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NHS struggles with data for foreign visitor costs



NAO report finds that efforts to improve data sharing to recover treatment costs for overseas visitors have not yet been successful

Shortcomings in attempts to use relevant data on digital systems have contributed to a disappointing performance by NHS trusts in recovering costs from treating overseas visitors, a new report by the National Audit Office (NAO) has found.

It is one of the factors contributing to a forecast that the Department of Health (DoH) is unlikely to meet its target figure in the foreseeable future.

The NAO carried out the review in response to concerns that the NHS has been overly generous to foreign visitors, even though in 2014 the DoH launched a programme to extend the scope of charging and implementing existing regulations more efficiently.

It has had a target of recovering £500 million a year compared with just £73 million in 2012-13, but the NAO says the current data indicates it will only reach £346 million in 2017-18.

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Among the issues highlighted in the report is that in April 2015 the DoH, working with NHS Digital (then the Health and Social Care Information Centre), added new data fields to patients’ personal demographic service records to help overseas visitor managers in trusts. The data, which shows as a ‘banner’ in the summary care record application, draws on visa information to highlight whether a patient is subject to charges.

But trusts have been unable to rely on the banner providing a reliable guide for short term visitors, British expats and temporary migrants with visas from before the launch. It has also been difficult to process cases involving asylum seekers.

The DoH is now reviewing proposals for further changes to IT systems to support wider sharing of the relevant information.

Since August, overseas visitors managers with the relevant training have been able to update the data, and the department aims link the chargeable status information to trusts’ patient administration systsems. It is also working with other government departments to identity data sources that could help in the effort.

Further measures with digital technology have involved setting up an online toolbox and forum for overseas visitor managers to help them share knowledge.

Mixed record

The report says the amounts trusts have collected have varied, which suggests there is still significant scope for improvement. Also, the DoH does not have a good understanding of why some trusts do better than others.

Amyas Morse (pictured), head of the National Audit Office, said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.

“In the past two years, the amounts charged and amounts actually recovered have increased. Much of this increase is the result of changes to the charging rules.

“If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500 million of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of £150 million.”

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