My Lords, I am moving this amendment on behalf of the noble Baroness, Lady Thornton, and myself.
Amendment 16 seeks to tackle the difficult issue of cost recovery—which we started to debate in the previous group of amendments—and states simply:
“The Secretary of State must grant funding to NHS Trusts sufficient to meet the costs associated with administering healthcare agreements under this Act”.
I refer again to the excellent National Audit Office report, Recovering the Cost of NHS Treatment for Overseas Visitors, which looks back over the preceding five or so years. It becomes apparent on reading the report the point at which Governments and then the NHS started to seriously recover the costs which are due.
However, within that, it is very noticeable that different trusts have different abilities and resources available to collect these costs. London has 44% of EEA visitors and records 35% of the value of all EHIC cases in this country. Even within that, only 10 of the 150 acute and specialist trusts accrued half of all charges made to visitors from the EEA. So we have a very small number of very large hospitals which are expert in collecting and recovering these costs. Ten trusts were responsible for more than a quarter of the amounts, just under the EHIC scheme. As I said, 22 trusts did not report any cases under the EHIC scheme at all.
The NAO report refers to the capacity of trusts to administer these schemes. In the debate this afternoon we discussed “usually resident” and how it is defined. After further digging it transpired that in the NHS there are 32 identifiers that clerks need to go through to establish whether somebody is normally resident in the UK. So already a large bureaucracy is being added on to an A&E department or any other part of a hospital.
The NAO report has a helpful flow chart to show where the pressures come within each NHS trust in working out cost recovery. While one could wish it were otherwise, one can understand how small, hard-pressed district hospital trusts struggle to cover the administrative costs to make those decisions and then to charge.
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I am grateful to the BMA for its helpful briefing. It has a particular concern, which the noble Baroness, Lady Manzoor, referred to in responding to the previous amendment, about the possible number of different reciprocal arrangements if we cannot get a broad EU reciprocal arrangement post Brexit. One of the worries is that we may end up having to recoup different levels of resource. Will that requirement be made on an individual trust basis or will it be administered by the NHS in a fairly easy manner? I can see that, if there were 27 different arrangements alone for the EU before we even start to get into the wider world—we had that debate earlier—it would completely overwhelm some hospitals.
We therefore tabled this amendment because it seems clear that we have to have some support for trusts which require it for accounting costs that are not directly related to treatment. It would also ensure that in those areas where there is substantial demand from overseas visitors using those facilities, the trusts are funded to cater for those numbers with clinical staff. That does not happen at the moment, either.
I move on to the point about the arrangements that exist with the non-EEA countries. There is a guarantee of contributions for a non-EEA incentive scheme where commissioners, the NHS and the department share the risk of non-payment between trusts and commissioners. In light of a no-deal Brexit, when suddenly we would face a considerable amount of new non-EEA arrangements, I wonder whether the Minister can provide a guarantee that that arrangement will continue. I know that it works at the moment, but it is likely to be put under considerable pressure because presumably at that point, without any new reciprocal arrangements in place, hospitals will have to charge anybody who comes from the EEA in the event of a no-deal Brexit—and in the event of no transition agreement, which is what we would expect to happen.
Finally, I will make the point again about administrative costs. The NAO report says:
“When reporting EEA visitors, trusts incurred administrative costs in recording details”,
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“for which they were not previously reimbursed. The Department received the income relating to these patients. When charging visitors from outside the EEA, trusts relied on patients, rather than commissioners, making payments. Difficulty collecting payments meant that trusts collected less than the amount they invoiced”.
Clearly, some of this is covered by the guarantee that I have just referred to, which is extremely helpful. But the other worry is that trusts may, frankly, turn a blind eye if they are suddenly deluged with very large quantities of people under the threat of a no-deal Brexit. I look forward to the Minister’s response and I beg to move.