22nd November 2016

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Simon Stevens
In conversation with Roy Lilley 
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6th December - King's Fund - Details here.
The Min' of Ag' n Fish
News and Comment from Roy Lilley
You've probably never met Chris Wormald.  He is the sort of bloke you'd stand next to, in the queue at Waitrose and not notice.  I doubt you'll see him in Aldi.

You could well stand, crushed against him, on the Jubilee Line tube, in the rush hour, on the way to Westminister; there would be no eye contact, no whiff of aftershave.  You just wouldn't notice him.

He is about as colourful as the November sky, sifting drizzle across College Green.  Early middle-age with the pressures of his work showing in the grey flecks appearing at his temples.  Somber grey suit, a tie the colour of a Cardinal's cassock on a Good Friday.  

You would never know he was the most senior civil servant in the Department of Health.  It's something of a cul-de-sac job.  

The DH was deliberately sidelined by Lansley's reforms.  The real work is done by the much more glamorous NHS England and the sizzling waz-Monitor, now NHS Improvement.  These days the Treasury is far more influential.

The DH doesn't have much of a budget; fenced in by the annual palaver called the Mandate; a cross between a shopping list and a wish list.  A prisoner of Tarzan's Five Year Forward view.  

No Parliamentary time to do anything worthwhile, change anything.  No money; its job is to provide a bolt hole for the Tinkerman and look busy... keep out of trouble.

It looks like Mr Wormald has come unstuck.  He was making a routine appearance before the Public Accounts Committee.  It was all going blandly before he got bushwhacked by the Brexit Brigade.

'Foreign patients coming here and stealing our operations... what is the NHS doing about it?'  


Reciprocal arrangements with EU and some other countries means we pay out 674m for our citizens to be treated 'over there'.  We collect 49m for their lot treated 'over here'.

We have tax funded socialised medicine, they have insurance and top-ups and the infrastructure to do 'billing'.  We don't.

Mr Wormald grandly announced the NHS was not '.... doing its duty to the tax payer...' by collecting more cash.  Thank you for that.  

I think he meant he couldn't figure out a way to do it and blaming the NHS was easier. 

Wormald thinks because doctors and nurses are unable to determine who is entitled to be treated by the NHS, free at the point of need, we should all turn up with a gas bill and a passport.

A nice middle-class solution, ignoring anyone living at the hotel of Mum and Dad and doesn't have a passport, or any anyone canny enough to borrow a gas bill and leave a hospital receptionist banjaxed by the complexity of a foreign passport and 'leave to remain'.  

Ignoring, also, the little matter of how they found their way into the system in the first place.

It is safe to assume the referral would be triggered by a GP.  To be registered with a GP you will have had to satisfy the ever vigilant receptionists; with a gas bill and a form of identity... routinely.  Even then, I can think of ways of fiddling that.

The NHS is a national health service, not an international health service.  I get that and so do you.  The National Audit Office estimate there might be 200m a year in flow, not, or partially collected.

There are mechanisms in place to collect the cash for non-urgent treatment.  Copy the places that are best at doing it, making systems more robust and universally operational might be a better option than making yer granny apply for a passport and keeping a copy of the care-home's gas bill in her handbag.

The NHS funding deficit is about one hundred times the amount not collected but we should, nevertheless collect it.  

Emergency treatment is another matter.  There are international agreements.  Retrospective invoicing is too easy to dodge.  Credit card terminals and price lists on the wall in A&E are inevitable; like the US.

Instal the charging infrastructure for foreigners and bingo, it's conveniently available for top-up payments from the rest of us...  Mmmm.

This is about Brexit.  When we are out of the EU and reciprocal arrangements are dumped there will have to be credit card readers by the bedside.  Get over it.  Remember to take your Gold Card on holiday, you'll need it.

The up shot; expect post-Brexit ID cards.  They are common across Europe and will be back on the agenda here.

Anyway, now, we all know who Chris Wormald is.  I'm guessing promotion beckons; probably the Min of Ag'-n-Fish.

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