British Government: Making a meal of something very simple (1)

Controlling entitlement to free health-care in the UK

The UK government’s legislative programme for the next 12 months or so is traditionally laid out in the Queen’s speech which was read out by the Monarch to the new session of Parliament beginning this week on May 8th.

Most people in most other countries will be amazed to learn that up to now, foreigners in Britain have been able to walk into any General Practitioner’s surgery and be referred from there to obtain medical treatment in a hospital without having to pay[1].  The Queen’s speech included proposals for requiring GPs to check that people seeking medical treatment were entitled to it.

Opposition to charging from doctors

As is par for the course, this proposal has been greeted with opposition from Britain’s NHS doctors’ organisations[2] with potty suggestions that GPs are being put in the “invidious” position of behaving like “a new border agency”.  What is invidious is that even now with cuts in the National Health Service being imposed on British citizens, GPs in a state of moral confusion don’t see that it is their bounden duty to ensure that their services are provided free only to those people who are entitled to them.  These are British citizens and their spouses (of course), British patrials[3], and those with indefinite leave to stay[4].  The rest will have to pay or provide evidence that their home countries, e.g. Poland, Romania, Nigeria, Ghana, will pay on their behalf.

How can this be done easily?

There has been in existence for some years a system by which citizens of countries in the European Economic Area (EEA)[5] can obtain state-provided health-care when visiting each other’s countries.  All that is needed is for a citizen to obtain a European Health Insurance Card (EHIC) from their own country’s health authority.  The card is standard credit card size and is free on application in the UK at  The card can be readily adapted for UK domestic use as follows.

It is at this point, not at the doctor’s, that an individual’s entitlement to free treatment abroad is established or not.  The card does not bear a photograph, but can easily be made to do so, like a car licence, to reduce fraudulent claims.

When a UK citizen goes to a foreign GP or hospital in say France or Switzerland, he is normally expected to produce the card on a first visit[6].  The foreign GP or hospital will note the number on the card and then bill the UK health service via their own national health authority.

Provision of Health-care Entitlement Card for treatment in the UK

If all those entitled to free NHS treatment in the UK were provided with a similar card bearing their photograph and NHS number (which card could be designed to double as an EHIC), then it would be simple standard practice to insert the card into a standard reader at any GP surgery or hospital reception desk in the UK when going for the first time, exactly as people present their credit or debit cards when buying any other service.  The same card could provide access to the patient’s own health records when these are held electronically.  EEA visitors would present their EHIC cards and their countries would be billed via the NHS[7].  What on earth is difficult about that?

The answer is nothing at all.

Resistance by NHS doctors

The source of the resistance by NHS doctors and their unions like the BMA and the RCGP is not the minimal amount of administration (which in any case can be made entirely electronic), but their own ideological objections to people paying for treatment by the NHS.  Yet individual doctors have no such ideological objections to directly charging British citizens when acting in their capacity as private consultants.  Every single thing which the NHS provides costs money which has to be obtained from someone.  While there are signs[1] that some doctors recognise this and embrace the idea that money wasted or not properly claimed from foreigners is money that can’t be spent on British citizens, there are still far too many who do not accept the way the rest of the world works and Britain must work.

Not long ago a young GP in London was actually rebuked by her hospital trust for attempting to establish by simple questions whether someone presenting at her surgery was entitled to free service.  None of her non-British European Union patients present an EHIC so their countries couldn’t be billed.

Similarly the NHS resolutely refuses to bill any foreign mothers for the costs of giving birth in British hospitals.  Given that the 2011 census revealed that well over 25,000 births in London alone were to foreign mothers, and private hospital charges are over £1,000 per day, it is clear that this wilful refusal by NHS authorities to recover costs[8] (which every other country in the EU and the rest of the world does) is a huge direct and unnecessary cost to the very service that Health Trust directors so loudly proclaim they serve.

What should be done?

  • Introduce the health service entitlement cards (HSEC) immediately for every British citizen, their spouse if not a citizen, and those with indefinite leave to remain.  If possible design this card to function as a European Health Insurance Card (EHIC) for short-term residency in EEA countries.
  • Install HSEC and EHIC readers in every NHS surgery and hospital.
  • Set up a billing system based on NHS costs of treatment which would provide an immediate invoice for all those without an HSEC or EHIC.
  • For those foreign nationals from the EEA presenting an EHIC, send the invoices to their home health authorities automatically, using the patient’s details from their EHIC.
  • When the NHS trusts do not have the cost of a treatment to hand, use the costs of an established private sector organisation such as the BMI hospitals.
  • Don’t let the NHS managers, consultants and GPs prevaricate over this.  Tell them they must sharpen up their act, by linking their budgets to their recoveries of monies owed by foreigners to the NHS.


[1]  Belatedly, some health service trusts which are financially responsible for hospitals in England have started to try to recover the costs of surgery and chemotherapy after the event.

[2]  Clare Gerada, chairperson of the Royal College of General Practitioners.

[3]  Patrials are those who by virtue of their parents’ and (some) grand-parents’ British citizenship, have a right of entry to Britain under the 1981 British Nationality Act.

[4]  Usually granted after 10 years’ residence or earlier in some cases.

[5]  Twenty-eight EU countries plus 4 EFTA countries (Switzerland, Norway, Iceland and Lichtenstein).

[6]  If the care is likely to be prolonged or predictable before travelling (e.g. giving birth) they will be asked to provide insurance cover as well.

[7]  It is a particularly obnoxious scandal that while EU countries bill the NHS for their treatment of UK citizens, the NHS seldom does this for EU citizens.

[8]  This fact led a former Labour Health Minister to protest that he was not funding a free International Health Service.  New Zealand, which is probably the nearest to Britain in the provision of state-funded health services, charges people without residency status (which is a very restricted category) or New Zealand citizenship, for a large range of health-care services (outside accidents and emergencies) including antenatal, actual births and post natal services.  Elective caesarean deliveries are charged for everybody, citizens or not.

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