The NHS can’t do this

More than six in ten doctors want to introduce charges for some patients, including fees for overseas patients attending Accident and Emergency units, a survey shows.

Ministers recently introduced “upfront” hospital charges for patients receiving planned treatment, if they are not eligible for free care.

They’ve simply not got the systems. Not the ones to check and not the ones to accept payment.

No one has to carry ID in the UK. Your patient records, which might show your health care status, are with the GP. What are people to check? Which is before the fact that no one has a card machine.

Further, who the hell is going to demand payment before sewing up a jugular? Not even California does that…..

34 comments on “The NHS can’t do this

  1. Arizona hospitals do ask when you are wheeled into ER if you have insurance. But they don’t insist on payment up front:-)

  2. It’s not just the mechanics of payment acceptance. It’s what you do with defaults or people whose means of payment won’t let them have the funds as they lie bleeding or dying or giving birth in your A&E corridor. And the Twatterers’ faux outrage when an NHS employee or an agency hired by the NHS pursues an unemployed, single-parent, one-legged, black gay transgender person with some unspeakable illness, for recovery of the debt.

    Doctors might be clever people, but they’re very often completely detached from the realities of non-medical life.

  3. No one has to carry ID in the UK. Your patient records, which might show your health care status, are with the GP.

    I suspect that may change. Any moment now the government will, no doubt, call for some sort of national identification number. No doubt they will call it something innocuous like a Social Security Number perhaps. But a National ID Card is what it is. The civil service wants it and so they will get it in the end.

    As for charging foreigners, there are two simple solutions to this. One is not to let the f*ckers into the country in the first place. Half the problem solved. The other is to insist, now we have Brexit, no ticket is sold to the UK unless it comes with a visa. That visa requires a fee of, say, £2500 some of which goes to pay for emergency medical insurance. So if they cut their throat, the insurance company pays.

    The rest is defaulted to the Treasury if they so much as look sideways at a 12 year old.

  4. The NHS doesn’t even bother to bill foreign health insurance companies for services rendered (source: personal experience).

    It’s obviously not cost-effective to set up the infrastructure as for 99% of clients it would just be another pointless circulator of hypothetical money creating additional potential for fraud. So those who should be paying, or getting some other insurer to pay, mostly get it for nowt.

    SMFS: You have the ID already, it’s your NHS number, usually issued at birth. But it doesn’t come printed on a glossy card with photos and fingerprints.

  5. There will be no ID card. Cos there are still several million like me who wont comply with such tyranny.

    Which is why The Bottler dropped the scheme. Because he know the cost and bad publicity wasn’t worth it.

    It may come in a few years when all those who knew the UK as a free country are dead. A generation of morons who are willing hand biometrics to iphones may do freedom in finally.

    But perhaps not.

  6. My GP in Austria only took cash ( the missus had superlative and expensive insurance and so of course never had to wait or pay up front ).

  7. Are they supporting a change they know is difficult to implement because it is difficult to implement and so unlikely to happen, but still makes them look like they are concerned?

    Foreign freeloading on the NHS extends beyond A&E.

    The answer is of course, bitcoin. Seems to be the solution to everything at the moment. Not the transaction and mining side, just the ledger bit. With a computer or 3 in every hospital keeping a copy of it and keeping a national record of everyone’s eligibility for free treatment up to date.

  8. It is no more of an imposition to have to produce ID to get hospital treatment than it is to get on a plane. No NHS card because you’re a foreigner? A card issued by your insurance company will do. Or an EHIC card. Don’t like it? Go private.

  9. Oh, and the tryanny of compulsory ID is that you must carry it and can be asked to produce it by some jack-in-office at any time. This does not apply when you have opted to ask for some service or product.

  10. Third comment. Promise it’s the last. The case to google re the tyranny of ID is the wonderfully titled Willcock v Muckle.

  11. You could always charge everyone up front and then either reimburse them when they can prove entitlement or when their insurance company coughs up the readies to the hospital. Initiating a department to do this would pay for itself in a short while. Just look at the hospitals in Spain and the Canaries. They seem to manage it.

  12. It’s fairly obvious that the introduction of a compulsory ID card in the UK is going to a one-off bonanza for scam artists of every persuasion. Unlike other countries have ID cards,UK has no uniform, from birth, proof of identity. It’s one I’d be tempted to perpetrate myself.
    Come over to the UK, buy a few shoddy clothes from Oxfam, tip half a bottle of White Lightning over my head, chuck a brick through a shop window & sit down & wait to be arrested. Claim to be a homeless vagrant alcoholic with mental problems. Get inserted into the system. Trivial court penalty, if they bother prosecuting, then handed over to the social workers. Everyone in the UK is required to have an ID card, ergo everyone in the UK is entitled to one. They’ll be required to expedite one for me.
    Reckon it’d be possible to work this scam, simultaneously, half a dozen times, different parts of the country. Result: half a dozen kosher ID cards, half a dozen benefit streams going into newly opened bank accounts. Even half a dozen council flats if the breaks are right.
    Should clear a million quid in the first year.

  13. “Oh, and the tryanny of compulsory ID is that you must carry it and can be asked to produce it by some jack-in-office at any time.”

    There’s no question the UK would insist on that and prosecute trivial infringements to the letter. Less jackbooted countries like Germany have ID cards but absolutely no obligation to carry them around or produce them on demand. 🙂

  14. “Come over to the UK, buy a few shoddy clothes from Oxfam, tip half a bottle of White Lightning over my head, chuck a brick through a shop window & sit down & wait to be arrested.”

    You might have an extremely long wait for that.

  15. @BiS: would the ID card system not run data matching to check for this sort of problem? One assumes the system would be biometric – how would you be able to get multiple cards, when the second registration attempt resulted in the same biometrics at the first? The system would flag it up immediately (one hopes!)

  16. Bloke in Germany,

    “The NHS doesn’t even bother to bill foreign health insurance companies for services rendered (source: personal experience).”

    They don’t care/can’t be bothered. It would take almost no effort to simply sell the debt to a collection agency. Maybe you’ll only get a tiny percentage of it, but it would be better than nothing.

    The day when the public stop viewing nurses and doctors doing their job as heroic will be the day the NHS reforms. This acts like a shield to how crap the NHS is. “Oh, my gran went into Neasden hospital and the NHS was marvellous with her”. No, they did their job. They got well paid for it. Doing an operation right and being polite to people is their job. They deserve as much gratitude as someone fixing a tyre on right at Kwik-Fit or a plasterer doing a wall well.

  17. Oddly enough, I was in A&E on Christmas Day (tripped over and hit my head). There were 2 other patients: a woman kicked by her horse with broken ribs and worse (possibly), myself, and odd character with nothing visibly wrong (oh, and a sad individual, ex hospital porter, who was lonely). The five receptionists stood around chatting – I was triaged by 2 nurses, another couple dressed the wound after 3/4 hour wait, and after only 90 minutes I was on my way. Excellent treatment, if slow. And it healed up brilliantly.

    There was a big sign up about who might be charged, and when. A&E is free (fair enough, and I wouldn’t want it differently), inpatient treatment or GP referral might not be. However, the list of who might have to pay included “even if you are legally in the UK, pay taxes and have an NI number”, which I would have thought was eligibility for free at the point of delivery NHS services.

    Those of us who protest about NHS freeloaders meant (a) illegal immigrants, (b) NHS tourists, (c) women popping out an anchor baby. Well, I did.

  18. @Jim
    Biometrics don’t really work like that. They validate a specific challenge against a recorded biometric profile For what you suggest it’d be necessary to compare every individual going onto the database with every other individual going onto the database. For over 60 million people involving heaven knows how many parameters? (Insert very big number here…….)

  19. Thin end of the wedge. They haven’t got the systems to do this…. therefore, they’ll need to introduce the capacity. Then it is all set up, ready to charge all of us.

  20. The systems can surely be created. Probably too hard to do for A&E, but otherwise you produce your social security card when you go for treatment, else you get billed. No need to carry ID all the time, only when you require non emergency treatment.
    It works for insurance, access to airplanes, nightclubs, tobacconists etc.
    As far as A&E is concerned require every visitor to have health insurance to cover this.
    Free at the point of use is precisely why the NHS is unsustainable, and becoming more so as travel gets easier and cheaper. In 1947 there were to a rough approximation no foreigners visiting the country, now there are lots. Either we recover the cost of their treatment or we go broke.
    Alternatively a charge for all, if implemented, would kill the perception that doctors and nurses are saints- nothing like a bill to make people understand that they are dealing with human beings not angels.
    In fact why not charge everyone and provide a subsidy for the poor enough so they can afford medical insurance?

  21. For over 60 million people involving heaven knows how many parameters? (Insert very big number here…….)

    And the vulnerability to false positives means that the Bayesian probablities of something going seriously wrong asymptotically approach 1 long before you get to 60m.

  22. Excavator Man,

    “The five receptionists stood around chatting – I was triaged by 2 nurses”

    This always annoys me (I saw it at a local health centre with 4 receptionists, 2 doctors). You need as few receptionists as it takes to get patients through to doctors. Doesn’t matter if people are waiting at reception, as long as doctors have patients in the queue. But lots of bits of the NHS seem to be stuffed to the gills with them.

    I had a visit to Virgin Healthcare (via the NHS) where there was no receptionist. Just a board telling us to fill out a form and a nurse with a list of names. I’m sure that meant occasionally that the nurse had to help someone, but almost everyone is going to manage that just fine.

  23. The FBI’s National Crime Information Center has 12 million records and can do 28 million transactions a day. So there are systems out there that can do it. Although it was a long, painful, expensive process to get there.

  24. When I went into A&E in Singapore there was no receptionist. Just a nurse who saw me then the doctor. The “receptionist” was the person I saw when I had been treated and needed to pay.

    The NHS way is going to cause trouble as petty beaucrats feel they have no personal ability to change or flex the rules to be sensible, possibly as they don’t own the problem they merely pass it along to the next small link in the long chain. As a consequence every incentive exists only to pass things along that fit the paperwork. I see this where I work.

  25. “The FBI’s National Crime Information Center has 12 million records …”: but the FBI get to murder people deliberately. With the NHS it’s generally accidental.

  26. Everybody who wants to NHS services simply has to turn up with a piece of plastic identifying them uniquely, that can be swiped and the id on the card used to initiate a payment to the NHS from their bank account. No idea how the NHS could get that to work.

  27. ” Less jackbooted countries like Germany have ID cards but absolutely no obligation to carry them around or produce them on demand. ”

    Very good Biggie.

    You might end up with a working sense of humour after all.

  28. @ Alex
    If you are a genuine emergency following an accident, you probably won’t have the piece of plastic in your pocket – you might not even have a pocket. I didn’t last time it happened to me (knocked down by a cyclist, soming round the corner too fast, on a footpath).

  29. And of course there’s the British habit of refusing to look at how e.g. the French or Germans manage it….

    But then most are blissfully unaware that the “average” continental system is insurance based…

  30. That’s not entirely true. The NHS systems do interface with the private sector systems via NHS Digital. As private sector patients are also NHS patients. The payment system is achieved through insurance or a payment portal run by VISA/Mastercard.

    How you would vet the individual is another matter.

  31. @ Alex

    No, not just “some” – virtually all emergencies that matter.

    For non-emergencies, yeah – it makes sense. And that would cover 90+% of the costs that should be borne by other EU governments.

    Some years ago I was knocked down on a street closed to traffic (by a Volvo, of course) while running a marathon: fortunately I was still under 50 and bounced off the tarmac – if it happened now I should probably break something and need A&E – just how many marathon runners carry their Mastercard in the (usually non-existent) pocket of their shorts?

  32. European ski slopes

    Actually, I personally know quite a few examples where cards were required to be shown (or other evidence of insurance) before assistance was provided.

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