free to all. All hospitals have a legal duty to establish if patients are entitled to free treatment...This hospital may need to ask the Home Office to confirm your immigration status to help us decide if you are eligible for free NHS hospital treatment… The information provided may be used and retained by the Home Office for its functions, which include enforcing immigration controls."
The form then asks for details such as the patient's nationality, passport number and date of entry to the UK.
The Department of Health insists that documents like these do not relate to the pilots but to other charging rules within hospitals. But critics are afraid that patients are receiving these forms on top of other letters requesting to provide identification and are therefore deciding not to attend appointments or receive care.
A patient undergoing tests for suspected cancer at one of the hospitals told Politics.co.uk that after attending an appointment to investigate her condition, she received a big envelope in the post from the NHS.
"The documents explained that I was suspected of not being entitled to free NHS treatment," she says. "I was told to bring my passport and visa to my next appointment or be prepared to pay the full cost of my care.
"This wouldn't normally have been a problem but my US passport and visa were up for renewal so were at the embassy for a six-to-eight week period. My next appointment at the hospital was in a week. Because cancer was suspected, I was horrified. I had to spend a long time on the phone to the Home Office trying to get them to confirm to the NHS that I'd paid my health surcharge and was entitled to care. It was extremely stressful."
One of the pilots was due to take place within an infectious disease unit in Newcastle. Within days of it starting and letters going out to patients, it had to be pulled because there was so much outrage surrounding the plans. In a letter to Jeremy Hunt on the issue, Conservative MP Sarah Wollaston said:
"A letter from one of the NHS Trusts participating in the pilot has been shared with me, in which the Trust instructs patients attending an appointment at its Infectious Diseases Department to bring two forms of identification proving their permanent residence in the UK. The letter goes on to mention that those who are not ordinarily resident in the UK, or those who are exempt from charges for some other reason, may be charged for any treatment they receive. I am concerned that patients in areas covered by the pilot may be deterred from accessing treatment, particularly if they have misunderstood the pilot's purpose and/or are not aware of the exemptions that apply to them."
The health secretary responded by confirming that the pilot had been cancelled after the trust decided there was "too great a risk" of confusing patients.
The Department of Health has been contacted for a comment.
Natalie Bloomer is a journalist for Politics.co.uk. You can follow her on Twitter here. If you are a healthcare professional or patient at one of the pilot hospitals and have a story to tell please contact firstname.lastname@example.org. The NHS trusts included in the pilot are: Barking, Havering and Redbridge University Hospitals, Barts Health, Bradford Teaching Hospitals, Cambridge University Hospitals, Chelsea & Westminster, University Hospitals Coventry & Warwickshire, Guy's & St Thomas, The Hillingdon Hospitals, Imperial College Healthcare, King's College Hospital, Leeds teaching Hospitals, University Hospitals of Leicester, Royal Liverpool and Broadgreen, London North West Healthcare, Nottingham University Hospitals, Royal Free, St George's University Hospitals and University College London Hospitals.
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