11th August 2015

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Health Chat

Sir Robert Naylor

In conversation with Roy Lilley, Kings Fund 16th September


Returns maybe here.

Enforce what we've got 
News and Comment from Roy Lilley
When is a loop hole not a loophole? If someone walks into Tesco's picks up a bottle of milk, walks out of the supermarket through the 'in' door, instead of through the checkout, is that a loophole?  No it's shop lifting...
If you spend a bank holiday drilling, through 6ft of concrete, into a bank vault, lifting nine million quid's worth of diamonds, if there is no alarm in the concrete, is that a loophole? No its theft.
If you pitch up at a GP's surgery with a bunch of false documents, get an NHS number and use it to obtain an EHIC card which you later use to obtain healthcare you are not entitled to, is that a loop hole? No, it is obtaining a benefit by means of deception. Call the police.
Yesterday, the good-old Daily Mail ran a fluff-story about their Hungarian journalist who; got on a plane and came to London, generated various fake documents, found a GP practice, registered, obtained an NHS number, went on line got an EHIC (E111) card, went home to Hungary and used the card to obtain medical treatments that, it is alleged, could be charged to the British tax-payer.
Cutting edge investigative journalism?  No, a smash and grab raid on the NHS, egged on by the Daily Mail. Close examination of the Mail video reveals the journalist never got further than conversations with Hungarian receptionists... no actual healthcare was obtained.
Various MPs have been doing the dance of the headless chicken calling for inquiries and public flogging; they appear not to know the rules. Facts?
You do not have to be British to get NHS care neither a British taxpayer. You just have to be able to prove you live here legitimately. It is the GP practice that has to sort all this out; registering the patient and triggering the process that issues an NHS number.
The practice has to be satisfied with the person's ID. All the usual documents will do. They must also establish the person is ordinarily resident here. It's a minefield; documents such as a tenancy agreement can easily be forged.
An NHS number is eventually sent to the applicant; to the address they claimed to be living at. So, pretending to live at a place you are not, in order to obtain NHS care, puts you in the crook department, not the loophole department.
Could practices do more? There's guidance but receptionists are not the Borders Agency nor the immigration police and they have enough to do answering the phones between 0820hrs and 0822hrs booking appointments.
With an NHS number, getting an EHIC card is a five minute, on-line job. It should be easy; millions of us use them when we go on holiday.
Need treatment in Spain; you'll get the treatment a Spaniard will get. The same in France, Germany and Hungary.
If local rules required top-up or co-payments, tough. The NHS stopped reimbursing them in July 2014. You'll have to cough up yourself.
Maternity care abroad; possible, but you have to get a form S2 from the admin people at NHS Newcastle, plus a maternity certificate, NHS number, DoB and full UK address and dates of travel. Many migrant young Mums go 'home' for the birth, it's normal to be with their families.  Now there are many more young migrant workers here it is on the increase.
In Hungary about 3% of wages goes towards healthcare from Országos Egészségpénztár Penztar registered providers. Pretending you live here, avoiding Hungarian taxes, to get your Hungarian healthcare 'tax-free', is a crime in Hungary.

How do we resolve this? We could:

  Leave the European Union... that fight is yet to come.
  Issue ID cards... that fight was fought some time ago.
  End all reciprocal arrangements and require all non UK citizens to have private health insurance... be careful what you wish for; they'll do the same to us.
  Harmonise healthcare entitlement across Europe... huge cost, political and organisational ramifications.
  Take registration of patients away from GPs and do it centrally; through the Borders Agency... they seem to be struggling with their workload now.
  Opt out of EHIC... if you fall out of your pedalo be sure you have your credit card with you.
Do we need more laws, regulation, rules and guidance or shall we call a loophole a loophole, a spade a shovel, a crime a crime, stop panicking and enforce what we've got?
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Sir Robert Naylor
In conversation with
Roy Lilley 
King's Fund
16th September.
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