Chris Skidmore MP: Five steps to tackle foreign citizens' abuse of the NHS

Chris Skidmore is MP for Kingswood and a Member of the Health Select Committee. His report can be read on his personal website. Follow Chris on Twitter.

There will be many issues facing the new Health Secretary Jeremy Hunt as he inspects his in tray this week. Crucially, there remains the challenge of finding 20% savings to be reinvested in frontline care. Already Andrew Lansley's reforms have managed to save £7.5 billion in management and bureaucratic costs, something that should be rightly highlighted. Yet to meet the target by 2015, no stone should be left unturned - after all, the NHS is not free, it is paid for by taxpayers who deserve to know that every penny is being wisely spent, and above all not wasted.

Over the past two years, I have been investigating the issue of foreign nationals using the NHS without paying for its services, something which costs the NHS over £100 million, though it seems that this figure, given data is not collected effectively and primary care remains free for foreign nationals, is just the tip of the iceberg. ConservativeHome has already highlighted this issue, which if tackled effectively would be a popular measure, demonstrating our commitment to protecting the NHS as a service funded by taxpayers who want a service free at the point of use, not abuse. So today, I have sent the new Secretary of State a copy of a new report I've released – The Missing Millions — that gathers together the results of a long-running investigation, and offers advice on how to deal with the problem.  Ronald Reagan famously said that there are no easy answers, but there are simple answers. Here then, are five recommendations which I shall be submitting to the Department of Health.
 
1. All trusts should be legally obliged to collect data on the cost of treating individuals not entitled to free NHS care, and those treated under the EHIC scheme. This is the subject of a Ten Minute Rule Bill that Henry Smith MP is introducing to Parliament on Tuesday. It is a vital measure - it is clear that from Freedom of Information requests from trusts that currently not all trusts are recording or keeping the data needed to charge foreign national patients. Without this information, it is impossible to operate a watertight system.

2. When registering with a GP, all individuals should be obliged to demonstrate that they are ordinarily resident in the UK and thus eligible for free care. This is something that is permissible under the current guidance, provided that it does not involve discrimination. This should include providing proof of address and citizenship.
 
3. Non-residents should be charged for primary care - for example a flat fee for consulting a GP. At present primary care is free, however given the financial pressures on the health service and the need for fairness, it would make sense to extend charges for overseas visitors. In European countries, British patients are charged for primary care - with the costs being paid for by the NHS. It should be the same therefore that European users of the NHS should similarly pay for their care. This need not be a disproportionate fee, but it would underline the fact that health care has to be paid for by someone, and that the contributory principle of the British welfare state should apply to all.
 
4. The EHIC scheme needs to be renegotiated to address the disparity between the amount that the NHS pays and the amount that we receive. Though much of this disparity is caused by the large number of British retirees living abroad, then Health Minister Anne Milton has also accepted the need for the NHS to be better at collecting income that we are entitled to. Moreover, there is the question of reciprocity. Given that UK nationals are eligible to pay any charges for primary care abroad, we should look at implementing similar charges for EEA nationals here.
 
5. All hospitals should follow the example of West Middlesex University hospital, and introduce a “stabilise and discharge system”. If a foreign national is admitted to hospital, the doctor first establishes whether there is a need for urgent life-saving treatment, which is obviously a priority for the NHS. If that is not the case, the person is told what treatment is required and how much it costs. If they are unwilling to pay, they are asked to leave.
 
Action on this issue is long overdue - yet it has three distinct advantages. It will save the NHS money, be popular, and most importantly of all, it is the right thing to do. A debate I called in Parliament demonstrated that there is cross party support for the issue, from Priti Patel and Frank Field on the backbenches, to Labour shadow health minister Jamie Reed. Now it is in the hands of the Department of Health.