Just over a month ago, the Department of Health refused to provide data that we had asked for under the Freedom of Information Act. Amid all the discussion of what 'health tourists' cost the NHS, we wanted to see the evidence behind Jeremy Hunt's claim that:
"Currently, we identify less than half of those who should be paying and collect payment from less than half those we identify."
Disappointed with the initial response, we asked for an internal review of our request. The department has now responded and supplied us with a huge file of information that hasn't been made public. It's part of a government review into how overseas visitors access healthcare and how migrants might contribute to NHS provision.
Do we identify less than half of those who should be paying?
The Department is clear that - in the absence of a national data set on the treatment provided to overseas visitors by the NHS - it has collected its own evidence "specifically for this review".
It therefore admits that most of the figures in the report are illustrative, rather than precise. This aside, the Department does move towards suggesting a figure for the number of overseas visitors who evade charges:
"Our best estimate is that that Trusts identify between 30% and 45% of all chargeable OV [Overseas Visitors] income".
This is not quite the equivalent of saying that "we identify less than half those who should be paying", as the 30-45% statistic refers to income, rather than people.
It's also something of a best guess, being based (in the main) on a limited survey of hospitals. The Department sent out questionnaires to 53 Trusts, repeating the questions from a 2007 survey of Overseas Visitors Managers. OVMs are the hospital administrators with responsiblity for collecting payments from those who aren't eligible for free NHS care.
Of the 23 trusts that responded to the survey, almost two thirds said that patients are "never" or "not very often" asked the standard questions which are used to identify whether they're exempt from charges. Half said that frontline staff never asked for evidence that patients were entitled to free treatment. It looks as if the 35-40% figure has been generated by weighting the answers to these questions.
According to the authors of the analysis, NHS Trusts based in regions "with a relatively high inflow of international migrants" were more likely to respond to the survey. They therefore warn that any estimate based on this sample might overestimate the number of overseas visitors treated by the NHS.
More importantly, this is a very small sample of trusts (9% of the total number in England). As a result, it's a bold move to make a headline-grabbing claim on the basis of so few responses which - as the department itself admits - might well be unrepresentative.
Part 2: we look into the claim that we "collect payment from less than half those we identify".
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