European health costs

I have been asking questions about how much it costs the UK to pay for health treatment for our citizens seeking treatment on the continent, and how much we charge people from other EEA countries for their treatment here.

In 2016/17 the UK received just £66m from charges imposed on the other member states for treatment of their nationals in the UK, whilst they charged us £630 m for the treatment UK citizens received. It is difficult to believe it should be that one sided. It is true a considerable number of UK citizens live in Spain, which charges us £200m for the health treatment they supply, but we also act as host to many people from the continent who also need to visit surgeries or receive treatment. The UK only received £5m from France for the whole year, compared to the £154 m they charged us.

The NHS in 2016/17 identified just £81 m of treatment carried out for people from the rest of the world, and recovered £30.4m in cash.

It does appear that despite the policy that EEA nationals health costs should be recharged to their governments, and non EEA people should be expected to pay for non emergency treatment, there is still some way to go for the system to identify the full amounts and to collect the cash from those who should pay.

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198 Comments

  1. Lifelogic.
    Posted April 4, 2018 at 5:26 am | Permalink

    Indeed you make a good point, but why on earth did we agree to a system where the tax payers are paying at all. Let people pay for their own health care if they choose to live abroad. Or let the host country cover it. That country, after all, are taxing the resident individual on their income in most cases. If people pay they might take care to live a more healthy lifestyle too.

    The NHS here should also charge all who can pay and encourage as many as possible to go privately o as to reduce NHS demand. Lord Landsley yesterday claimed 3000 lives a year could be saved by competent bowel cancer screening. This could easily be afforded if the NHS just start to charge everyone who can afford it something and encourage more to make their own provision with tax relief or vouchers. But no we do nothing and pretend we have the envy of the world NHS.

    • Lifelogic.
      Posted April 4, 2018 at 6:02 am | Permalink

      And let thousands die early or wait for years for simple operations as a result.

      • Hope
        Posted April 4, 2018 at 11:49 am | Permalink

        I think most of us agre with you JR that this is no bounds to level of incompetence of your Tory govt. eight years in office without anything to crow about. Central plank of economy kicked into touch, EVEL not delivered, Brexit being thwarted by May.

        I watched your lecture about leaving the EU and agree with you. May,does not. However, the reason for leaving the EU is to take back control of borders, laws and money, so why is May giving these,away to talk about trade! She has lost the plot. Today she is bandaging in about a non issue pay gap. Her last intervention over PC crap on stop and search has led to the highest murder rate in London compared to New York! For goodness sake get rid of her.May is not modern she is a walking disaster.

        • margaret howard
          Posted April 4, 2018 at 10:01 pm | Permalink

          We were never part of Schengen so never lost control over our borders. Another Brexit ‘red bus’ lie along with that of Turkey becoming an EU member.

          As for the discrepancy between health costs it was up to the government to sort that out. Just shows yet again how useless they can be. And of course it’s far easier to play the hard done by card and blame others.

          • Edward2
            Posted April 5, 2018 at 6:48 am | Permalink

            I read some ridiculous posts on here over the years Margaret but your claim that the UK had control over its borders takes first prize.
            Since 2000 we have seen the biggest increase in our population in our nation’s history.
            You are the only remain supporter who seems not to have heard of the EU’s policy of open borders via freedom of movement.
            On top of that you give us more remain nonsense about the EU’s policy of steadily getting Turkey to join the EU as well as several other Eastern bloc nations.

          • Know-Dice
            Posted April 5, 2018 at 7:49 am | Permalink

            Not in Schengen, but unable to have any control over immigration from the EU.

            Certainly this Government it totally incompetent and could control non-EU immigration…

            What about the EU financing the move of Ford Transit from Southampton to Turkey and the £2.4 billion to be paid to Turkey from the UK for the “migrant deal” – Why are we being asked to pay 16% of the total when there are 27 other countries in the EU?

          • NickC
            Posted April 5, 2018 at 9:17 am | Permalink

            Margaret Howard, You are wrong. Hope did not claim we are in Schengen, he said that “… leaving the EU is to take back control of borders …”. And that is true: in the single market we cannot prevent entry of any person from the EU. So we have no control over who comes in, and how many.

          • margaret howard
            Posted April 5, 2018 at 10:29 am | Permalink

            Edward2

            “Since 2000 we have seen the biggest increase in our population in our nation’s history.”

            Mostly from Commonwealth countries.

            or as this example shows for 2013/14 most came from the following countries:

            “China, India, Poland, the United States, and Australia.”

            All except Poland outside the EU.
            ==

            “On top of that you give us more remain nonsense about the EU’s policy of steadily getting Turkey to join the EU as well as several other Eastern bloc nations.”

            Turkey is NOT an Eastern bloc nation.

          • Lifelogic
            Posted April 5, 2018 at 2:31 pm | Permalink

            “never part of Schengen so never lost control over our borders” surely you do not think that do you?

            This is a blatant lie that T May tried to trick referendum voters with! Control of our borders surely means we can choose who we let in and who we do not let in.

            In the EU (regardless of Schengen) we had to let almost everyone one in from the EU.

          • APL
            Posted April 6, 2018 at 8:30 am | Permalink

            Lifelogic: “In the EU (regardless of Schengen) we had to let almost everyone one in from the EU.”

            To give credit where it’s due. Redwood was making the argument years ago, that if we give up control of our borders, we will end up being dependent on Spain, Italy and France for our border.

            We’ve seen how that worked out. Spain ushers it’s immigrants to its border with France, Italy its immigrants to its border with France, and France sends them to the Jungle. Where our NGO, agitate to let them into the UK.

  2. duncan
    Posted April 4, 2018 at 5:30 am | Permalink

    My party have now been in government since 2010. With that in mind, it doesn’t require an Einsteinian imagination to work out exactly who is to blame for this ridiculous and perverse anomaly

    The UK taxpayer is abused by the state, its vested interests and those interest groups who feed off us. This is a direct result of affording government and its politicians an almost unlimited capacity spend our money without regard to value or efficiency

    This is political spending. State spending to finance transactions that smooth or reduce the possibility of political altercations or political embarrassment for the incumbent party in government

    Throwing money at the proverbial bottomless pit that is the NHS without demanding massive reform is a classic case in point. Using our money to ‘buy off’ a noisy public sector vested interest to dampen a political storm.

    Get a grip and confront the problem of reform rather than using OUR money to silence state vested interests

    We need tax cuts as this will reduce the amount of money available to government to waste at will

    • Lifelogic.
      Posted April 4, 2018 at 6:28 am | Permalink

      Exactly reform and tax cuts. Hammond has taxes that are at the highest for 40 years and they are idiotically structured and hugely complex too. Thus doing still further damage to the economy. Meanwhile the services that are actually grudgingly delivered, the NHS, roads and transport, rubbish collection, law and order, schools, defence, the legal system, police …. are rather poor, very inefficient and getting worse by the day.

      Still at least the dire head of the DPP is to go (unfortunately with her huge pension pot). Richard Littlejohn was spot on on this topic the other day.

      • Hope
        Posted April 4, 2018 at 11:58 am | Permalink

        All the failures in JR’s recent blogs have their origins in the incompetence of the current govt. when there was a chance to put things right after Cameron ran off, they put May in charge when they knew she had an appalling record as HS and knew she did not beleive in the policy of leaving the EU that she was charged with!

        How many of us have written here about the appaling amount of foreigners at hospital being asked are you entitled for medical treatment? They answer yes and that is it! May would not get rid of Hunt, another dull remainer who is happy to give away our taxes hand over fist and treat the world ahead of our own citizens. Now May and Hunt want o embark on charging us all three or four times for social adult care! Complete incompetence. The strap line of more people living longer is because there are more older people and Rudd has invited families of EU citizens to come here without any age restriction!

        etc ed

        • APL
          Posted April 5, 2018 at 8:53 am | Permalink

          Hope: “they knew she had an appalling record as HS”

          JR: “etc ed”

          Appalling record? ‘Appalling’, doesn’t even begin to describe her incompetence.

      • Sir Joe Soap
        Posted April 4, 2018 at 8:00 pm | Permalink

        Indeed, grudgingly delivered to those who actually pay, and doled out and gratefully lapped up to those who don’t. Eventually, this rotten system has to cave in and revert to equilibrium, surely?

    • majorfrustration
      Posted April 4, 2018 at 8:17 am | Permalink

      Quite right but dream on

    • graham1946
      Posted April 4, 2018 at 10:05 am | Permalink

      ‘Your party’ did a 3 billion re-organisation of the NHS and made a pigs ear of it. It is still underfunded by about 3 percent of GDP compared to world averages. I agree it needs another proper reform, but not by this lot of incompetents. I did a post as to how this could be achieved but it never made it past the censors, so I’m not going down that road again.

      We need to get politicians out of the NHS and education.

      • Lifelogic
        Posted April 4, 2018 at 12:29 pm | Permalink

        Hong Kong has rather better life expectancy and spends a lot less on health as a % of GDP.

        • graham1946
          Posted April 4, 2018 at 5:38 pm | Permalink

          USA spends twice as much as us with many having no healthcare provision at all and lower life expectancy. What does that prove? It’s not all about money, but incompetence of politicians.

          • NickC
            Posted April 5, 2018 at 9:23 am | Permalink

            Graham, You’re the one who said that the NHS is “underfunded by about 3 percent of GDP”. If you now accept it is “not all about money”, why make an issue of the funding in the first place?

          • graham1946
            Posted April 5, 2018 at 7:19 pm | Permalink

            Nick C

            It is – I said it because, although it is not ‘ALL about money’ (although it IS grossly underfunded) and will never work as it is. It could be better with the right amount of money. I said it needed reform, but not by this lot. The NHS is 22 billion short of what the CEO, when given the job, said was necessary to work as as present constructed. This is 22 billion which would have made the NHS much better even under this ridiculous ‘internal market’ system,but which ‘cannot be afforded’ at the same time we offer the EU twice as much to talk about talks. Go figure.

      • Timaction
        Posted April 4, 2018 at 3:08 pm | Permalink

        ………….We need to get politicians out of the NHS and education…………and everything else that we can, before they mess it up with left wing PC nonsense and put English tax paying people to the back of all queue’s for health, education, social housing and all other public services!.

  3. Mick
    Posted April 4, 2018 at 5:33 am | Permalink

    Off topic
    https://www.express.co.uk/news/politics/940937/brexit-news-latest-eu-referendum-jacob-rees-mogg-commons-select-committee-report
    JRM is spot on, these remoaners really do get on my nerves, the snooner we are out of the Eu the better with no strings then a GE so Westminster can be purged of all these democracy deniers , Benn does make my blood boil especially when he talks with that irritating way he runs his tongue on the inside of his mouth which looks a sure sign he is talking porkys, just get us out NOW

    • Henry Spark
      Posted April 4, 2018 at 8:29 am | Permalink

      I note that Mr Mogg has no suggestion on how to solve the problem of the Irish border. His intervention is thoroughly irresponsible

      • jerry
        Posted April 4, 2018 at 12:03 pm | Permalink

        @Henry Spark; Would that the the 1922 Irish border problem or one of the many more recent problems, after all the UK and Eire do not share a common taxation policy so there are many examples of people ‘abusing’ the open boards between north and south.

        Neither the EU nor the Good Friday agreement did anything to tackle such issues so the current complaints by Eurocrats & Europhiles is pure hyperbole. Freedom of movement, as laid out by the 1922 settlement, will remain post Brexit.

        • acorn
          Posted April 4, 2018 at 5:11 pm | Permalink

          jerry, you should catch-up on the Statute Law (Repeals) Act 1989.

          • jerry
            Posted April 5, 2018 at 6:50 am | Permalink

            @acorn; Please explain, I do not see any relevance to Ireland, have you cited the correct year for the Act?

      • Lifelogic
        Posted April 4, 2018 at 12:31 pm | Permalink

        It is not a problem at all, it is up to the EU to decide what they want to do. It is clearly a manufactured problem for negotiation purposes.

      • Richard1
        Posted April 4, 2018 at 1:57 pm | Permalink

        Whatever is the issue with the Irish border? in the event there need to be customs duties added – which will be because of EU protectionism, not for an UK policy – they will be added as now like excise and VAT charges, ie remotely. there has always been free travel for people between the UK and Ireland. this is an issue being cooked up by the EU, using Ireland, as a way of trying to keep the UK de facto in the EU using a technicality. the idea that suddenly terrorists will reappear and kill people if there are eg, the sort of vehicle recognition systems such as are used for the congestion charge in London, is absurd (& I would have thought rather offensive to Irish people).

        • Denis Cooper
          Posted April 5, 2018 at 10:56 am | Permalink

          There is no new issue with the Irish border other than those invented by the EU and the Irish government and UK quislings.

      • Know-Dice
        Posted April 4, 2018 at 3:23 pm | Permalink

        What about the EU’s own solution – Smart Border 2.0

        KEY FINDINGS
        Smart Border 2.0 that keeps the border open for free movement under the CTA using
        free movement lanes, enhanced licenses and collaboration between jurisdictions

        Smart Border 2.0 that benefits both governments and traders through the innovative
        implementation of international standards, best practices and new technologies

        http://www.europarl.europa.eu/RegData/etudes/STUD/2017/596828/IPOL_STU(2017)596828_EN.pdf

    • Denis Cooper
      Posted April 4, 2018 at 9:41 am | Permalink

      It says a lot about where we are coming from and where we still are that we have a Commons committee for exiting the EU with a majority of MPs who are opposed to exiting the EU and a chairman who is unscrupulous in his attempts to frustrate the will of the people as expressed in a referendum ordered by Parliament. I have said before that his father would probably be turning in his grave, if he had one.

      • Rien Huizer
        Posted April 4, 2018 at 11:04 am | Permalink

        There is no “will of the people”.

        • juter
          Posted April 4, 2018 at 3:06 pm | Permalink

          How little you know or understand about the British people. Go back to troll school.

        • Timaction
          Posted April 4, 2018 at 3:10 pm | Permalink

          What do you call the referendum in your EU world?? Oh, of course, no democracy in that unelected behemoth!!

        • Political Scientist
          Posted April 4, 2018 at 6:44 pm | Permalink

          WAS no “will of the people”.

          • Denis Cooper
            Posted April 5, 2018 at 10:53 am | Permalink

            Yes there was, and there is, as expressed in the referendum. Or perhaps you think the whole exercise was meaningless.

        • NickC
          Posted April 5, 2018 at 9:28 am | Permalink

          Rien, In a democracy, sovereignty belongs to the people. Your comment illustrates exactly what is wrong with the EU (and Remain) world view.

      • rose
        Posted April 4, 2018 at 7:59 pm | Permalink

        His father would not be turnng in his grave. He was in favour of the EEC until the PLP rejected him as their leader. Only then did he jump on the anti EEC bandwagon to pinch the leadership of the left – outside the PLP.

    • Denis Cooper
      Posted April 4, 2018 at 10:32 am | Permalink

      https://www.theguardian.com/politics/2018/apr/04/brexit-uk-free-trade-deal-europe

      “Benn added: “Should negotiations on a ‘deep and special partnership’ not prove successful, we consider that Efta/EEA membership remains an alternative which would have the advantage of continuity of access for UK services and could also be negotiated relatively quickly.””

      As repeatedly pointed out there are multiple disadvantages with that so-called “alternative”, but to start with I would challenge his assumption that it could be negotiated “relatively quickly”, or even that it could be negotiated at all.

      At present the UK is a member state of the EU and also a member state of the EEA as a member state of the EU. Of course in principle the EEA Agreement could be modified to accommodate the UK as a continuing EEA member state which is no longer a member state of the EU, and not even necessarily a member state of EFTA instead of the EU, but only with the consent of all 32 parties to the EEA Agreement – the UK, the EU, each of the EU’s 27 other member states, and each of the 3 EFTA member states which are parties to the EEA Agreement.

      And if the UK’s continued membership of the EEA was to be as a member state of EFTA, as Hilary Benn implies, then the agreement of the fourth of the four present EFTA member states, Switzerland, would also be needed.

      It is simply not the case that the UK has a unilateral right to change the present treaty arrangements as the UK authorities, or Hilary Benn, might choose; and as some of the other parties to the existing treaties have already shown that they are perfectly willing to be obstructive – notwithstanding their commitments under those treaties – there is no reason to assume they would cease to be obstructive just because a British quisling like Hilary Benn was prepared to take their side against the British people.

      • Peter D Gardner
        Posted April 4, 2018 at 10:21 pm | Permalink

        Anyone who thinks our Government would do better in a three-way negotiation between UK, the EU and EFTA needs his head examined. And then repeating the exercise once UK has decided what sort of long term relationship it wants with the EU!

      • Mark B
        Posted April 5, 2018 at 6:59 am | Permalink

        Nothing tried, nothing gained.

        The way I, and many others are coming to see it, is we are heading for a Norway Option but will all the bills and no say of FULL EU membership.

        I have always argued that the UK was never in a good position as some have lead us to believe. At least initially. But long term we would be better out. Unfortunately the EU, but not the political class, seem to know this and want to restrain us.

        • Denis Cooper
          Posted April 5, 2018 at 10:52 am | Permalink

          Well, we won’t increase our negotiating strength by trying to negotiate something that we don’t even want, nor by accepting that unsatisfactory position then trying to have another negotiation to improve on it. Far better to get it sorted out as best we can in a single step.

      • NickC
        Posted April 5, 2018 at 9:36 am | Permalink

        Denis Cooper, You have laid out the problems with the EFTA/EEA route exactly. There is no get-out-of-jail-free card with the EU precisely because of that obstructiveness. Consequently the only viable solution is the WTO trade deal. It is painful watching politicians gradually realising that (or giving up our independence because they refuse to acknowledge reality).

  4. NHS bill payer
    Posted April 4, 2018 at 5:34 am | Permalink

    Mark out the people in each medical establishment who are responsible for collecting payments and treat them as till check-out assistants in supermarkets.
    Failure to collect just one shopper’s bill is immediately questioned by the supervisor. If a legitimate reason is not provided, the person is sacked.

    Discriminating against predominantly female check-out assistants in supermarkets is wrong!

    • eeyore
      Posted April 4, 2018 at 7:18 am | Permalink

      Yes indeed, make a named individual in each trust responsible. Once again JR’s research seems to indicate failures of leadership, whether within trusts or at the upper levels of government.

      When reward is divorced from performance, as so often it is in the public service, it’s human nature to do as little as you can get away with. The traditional remedy is to make individuals responsible. A senior official in DHSC should be charged with specific and personal responsibility in this matter, and if necessary put on a bonus scheme to galvanise his zeal.

  5. Cheshire Girl
    Posted April 4, 2018 at 5:34 am | Permalink

    Is anyone surprised! We are a soft touch, and everyone knows it. These are figures that our Government would prefer that we dont see. I suspect that this has been going on for years, and although much is promised, nothing is ever done about it. I dont expect anything to change anytime soon. I’m disgusted!!!

  6. Andy
    Posted April 4, 2018 at 5:42 am | Permalink

    Yes – but the problem here is with the NHS not with the EU. Most UK hospitals and GP surgeries do not have the infrastructure to charge patients. They do not have invoicing and credit control staff to deal directly with patients or with other health providers. And in a time of cuts such staff are the first to go when the decision has to be made about whether or not to retain a nurse or a bureaucrat. It is ironic that people who don’t like bureaucrats also do not like the consequences of not having bureaucrats.

    Unlike many EU countries we also do not have to provide ID to be treated. Suggestions a few years ago to introduce ID cards were, ironically, rejected by MPs David Davis. (They’d make his life a hell of a lot easier now).

    • Peter Wood
      Posted April 4, 2018 at 6:38 am | Permalink

      I agree, an ID card system would eliminate, almost overnight, such abuses of the UK’s many social services. The problem is not many UK citizens want it; I suggested it here a while ago but there were only dissenting voices. This is part of our national trait I suppose, a solution is there but we don’t want to take it. Well, we continue to pay the cost then.

      • Anonymous
        Posted April 4, 2018 at 3:06 pm | Permalink

        “Mass migration will be good for you but will necessitate anti terror laws, equality laws, the destruction of green belt, armed police and ID cards”

        Can you imagine if they’d tried to sell that in the ’50s !

    • Edward2
      Posted April 4, 2018 at 6:55 am | Permalink

      Ridiculous post from you.
      First as most EU citizens have ID cards it won’t be difficult to identify them.
      Even if they do not thete are several other ways of achieving this simple task.
      Secondly the NHS does have accounting staff and raising an invoice and getting it paid is not a particularly complicated task. The NHS does have over one million staff perhaps a few can be transferred to this vital and profitable task or even a few more hired.
      Thirdly the article wasn’t blaming the EU.

      • Lifelogic
        Posted April 4, 2018 at 12:34 pm | Permalink

        The EU system does however create the problem. But the NHS should be able to deal with it. It must be rather open to fraud too.

      • Andy
        Posted April 4, 2018 at 3:23 pm | Permalink

        In virtually every post on here one, or all of you, blame the EU for something bad.

        The real failure for nearly all of these issues belongs in Westminster. The NHS is down to Westminster. If the NHS is not doing something right MPs can fix it.

        Exactly the same applies to education, housing, transport, defence. The EU has a negligible role in any of these things and, yet, miraculously the EU is to blame.

        Perhaps the only positive of Brexit is that the Tories will no longer be able to blame Brussels for everything – as they have for the last 40 years. The wrath they will incur from voters when the penny finally drops is going to be fun to watch. Wipe out time.

        • Edward2
          Posted April 5, 2018 at 7:05 am | Permalink

          Andy
          Your original claim was that the actual article blamed the EU for the NHS failure to collect payments from treating EU citizens.
          Now you have given up on this yet you now say posts on here blame the EU.
          Yet a quiche scroll down of posts show no such thing.

          You last point is interesting coming from you.
          You are correct in that democracy and control will revert to our own Parliament after we become free.of the EU
          Voters will soon realise they have some direct power and will vote out poorly performing governments be they Conservative or Labour.
          Who knows perhaps even your much loved young people will be enthused to actually get up go out and vote.

          • Edward2
            Posted April 5, 2018 at 7:07 am | Permalink

            Quiche?…..quick !

      • Bob
        Posted April 4, 2018 at 6:30 pm | Permalink

        The NHS is not short of admin staff, they’re usually dis-organised with rather chaotic and inefficient methods but there are plenty of them. I get the impression that many of them are employed for reasons other than ability.

    • mike fowle
      Posted April 4, 2018 at 7:07 am | Permalink

      “Suggestions a few years ago to introduce ID cards were, ironically, rejected by MPs David Davis.”

      There’s a fundamental difference between providing proof of identity – which is often required for many transactions – and being required to carry identity papers all the time.

      • rose
        Posted April 4, 2018 at 8:01 pm | Permalink

        In the light of the revelations today about the Home Office fraud in manufacturing British nationality on a huge scale, would the same not apply to ID cards? Another scandal presided over by Mrs May.

    • Narrow Shoulders
      Posted April 4, 2018 at 7:10 am | Permalink

      Are Sainsburys and Tesco bureaucracies? They collect money owed to them as the debt is incurred.

      We do not need ID cards, everyone eligible for treatment has an NHS number. This is held on a central database which can be verified with the questions, date of birth? Place of birth? No NHS number means payment up front if no EU health card can not be produced.

      This may not catch everyone but it will catch or deter many.

      • gregory martin
        Posted April 4, 2018 at 9:30 pm | Permalink

        Every NHS Patient has a number. Many NHS Patients also have a FP4 Medical card, which states basic information such as name, address, registered Gp, NHS number etc. The issue of these seems to be arbitary. Why have a partial system? Currently it is not needed for the receipt of treatment.
        If the major supermarkets can operate a simple ‘Reward’ scheme, thereby capturing purchase details tied down to the cardholder for whom they record name ,address etc, by a (free) barcoded tag, why cannot the NHS recognise their users in a similar manner.
        It would benefit every patient to receive a statement of the costs of their treatments, to quantify the value of the service and to emphasise the value that it represents.
        ‘Free at the point of delivery’ is tremendous but would be better appreciated by all if the value given was seen in the light of a prepayment.
        It may also demonstrate to the patient that the cost is disproportionate to the effect.

    • stred
      Posted April 4, 2018 at 7:51 am | Permalink

      The problem is motivation. The NHS is a State organisation similar to a communist health service but with very powerful state -financed unions for the doctors and nurses resulting in higher pay and restriction of numbers trained. On the continent the hospitals and surgeries make their money through the patient in an insurance based system and the patient reclaims the cost through the state if they cannot afford insurance. In the UK the health workers get paid anyway through taxation and the patient has no control and is treated as a supplicant.

      A senior consultant has written about the charging system. ( Mr Thomas?) His trust agreed to improve the charging of non-UK patients. In the event, they set up a system which depended on the patient just being honest and declaring that they had been in the country for long enough not to be charged. It was way open to abuse, but of course, the hospital didn’t really mind, as they were paid anyway.

    • stred
      Posted April 4, 2018 at 8:12 am | Permalink

      On the continent, the hospital reception desk and GPs themselves ask for payment from foreigners. They have less ‘infrastructure’ than the NHS.

    • Anonymous
      Posted April 4, 2018 at 9:01 am | Permalink

      Always on the EU’s side.

      • WA Laugh
        Posted April 4, 2018 at 10:58 am | Permalink

        Anon, It is not to be on the EU’s side to say that continental hospitals and GPs ask to see your ID, your social security card, or your way of paying before providing care.
        It is one thing to want the UK out of the EU and another one to be a etc ed

    • Dave Andrews
      Posted April 4, 2018 at 9:58 am | Permalink

      Exactly, and perhaps it is better to keep the NHS free at the point of service. How much might the government spend recovering the cost? More than they would recover I suspect.
      On the subject of ID cards, we all have EHIC cards now and have them with us at all times when abroad, so perhaps we should replace them with NHS entitlement cards that everyone in the UK has.
      Anyone coming into the UK needs to have health insurance, and they would be diverted to private healthcare if they reported sick. Keep the NHS services for those who are entitled to them, where no charges are made.

    • DaveM
      Posted April 4, 2018 at 11:52 am | Permalink

      Perhaps, but if they’re in this country surely they should have passports with them?

  7. Peter
    Posted April 4, 2018 at 5:56 am | Permalink

    A stricter approach before any treatment is given would save a fortune for Britain. There is no reason to allow health tourism to flourish.

    ID could be required before costs are incurred. Foreigners without insurance could be turned away or left on a trolley. Once we lost the reputation of being a soft touch less foreigners would appear seeking treatment.

    • Posted April 4, 2018 at 9:57 am | Permalink

      A hospital in Australia that my wife visited had a sign at reception:
      “Show your entitlement to free treatment or produce your credit card”.
      That’s one thing about the Aussies, straight to the point, no messing about!

  8. Lifelogic.
    Posted April 4, 2018 at 6:00 am | Permalink

    Theresa May shows again just how daft and innumerate PMs and Oxford geography graduates can actually be. (Telegraph today). Even wanting to advertise this foolishness in a nation newspaper.

    “Pay equality is a right – like having the vote
    And if women had parity in hours, pay and seniority at work up to £150 billion could be added to our GDP“

    This is a bit like saying if we up everybody’s wages by 10% we will add X billion to GDP. It is economically illiterate (has she been listening to P Hammond too much perhaps?). If businesses have to pay more wages they will sell less and lay people off, and/or make less profit to reinvest. You actually decrease GDP by having minimum wage laws, daft regulations and gender pay reporting laws and create more damaging and pointless admin work for them too.

    There is no gender pay gap that is not completely explained by the different jobs women choose, the different subject they study (look at A level and degrees in say Physics, Engineering and Computer Studies) and the different work life balance choices they make (look at shift work or work on offshore oil rigs for example). What May is asking for is blatant active discrimination against Men as that is the only way you could get equal gender pay given these choices in many areas. So if she gets her way some women might earn a bit more but their husband or boyfriends will be actively discriminated against and earn less. So it will only help single women and lesbian couples at best.

    Interestingly self employed women also earn considerably less then men. Who does May think is to blame for that? The self employed women one assumes, for clearly not being as money motivated or, if they are, for being less efficient as the men (or in lower paid areas of work) that they choose as it fits in with their family?

    Some women are even daft enough to call an early election with a manifesto promising to increase taxes, cut benefits and kick their core voters in the teeth if elected. Perhaps this is why they sometimes deserve to earn less?

    • Lifelogic.
      Posted April 4, 2018 at 6:42 am | Permalink

      T May used to sound like she was governing only for the interest of the 20% working in the state sector and not the other 80%. She clearly has no understanding of private industry at all. Now she is attacking men and so limiting herself to only half of these. Most of whom will be lefties and against brexit, or bright enough to see through T May’s foolish agenda.

      She really must go as soon as possible and certainly we’ll before the next election. Corbyn and the SNP really must be kept out of power.

    • Richard1
      Posted April 4, 2018 at 7:15 am | Permalink

      I enjoyed Mark Littlewood’s observation that the company with the biggest gender pay ‘problem’ is likely to be Manchester United football club, which has a number of men, but no women, earning c. £1/4m per week.

    • stred
      Posted April 4, 2018 at 7:58 am | Permalink

      The airlines have been shown to be the worst exploiters of women, with huge differences in pay. The best way to correct this would be to re-train the stewardesses to fly the plane and make the pilots serve drinks and wave lifejackets around showing passengers how to save themselves when it crashes. Could some MPs suggest this sensible idea to Mother Theresa and she would probably do something about it.

      • Lifelogic
        Posted April 4, 2018 at 12:37 pm | Permalink

        Indeed – “to save themselves when it crashes” using just a torch and a whistle!

    • Lifelogic
      Posted April 4, 2018 at 8:09 am | Permalink

      In my experience the NHS do not even bother to invoice lots of people who should pay, not even people who have insurance to cover. They are too poorly organised and badly run to manage even this task. Not their money that is wasted just tax payers after all.

      • Wessexboy
        Posted April 4, 2018 at 12:17 pm | Permalink

        Quite. ‘Not my job’ says the Doctor. ‘Nor mine’ says the nurse. Funnily enough the admission criteria requires 101 things to be filled out, usually by a nurse or ward clerk. Who should pay is not on the list.

    • rose
      Posted April 4, 2018 at 8:19 am | Permalink

      I too am exasperated that Mrs Burning Injustices is off again. You would think after the damage she did with her last foray over stop and search that she would have learned her lesson: don’t try to make yourself popular at the expense of your country. But oh no, this is just the start. Next will be the race pay gap, so immigrants who have been here five minutes and don’t speak English will be entitled to earn the same as natives who have toiled long and hard for decades. And guess who will be a the bottom of her burning injustices hierarchy of grievance? Working class Englishmen.

    • Man of Kent
      Posted April 4, 2018 at 8:57 am | Permalink

      Discussed this topic with family at Easter .

      I asked why , if men are paid so much more , that commercial businesses don’t hire more cheaper women ,reduce employment costs and make better profits .

      We touched on your points above , but missed out on the self employed which is new to me !

      Loved your last paragraph !

      • Lifelogic
        Posted April 4, 2018 at 12:41 pm | Permalink

        Indeed if these women were really X% cheaper for the same work value then anyone hiring them would out compete the competition by miles! So they are clearly not.

        But May obviously cannot see this.

    • WA Laugh
      Posted April 4, 2018 at 9:34 am | Permalink

      Well, well, well: studies for a number of US states do not seem to agree with your rather simplistic (and usually not very original) views:
      « What does a $15 minimum wage does to the economy? Economists are starting to find out » (Washington Post’ 20180111)
      Things are a bitty more complex than what a Cambridge STEM graduate can handle!

      • Lifelogic
        Posted April 4, 2018 at 12:42 pm | Permalink

        Nonsense what is the point of a law that says you cannot work unless your work is worth more than X per hour, even if you want too!

        • graham1946
          Posted April 4, 2018 at 5:58 pm | Permalink

          Who wants to?

          What is the point of any job that does not pay for the basics of life let alone any little luxuries that surely a worker is entitled to? We are not a bowl of rice a day economy, nor should we be – we’ve done all that in the past and have now grown up. If a firm cannot pay its workers properly and relies on government subsidy it has no business being in business. Higher wages mean higher productivity, GDP and profits. The car firms pay well and profit, the penny pinchers do not. Henry Ford knew this is the 1920’s and paid his workers sufficient that they could buy his cars, not screw them down so only a few could outside the factory could.

      • Peter Parsons
        Posted April 5, 2018 at 9:26 am | Permalink

        When the minimum wage legislation was first being proposed, I remember listening to a radio phone in discussion where someone from Scunthorpe working as a delivery driver for a takeaway was objecting to its introduction as he had made a deal with his employer that he would be happy to work for £10 per shift and then top up his income using the social security system.

        I don’t pay taxes so that cheapskate employers can get away with paying pitiful wages, lining their own pockets at the expense of the rest of us. To quote Sir Winston Churchill “It is a serious national evil that any class of His Majesty’s subjects should receive less than a living wage in return for their utmost exertions.”

    • Student
      Posted April 4, 2018 at 9:43 am | Permalink

      I agree. I haven’t found any of Mrs May’s policies to be the least bit exciting or imaginative. Things like gender or racial pay gaps are complete non-issues, But Mrs May seems to make them the focus of many of her ‘ideas’. I wish more time would be spent focusing on the pressing issues such as those that are often discussed on this blog. In my opinion these are namely trade, encouraging highly skilled immigration, removal of red tape for businesses, investment in higher education & research, and (perhaps selfishly) making it easier for young people to get on the housing ladder rather than pouring money down the drain for years in rent.

      I’d like to see a cabinet of Gove, Redwood, Raab, Javid, Cleverly, and Rees-Mogg – any of those could be PM and I’d be happy! (I would love for there to be women on this list, but at the moment no one springs to mind as particularly inspiring, and I don’t think virtue signalling to meet quotas is good, especially in the most important group in the Country i.e. the Cabinet).

      • Lifelogic
        Posted April 4, 2018 at 12:49 pm | Permalink

        Kwasi Kwarteng seems sound too. Peter Lilley too after he has been put in the Lords (for energy and green crap issues) and Owen Paterson if he has (hopefully) fully recovered from his hunting accident?

        • rose
          Posted April 4, 2018 at 7:50 pm | Permalink

          Yes to these three and I would add Priti Patel.

      • Andy
        Posted April 4, 2018 at 5:44 pm | Permalink

        I would love such a ‘cabinet’ to present itself to the British people at an election. Even Corbyn would wipe it off the face of the Earth.

        Most Britons are moderate. We do not want an extreme government – left OR right.

    • Ed Mahony
      Posted April 4, 2018 at 2:38 pm | Permalink

      ‘There is no ge … e balance choices they make (look at shift work or work on offshore oil rigs for example)’

      – Well said!

      The evidence (when analysed properly) shows that misogyny is only a small reason why there is a variance in gender pay. The lies of radical feminist ideology is dangerous. Not only does it cause a split between men and women, as well as emasculating men, it also gives women false hopes / aspirations.

      (And yes misogyny is a serious issue, including physical violence against women- and must be tackled – but this is largely irrelevant to the gender pay issue).

    • APL
      Posted April 6, 2018 at 7:24 am | Permalink

      ” gender pay ” gap.

      Guess who was minister for ‘Minister for women and equality’ while she was also Home Secretary.

      We know Theresa May wasn’t doing much Home Secretary work during her time as Home Secretary, but it looks like she wasn’t doing much ‘equality’ work either, I mean, she had five years to address the ‘gender pay gap’, while she was minister for equality. But no.

      Now suddenly, it’s a thing!

      Could there be some other news Theresa May want’s off the front pages more than Russia russia?

    • APL
      Posted April 7, 2018 at 11:54 am | Permalink

      LifeLogic: “Interestingly self employed women also earn considerably less then men. Who does May think is to blame for that?”

      Standard Feminist boilerplate answer: The Patriarchy.

      Reminds me of the joke:
      Man: Wipes sweat from brow. “What do you think of that then?”
      Woman: What?
      Man: “Civilisation. You know, hospitals, farms, bridges, refrigerators, motor cars, that sort of thing.”
      Woman: ” Yea, it’s ok, but what have you done for me today?”

  9. oldtimer
    Posted April 4, 2018 at 6:00 am | Permalink

    That is an extraordinary difference. No doubt we will be asked to believe the NHS needs yet more money to get its house in order.

    On a trivial level I asked for a copy of an X ray I had for which I was happy to pay. The process was hopelessly inefficient. I received at least three demands for payment after I had actually paid the cost (£15). The problem lay in the accounting function of the Trust in question; they were just not set up to handle invoicing and payments. Any business would not last five minutes if it operated like this.

    • stred
      Posted April 4, 2018 at 8:07 am | Permalink

      When I had an X ray of my chest they caught me looking at it and told me I wasn’t allowed to, as it was NHS property. It took a month for them to tell my GP what was wrong, so that after another month, he could tell me. My friend, who is a very good retired GP, went to have his cancer scan and was told the same. He argued that the picture was of his body, so he should have a right to look at it. It was a State picture and he was put in his place. Nine months later, the cancer has spread and he is still wating for treatment.

      • Lifelogic
        Posted April 4, 2018 at 12:50 pm | Permalink

        Patient to them are a nuisance not paying customers to be well served.

      • Mark B
        Posted April 4, 2018 at 6:47 pm | Permalink

        Last year I went to a spectacles company in the high street and they scanned my eyes. They were only too happy to show me the results even though I did not want to as there was nothing wrong.

        Public vs Private. Were in one, but not the other, the customer is king.

    • Adam
      Posted April 4, 2018 at 8:10 am | Permalink

      It should be simpler, oldtimer.

      An efficient hospital would hold X-rays in integrated patient records, & email you the image within a few clicks.

    • Lifelogic
      Posted April 4, 2018 at 8:21 am | Permalink

      Exactly. Had they recovered say another £1 billion or so (as they probably were entitled to) how many lives could this have saved had it been spent efficiently. How many more knee and hip operations done promptly. Perhaps a few thousand still who care about that?

      Has Simon Stevens not noticed this huge discrepancy and the lack of invoicing and done something about it? If not is he really suitable for his job?

      At least the sensible Duke of Edinburgh has not disturbed the NHS for his hip operation at King Edward VII Hospital (which I found very pleasant and efficient when my father had a couple of orthopaedic operations there some years back. Best of luck to him.

      • Lifelogic
        Posted April 4, 2018 at 8:24 am | Permalink

        Back in the days when he got BUPA cover through his old employer, got tax relief on the premium and did not have to pay Hammond’s 12% IPT tax on top.

      • graham1946
        Posted April 4, 2018 at 6:06 pm | Permalink

        Simon Stevens asked the government for 30 billion to make the NHS work under present conditions but Osbornne gave him 8 billion – hence the 22 billion shortfall the NHS is short of. Meanwhile the government brag about giving more than ever to the NHS whilst omitting that the population has grown by several millions over recent years therefore the per capita spend has actually gone down.

    • Nig l
      Posted April 4, 2018 at 9:01 am | Permalink

      That will be my comment if posted.

    • Jagman84
      Posted April 4, 2018 at 9:39 am | Permalink

      The NHS is run by a bunch of Socialists so what do you expect? They always run out of other people’s money and scream for even more. It’s run for staff convenience, not patient need.

      • Iain Gill
        Posted April 4, 2018 at 6:56 pm | Permalink

        Agreed

        • Miss Brandreth-Jones
          Posted April 6, 2018 at 10:01 pm | Permalink

          The rule about patients investigations , records and results is that every patient has a right to see their own records as long as they have a clinician who can accurately interpret what they see.As far as radiographers are concerned they are classed as not qualified to interpret and especially in the context of the whole problem. It is about context and knowledge. Results can be piece work and give wrong indications , not always , but can frighten a patient . I remember approx 30 years ago I had an x ray on my knee. I was sporty and had many knee operations. I looked at records many years later only to find out that cancer of the bone had been suspected and part of the report had been tippexed out . Myself as far as I know ,have not got cancer , however it is circumstances like this which cause results to be handled carefully.

  10. Nig l
    Posted April 4, 2018 at 6:22 am | Permalink

    I have mentioned before I have a friend who works part time in a large hospital in southern England chasing up cash owed by private patients and insurers, the latter often because the initial billing paperwork was incorrect.

    She chooses her own hours, mainly linked to whether there is a desk for her and if she doesn’t do the job, no one does. Over 15 months she has recovered 140k and 115k has had to be written of. Much of this is as a result of inaccurate billing. The billing team are inefficient and don’t care, this is known but the management can’t or won’t performance manage them, indeed she says performance management compared with her experience in the private sector is woeful.

    We have recently seen a few hospitals proudly boast they have saved close to half a billion pounds by purchasing the same brand of rubber gloves. Boast, I think not they should be ashamed of how much they have wasted over the years.

    Re care for foreign nationals, a no brainer , be like switzerland, if you break a leg skiing, your credit card is swiped or details of insurance taken on the spot.

    In the private sector efficient companies drive the debtor book hard, with MI ratios on days outstanding and write offs easily available to Management, JIT purchasing on non life threatening essentials, plus a ratio of purchases against T/O to drive down cost etc.

    One person spending a day, two max looking at these aspects of every hospital with a report and recommendations would for a small cost reap large benefit.

    Why are we still discussing this? Secretary of State and senior officials who have never run a business, the usual poor public sector management, and oh, its not their money and political benefit, nothing compared with the wonderful headlines that a massive increase in spending gets.

    I look forward to one of your blogs explains why inefficiencies like this exist.

  11. Peter VAN LEEUWEN
    Posted April 4, 2018 at 6:25 am | Permalink

    Although I promised not to comment before 30-3-2019, one exeption today:
    Even last weekend, my Dutch family, on holiday in the UK, had to use some NHS treatment. Although they are perfectly well insured for this, nobody at the NHS brought this up, much to my surprise. In the Netherlands, the doctors and hospitals are used to charge the insurance companies.

    • Richard1
      Posted April 4, 2018 at 2:00 pm | Permalink

      Absolutely, this is the problem. in the UK there is no system, nor culture, for charging. probably to try to introduce one would be a heresy. everywhere else it is obvious that someone at some point has to pay.

      • graham1946
        Posted April 4, 2018 at 6:09 pm | Permalink

        Despite the 3 billion spent on re-organisation.

    • rose
      Posted April 4, 2018 at 2:15 pm | Permalink

      Welcome back, Peter. I suppose the answer is that with so many millions of foreigners now residing in the country, the NHS don’t know whom to ask. That is where the hated ID card would come in.

      • a-tracy
        Posted April 4, 2018 at 3:33 pm | Permalink

        Rose, I thought we were all on the NHS Spine? I don’t know about you but if ever I rock up to a walk in clinic they want to know everything about me before I obtain treatment.

        Usually you have to phone NHS Direct ahead of time and book yourself in with all your details that are checked in the Spine.

        If my family use the hospital it is always by GP referral just what UK hospitals are they that no questions are asked, are these the ones calling out for more money all the time? Are these the ones with failing A&E response times? Are these the ones with people queueing in ambulances.

        Hunt, get a grip or leave the post to someone who will, a woman maybe, with a department full of women who are getting sick to the back teeth of paying more and more and getting less.

        • APL
          Posted April 5, 2018 at 9:00 am | Permalink

          rose: “That is where the hated ID card would come in.”

          Here is the problem with ID cards. – Not least the expense.

          You can buy, yes buy a national insurance ID. So if the organisation that administers the system is corrupt, the ID system, like the National Insurance ID system will be corrupted too.

          • a-tracy
            Posted April 5, 2018 at 7:55 pm | Permalink

            We should maybe put this nhs billing out to the private sector, they can keep 50% of everything they recharge, collect and credit control. The NHS should concentrate on the medical care.

            They should also check everyone’s NI number on the spine and see which are of working age and not making NI contributions to try to get to the bottom of this NI scam, a simple check against the residence to see if the person with an NI number is on the Council Tax bill of the home should also help to sort out this problem of people saying they’ve been here 50 years but GP registration, Council Tax registration isn’t enough evidence for the current system, these people must be in the tax system, the council tax system, the GP system, registered as parents of their school children, I’m just amazed at what I read now, the Government must have its own evidence of residence, what the heck’s going on. We were told operations were cancelled for January NO, our NI contributions weren’t cancelled for a month and I don’t think we should pay insurance for a service that’s not there.

          • APL
            Posted April 7, 2018 at 7:01 am | Permalink

            “NI contributions to try to get to the bottom of this NI scam, ”

            Well, it’s a bottomless pit. It’s not your average British citizen who wants another NI number ( for Sundays ). It’s your illegal immigrant.

            QED: infinite demand.

            It’s the one thing John Redwood and the administration is afraid to do anything about. – I presume because Labour have coddled up to the minority vote, which is clearly a very lucrative proposition. And exactly what the Democrats are doing in the USA.

            It’s why the Tory party always looses. Fighting the battle on ground chosen by the Labour party and its Ideological Marxists.

          • APL
            Posted April 7, 2018 at 7:25 am | Permalink

            “JR: “NI contributions to try to get to the bottom of this NI scam, ””

            Sorry mis-attributed Hope’s comment to JR.

  12. Posted April 4, 2018 at 6:35 am | Permalink

    #
    Isn’t this just another example of how EU systems work to the detriment of the UK?

  13. BenD
    Posted April 4, 2018 at 6:51 am | Permalink

    if government were following the peoples wishes we’d be out and clear by March 2019 but government and the tory party of which our host is a prominent member are hell bent on keeping us tied to the european juggernaut.. it seems..so there’s no point in whinging about anomalies while we are still pussy footing around with them- the europeans are better book keepers..they pay more attention to detail.. that’s all

  14. Mark B
    Posted April 4, 2018 at 6:53 am | Permalink

    Good morning.

    Some hotels may call private doctors or ambulances to take patients to private hospitals; the EHIC won’t be accepted there.

    And.

    As a general rule, if you need hospital treatment in Spain you’re more likely to receive appropriate care in a public healthcare facility (although in some tourist areas there may be no public healthcare facility nearby).

    From a government website so should be OK : https://www.gov.uk/foreign-travel-advice/spain/health

    Methinks that is where the problem lies. We assume that healthcare on the continent is exactly the same as here. It isn’t ! They have a mix of both private and public. The UK is slowly moving, due to political reasons, in that direction. But I think it is high time the government grasped the nettle. No amount of funding is going to satisfy the NHS, especially in mind how badly it is run and overused.

    I have suggested in the past a possible solution. It has either been deleted or, held in moderation. It is simple and does not need much government bureaucracy.

    Make all passenger carriers add the cost of health insurance to all tickets for people entering the country or visa’s if necessary. No health insurance, no ticket / visa, no entry and no government involvement. When said visitors need healthcare, they present their insurance to the NHS and the NHS bills the insurance company. The insurance companies weigh risk against reward and set the price. Again, no government involvement. Cost to the NHS is zero. If health tourism becomes a problem, the cost of insurance from those countries whose citizens are scamming us goes up. The market decides and will, eventually, win !

    Dear Mr. Redwood MP sir, where does one apply to become Healthcare Minister (England only of course as it is a devolved power) ?

  15. jerry
    Posted April 4, 2018 at 7:02 am | Permalink

    The missing factors in this article are; 1/. how many people do each of the EU28 health services employ whose job is to obtain this ‘charge-back’; 2/. whilst £66m is obtained in redress how much is actually billed out by the NHS, is the UK simply not billing other EU28 countries or are others simply not paying their bill (fully)?

    Post Brexit the front-line NHS staff could be required to see and take a copy of health insurance documents for non UK nationals before any treatment but if the back-office staff then do not or can’t act upon the data nothing will change

  16. Narrow Shoulders
    Posted April 4, 2018 at 7:03 am | Permalink

    How easy it is to spend other people’s money and then complain you have not been given enough.

    Many will say it is but a drop in the ocean but many successful small solutions are as effective as one big one and easier to implement.

    • Heath
      Posted April 4, 2018 at 5:49 pm | Permalink

      Typical. You worry about migrants using the NHS. Not a word about the taxes they pay. Basically brexiters dont like foreigners

      Reply Nonsense. Health tourists dont pay incone and capital taxes here.

      • APL
        Posted April 5, 2018 at 9:28 am | Permalink

        Just to assist you Heath, here is a breakdown of the cost of a prisoner in the UK prison service – it seems to be about £30,000 per year.

        So, in just this one case, fourteen prisoners – that’s the best part of half a million pounds each year to keep 14 gang members locked up, each year and every year.

        By the way, if you are on minimum wage, you are not paying income tax.

        That’s before we’ve even calculated the medical, costs of treating their victims.

        Government figures for 2014/2015 cost of prison places in UK.

        https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/471625/costs-per-place.pdf

      • Narrow Shoulders
        Posted April 5, 2018 at 4:27 pm | Permalink

        I am married to a “foreigner”.

        She and her friends pay very little in tax. Other foreigners who my “foreign: children go to school with have parents who do not pay sufficient tax for the public services they use.

  17. Old Albion
    Posted April 4, 2018 at 7:08 am | Permalink

    For far too long Englands Health Service as been seen as the Worlds health service. Governments of all colours have comprehensively failed to address the problem.

  18. George Dunnett
    Posted April 4, 2018 at 7:18 am | Permalink

    I remember when I was working in a British holiday camp in the Ardeche in 1992, we had a chap who injured his back quite seriously. We called the ambulance and when the ambulance did finally arrive guess what the first question the paramedic asked??

    …Yes that’s right, well done that person!!

    Who’s paying!!

  19. Ian wragg
    Posted April 4, 2018 at 7:20 am | Permalink

    The NHS is a disgrace. Always bleeting about being underfunded but continuing to treat the whole world and its dog. So many non medical staff at my local surgery but no one to check entitlement or charge.
    It’s funny how we get charged for glasses and dental treatment but the doctors can’t be bothered.
    How much do we pay interpreters or 20 minute appointments for non English speakers when we have to wait 3 weeks for an appointment. The whole set up needs shaking up before another penny is given to them

  20. Original Richard
    Posted April 4, 2018 at 7:32 am | Permalink

    The NHS/UK government have no idea how much they should be collecting from EEA nationals.

    No wonder the EU funded CBI is keen on the EU/SM as it provides a constant source of cheap labour undercutting UK workers and thus holding back investment in new machinery/techniques whilst using the UK taxpayer to fund the majority of the costs of healthcare, housing, schooling, etc. for these additional workers.

  21. Adam
    Posted April 4, 2018 at 7:53 am | Permalink

    Alternative NHS ideas:

    Restrict Govt-provided health to accident & emergency hospitals.
    Site them on health-only roads, & motorway pods.

    Privately-run non-urgent medical matters.
    Govt inspects, & awards contracts to highest quality cost-efficient operators.
    Govt pays for UK citizens’ treatment.

    Non-UK patients pay for non-emergency treatment, with loan if needed, refunded centrally if UK Govt approves as valid.

  22. Posted April 4, 2018 at 7:55 am | Permalink

    Surely this provision of health care to foreigners should be classed as ”foreign aid” and as such the balance should be paid from our foreign aid budget.

    Or is every penny of our foreign aid budget earmarked permanently for questionable payments to certain regimes, with nothing left over for fripperies such as taking care of our own?

  23. robert lewy
    Posted April 4, 2018 at 8:18 am | Permalink

    In 2017 there were 3.7 million living in UK ( 6 per cent) who are citizens of another EU country whilst there were an estimated 1.3 million UK citizens living abroad.

    For this reason alone one would expect the cost of treatment required in the UK for EU citizens to be greater than for the corresponding number of UK citizens in the EU.

    The annual NHS cost is about £124 billion.
    Therefore, if use of NHS services was equal amongst EU citizens living in UK as for UK citizens one would anticipate a cost of 7.44 billion ( 5 per cent) attributable to EU citizens.
    However, as use of NHS facilities is skewed towards senior citizens one would expect that in the EU cohort the age profile would be younger. Also, social care would be more relevant to UK residents as opposed to EU citizens living in UK.

    What does this tell us?

    Plainly, £66 million does not appear to represent a fair contribution of the probable costs and that as a minimum steps should be taken to establish the true cost and an informed decision can then be taken on charging.

  24. Epikouros
    Posted April 4, 2018 at 8:20 am | Permalink

    I suspect the main reason that recoverable health costs are not recovered is because the NHS does not have a robust system in place for doing so. France which is the only continental system that I have experience of does and from what you say so do many others. The French system is one that would probably go against British civil liberties loving ideas as to be eligible for state funded healthcare foreigners have to pass a rigorous assessment. Not so I note in the UK it is easily circumvented or abused or poorly applied.

    The patients have to be in possession of a Carte Vitalle, which they are given if the assessment deems them eligible, that has to be updated from time to time(that is normally done by passing it through a machine in the local pharmacie). It is for all intents and purposes and ID card but has the added facility that it works like a prepayment card. It must be presented to the medical practitioner that you are attending who will place it into a card reading machine similar to the ones we use for credit cards. So it always ensures that payment for the service rendered is collected and as the practitioners is reliant on that collection for their income; salary or wages the action of collection is never missed through neglect or other reasons.

  25. Student
    Posted April 4, 2018 at 8:28 am | Permalink

    Off topic, but the UK government should make it very clear that it will not put any further limits on the number of high skilled engineers coming into the UK from the EU. The head of CurrencyCloud recently said:

    “It is just a people thing. I think on the regulatory side we will figure it out. We understand passporting, regulation and compliance and it will cost us money, but we will sort that out. To me, the London fintech issue is more around having the right people and having very easy access to that.”

    We have a talent shortage in this area, so it would be completely senseless and self-harming to put restrictions on e.g. more software engineers coming in. Given that the EU has not made an assurance that UK talent can move frictionlessly into Europe, now would be a great time to get on the side of high skilled foreign workers and be very clear on this point.

    We will do tremendously well outside the EU if we continue to allow and encourage their talent to come here.

  26. agricola
    Posted April 4, 2018 at 8:36 am | Permalink

    Your entry today raises more questions than it answers.

    1. Is there a flat fee per annum for foreign residents in any European country or is the cost retrievable from the residents country of origin, based on usage. Please note that on arrival in Spain one has to register . The Spanish mostly know how many residents from other countries they have to cater for. Do all foreign arrivals who arrive in the UK ,with the intention of staying, have to register. If not how do you know how many you are catering for and who you should bill for NHS usage.

    2. The age pattern of immigrants will vary from country to country, consequently so will their medical needs. Spain deals with the elderly and the UK probably deals with a much younger age group. Many of the retired immigrants in southern Europe will have private insurance, only using the national service at GP level.

    3. Before flinging figures around concerning the level of reciprocal billing it is necessary to know how many French people reside in the UK and how many UK citizens are living in France.

    4. My last question is, how good and how serious is the NHS at billing foreign residents. I suspect , from personal experience , that the UK is very casual in this matter. Perhaps it is because medical staff in the UK see themselves as solvers of health problems, not as businessmen or accountants.

    I suspect that much of the problem arising in the UK is self inflicted. You do not know who is in the country, where they came from, or what they are doing. Consequently it is not only the finances of the NHS that suffer, but also housing ,education, transport, social services, with London now earning the accolade of more street murder than New York. In fairness to New York I always found it a very welcoming safe place to be, whereas London has become (more worrying? ed)

    • agricola
      Posted April 4, 2018 at 3:01 pm | Permalink

      It is now around 16.00 BST or 15.00 GMT. How is it that one contributor can write eight pieces relative to your article and get them all moderated. This despite the fact that you are always complaining about multiple submissions. I write one and so far it is ignored. Are the questions asked so complex or are the answers too revealing.

  27. Bob
    Posted April 4, 2018 at 8:54 am | Permalink

    Possible reasons for the enormous disparity:
    a) EU citizens are much fitter and healthier than Brits
    b) the British govt is monumentally incompetent

    I think I know which is the most likely reason.

  28. BOF
    Posted April 4, 2018 at 8:58 am | Permalink

    Have seen it. My brother from the land of weepy cricketers was unable to pay for treatment. I do not think that within the NHS, anyone gives a monkey’s. There seems to be a belief that they really are there to treat the whole world. It is only British tax payers money and if they squeal long enough and hard enough the Government will just keep coughing it up.

    Massive reform is needed in this black hole for money.

    • Lifelogic
      Posted April 4, 2018 at 1:11 pm | Permalink

      Massive reform needed but no one dares to touch it!

    • Posted April 4, 2018 at 1:29 pm | Permalink

      Isn’t there a reciprocal health care arrangement with Australia?

  29. MickN
    Posted April 4, 2018 at 9:06 am | Permalink

    O/T Why is an official from Porton Down being allowed to make reports to the media as to where the nerve agent used in Salisbury has or has not come from?
    Do we not have an official secrets act any more?
    The fact that they cannot attribute it’s production to Russia emboldens Putin at the expense of those countries that have acted against him and makes us look totally stupid.
    In years gone by heads would have rolled for less.

    • Mitchel
      Posted April 4, 2018 at 1:38 pm | Permalink

      It’s like watching the pub reserve tiddly-winks team square up against the chess Grandmasters.

      I did enjoy last week’s battle of the blondes between Boris and Sergey Lavrov’s glamorous,femme fatale-ish assistant,Maria Zacharova,over Crime & Punishment.”Mutually Assured Dostoevsky” as one commentator put it!

    • Political Scientist
      Posted April 4, 2018 at 6:42 pm | Permalink

      For once, the government is not making us…look stupid, just itself.

    • stred
      Posted April 4, 2018 at 8:06 pm | Permalink

      Probably, the director is fed up with politicians claiming he has said something which he hasn’t. Thank goodness we have some straight competent civil servants.

  30. ChrisS
    Posted April 4, 2018 at 9:18 am | Permalink

    The important point is that the mutual reimbursement scheme only applies to patients over state retirement age.

    We have an awful lot of pensioners living in Spain France etc for whom the British Government pays for their healthcare while the vast majority of EU citizens living in the UK are of working age and their governments cannot be charged for the treatment they receive as they are paying UK taxes and NI.

    That explains the wide disparity in payments.

    Because our citizens are only entitles to the basic level of “free” healthcare in the country in which they live and this is somewhat limited in some countries, many ex-pats pay top up insurance themselves. Several retired friends living in France do this to ensure they get full coverage.

  31. TomTomTom
    Posted April 4, 2018 at 9:24 am | Permalink

    Those figures are bizarre! Considering there are 3 times as many EU nationals living in the UK as UK nationals living in the EU.

    The French figures are very odd. There are approximately 200k UK citizens in France costing the UK the UK taxpayer £154m!

    How many people have to visit a hospital on average every year? 10%? ( I have no idea )

    How many tourists end up in a hospital and require treatment when on holiday? That’s got to be a low percentage. 2 – 3% max

    It would be very interesting to actually get a decent breakdown of these figures. I bet you’d find that some countries are charging a “Flat Rate” for each non-native resident irrespective of whether any health care was delivered.

    • a-tracy
      Posted April 5, 2018 at 8:52 am | Permalink

      Just look at maternity services alone, how many babies are born to French mothers and how many of these mothers are receiving free antenatal care not recharged back to France.

      They need to look at this in reverse, see what treatments Brits are getting in France that create the biggest part of the bill, then look to see how we recharge for the same services, then look at the smaller service recharges later.

  32. Denis Cooper
    Posted April 4, 2018 at 9:31 am | Permalink

    “It is difficult to believe it should be that one sided.”

    But it’s all one sided, JR, or at least it’s almost all one sided.

    I believe we may get more scientific research funding back from the EU than we pay in, and as I recall we sell them more lamb than they sell us; but these are exceptions, and the overall picture is that the UK ‘s participation in the EEC/EC/EU/USE project has always been far more to the advantage of the other countries than to our advantage.

  33. ChrisS
    Posted April 4, 2018 at 9:35 am | Permalink

    We should introduce ID cards as they could be used for so much more than basic identification. They could, for example, be based on the DVLA driving licence and double as a Bus Passes for those entitled.

    The added biometric security would be good for the DVLA and the extra cost would be very small because there are already so many driving licences in circulation. We would probably only need to issue an ID card for those aged 16 and over.

    According to the DVLA website :

    “As of 30 September 2014, there were 45.5 million active driving records in GB.”

    • a-tracy
      Posted April 4, 2018 at 11:02 am | Permalink

      I have an NHS ID card Chris don’t you? I have an NI card and a paper card with my NHS number on it, it was sent to me years ago when I first started work. The NHS do ask for my NHS number on documents so we all have a unique number.

      Jeremy Hunt needs to just get this sorted. Grab the bull by the horns and charge. We clearly do have systems otherwise no bills would be generated at all this is someone falling down on the job.

      • ChrisS
        Posted April 4, 2018 at 8:13 pm | Permalink

        The NHS card is effectively useless as it contains no photograph or biometric data. It is therefore not possible to rely on it for identification.

        We need an ID card which has an embedded photo, biometric data and a list of the entitlements that card holders are legally able to access here in the UK.

  34. Timaction
    Posted April 4, 2018 at 9:40 am | Permalink

    After 8 years in office you cannot blame any other party but your own. With the impact and costs of immigration being the largest concerns of the public we would have thought this would have been a priority over MP’s pay and conditions or obsessive foreign aid giveaways!
    The EU negotiations, the political choices to cut police and our armed forces whilst under the most significant threats in a generation have shown the legacies at their true level of incompetence!

  35. miami.mode
    Posted April 4, 2018 at 9:49 am | Permalink

    Root and branch change is required in the NHS for it to survive in a meaningful way and your figures amply demonstrate this. It’s become a political football and neither main party is willing to do anything as they fear political annihilation.

    Some way should be found to make staff responsible for the anomalies you highlight with penalties for not complying.

    Hospitals always seem to have senior admin staff running around “fire fighting” rather than getting on with their jobs and with efficiency that is apparent in some other countries they could probably manage with half the number currently employed.

  36. Augustyn
    Posted April 4, 2018 at 9:52 am | Permalink

    I recently accompanied a patient through the French hospital system. On entry into each of 3 hospitals proof of ability to pay was the very first thing required (EHIC, travel insurance, credit card). Then treatment would commence. In the largest hospital the proof of ability to pay was needed each time the patient transferred department.

  37. Posted April 4, 2018 at 9:54 am | Permalink

    No private organisation would fail to chase people who had used its facilities and indeed in the limit would send in debt collectors.
    Why can’t the NHS do the same. Other state organisations and local councils are quick enough to chase up debts, why is this extremely expensive NHS Administration unable to manage?

  38. ian
    Posted April 4, 2018 at 10:12 am | Permalink

    The reason the gov does not do check on free healthcare, illegal immigrants living in the UK.

  39. KZB
    Posted April 4, 2018 at 10:48 am | Permalink

    I would think this is just the tip of the iceberg. On the other hand, the sums identified in this article are tiny compared to the total NHS budget.

    The Coalition government opened up GP registration to anyone in the area for 24 hours or more. No ID, no NI number required.

    Some time back a consultant was fired when he undertook a proper audit as to how many patients in his area were entitled to free NHS care. About 1 in 3 were not. He was sacked for publicising this.

    Anecdotally, we all know if we go to A&E or a drop-in centre, you will barely hear English being spoken in the (packed) waiting area.

    • Iain Gill
      Posted April 4, 2018 at 2:43 pm | Permalink

      true, but the alternates proposed occasionally by politicians always make obvious mistakes like failing to make it possible for diabetics to get insulin thereby condemning them to death.

      sure immigration is out of control, but you dont really want someone who has lost their ID, for example, to be condemned to death by silly rules, especially the way healthcare is organised here where the state run monopoly has little competition and patients cannot go elsewhere in most of the country, like they could in other developed nations.

      and yes immigration is out of control, thats a different issue, very important but different.

      • KZB
        Posted April 5, 2018 at 11:21 am | Permalink

        I just see the hordes of people in the waiting rooms, 80% of them speaking foreign languages. What is the explanation for this?

  40. Writer
    Posted April 4, 2018 at 12:00 pm | Permalink

    When Hilary Clinton had more equilibrium ten years ago she freely admitted after studying the Canadian and British Health systems, the former perhaps a little more consistent with American voter expectations and values, declared
    “We have studied both systems deeply. the fact is ,we ( America ) cannot afford such systems.”

    No, we are a much poorer country than America and unfortunately we can’t either and, certainly cannot afford Europe nicking our plasters and bandages.

    No-one at the top of our society is talking much sense. There is still scope left on the UK credit card so our Health Minister and Mrs May will max it out. Then Corbyn will teach us how to rifle wheelie bins for food and our migrants will suddenly find our flag is not theirs after all and run back to more somber regimes in the EU

  41. Nig l
    Posted April 4, 2018 at 12:16 pm | Permalink

    Off topic but read Guido about the Russians and the poisoning. Goodness your Government looks stupid.

    Why not just hand the keys over to Corbyn?

  42. Martyn G
    Posted April 4, 2018 at 12:41 pm | Permalink

    Like many I suspect that the government does not want to expose the true situation of the scale and cost to the taxpayer of NHS misuse.
    For example, it could establish a central professional/legal billing and debt recovery organisation to which all trusts have to report their invoicing of those patients not entitled to free health services.
    Trouble is, that would expose the true scale, nationalities involved and the identity of those free-loading on the UK taxpayer. I also suspect that no government wants to be seen doing, as it would cause public indignation and ask them why for so long had the situation been allowed to exist.

  43. margaret
    Posted April 4, 2018 at 12:49 pm | Permalink

    So many want to bring the NHS down not realising that there is worse and worse and worse , but this is just another ploy to make the NHS inefficient. I have mentioned previously that in 1993 there was a rush her locally of private sector players and it went downhill from there . There is not doubt about it ;our envy of the world was set to be destroyed.. The managers got their fingers in the pie and didn’t really wrry about the outcome. Prior to this Nurses were managers and we were not even in debt. Poor little Nurses!!! how incompetently foolish to keep the books balanced .. get rid of them!

    • margaret
      Posted April 4, 2018 at 12:50 pm | Permalink

      correction’ here locally .’

    • a-tracy
      Posted April 4, 2018 at 3:53 pm | Permalink

      Which private services in particular margaret are providing a poor service? As long as the service is free for the patients most people don’t care and have found improvements in speed, efficiency, booking in and being seen on time in private clinics. I know my parents have.

      There have also been efficiencies in the past few years in my local GP services like blood tests, mammograms and evening women clinics for tests so that women don’t have to take mornings of work for their regular essential tests.

      • graham1946
        Posted April 5, 2018 at 10:08 am | Permalink

        Cleaning for a start. Ever hear of MRSA before it was privatised?

        • a-tracy
          Posted April 6, 2018 at 8:51 am | Permalink

          One other thing graham1946 who is in charge of a ward now? At work if I feel the cleaning isn’t up to scratch I speak to the cleaner and it gets sorted quickly, is the ward administrator in charge of ensuring cleanliness, do we still have a Sister in charge, a Ward Manager? Surely there is someone on a higher rate of pay to ensure that patients are not at any risk.

      • Miss Brandreth-Jones
        Posted April 6, 2018 at 10:14 pm | Permalink

        I know, I assess , consult, take tests on the same day , refer to secondary services . diagnose and treat , all in my consultation . I am a Nurse with experience of total patient care , not a Dr , but my qualifications and certificates are taken down from the public sight whilst Dr’s have theirs displayed as doing all the work. Now when I say this some don’t believe.If they did believe , I would have to be paid for the job I do ,BUT not in the private sector which treats all NHS patients.

  44. Posted April 4, 2018 at 12:57 pm | Permalink

    I do not think this government is amenable to reason – see all its actions since Mrs May formed it. They appear to be interested only in their image, duncan has said it all, and remaining in the eu.
    We cannot afford more years of this.

  45. Dennis
    Posted April 4, 2018 at 1:39 pm | Permalink

    I don’t understand why all think this an important question as Corbyn doesn’t, nor Hunt, nor May etc., etc….

  46. Qubus
    Posted April 4, 2018 at 1:40 pm | Permalink

    Off topic:
    I read in today’s newspaper that the German legal system is discussing whether Carles Puigdemont should be deported to Spain. I was under the impression that one of the alleged advantages of being a member of the EU was that a foreign national could be extradited to his home country following a simple request by the home country’s authorities. Wasn’t that presented as one of the advantages of the EU? Or am I quite wrong in this?

    • mancunius
      Posted April 4, 2018 at 9:15 pm | Permalink

      Qubus, CP isn’t accused of murder, so the Germans have 60 days to comply with the extradition order, and the chances are high that they will. Under the EAW – which provides no exemption from compliance in the case of political or military indictments – ‘Rebellion’ and ‘illegal appropriation of public funds’ are both open-and-shut case for extradition, and the German legal opinions I’ve read (e.g. Martin say so. The Spanish authorities charged him formally, he fled: so no grounds for appeal there either. What he’s charged with would also be crimes in German law. And CP’s threatened sentence in Spain would be far, far more than the 12 months minimum to meet the EAW conditions.
      Yet the German government are in a cleft stick: they know that CP’s extradition will be greeted with a torrent of angry protest from the Catalan separatists – and revive Catalan resentments about German pro-Franco intervention in the Spanish Civil War. On the other hand, if Germany were to disallow extradition on the questionable grounds that CP might not receive a fair trial, Spain would be outraged.
      I expect they’ll end up by handing him over into Spanish custody without any announcement. And hoping CP doesn’t become President of an independent state of Catalonia.

      • mancunius
        Posted April 4, 2018 at 9:16 pm | Permalink

        Martin = Martin Heger, Prof. of European Law at Berlin’s Humboldt University.

      • Qubus
        Posted April 5, 2018 at 5:03 pm | Permalink

        #mancunius
        Thanks for that clear explanation. I had in mind the fairly recent case where two parents were extradited from somewhere or other for taking their child to that country in order for the child to receive medical attention either not available in the UK or not recomended by the NHS. That didn’t seem to me to be a capital offence.

        • mancunius
          Posted April 5, 2018 at 8:24 pm | Permalink

          Yes, Qubus, that case certainly seemed like a vindictive abuse of process to me.
          On the Puigdemont case, it seems the Germans will not extradite CP on the charge of ‘rebellion’ as they say force would need to be involved for the nearest equivalent German crime of High Treason (‘Hochverrat’) in Germany. (Apparently Belgium had also said warned it would not extradite, for the same reason is Germany.) So Spain will have to find some other charge to get Puigdemont extradited.

  47. Qubus
    Posted April 4, 2018 at 2:08 pm | Permalink

    The government cannot charge other countries for medical treatment unless they can present the other countries with genuine bills. This can only be achieved by hospitals rigorously enforcing the already existing payment procedure, where a patient is asked his/her nationality etc. Unfortunately, the hospitals rarely seem to do this and when they do it , they do it rather less that half-heartedly. I recently had to attend for a day-procedure at our liocal hospoital A few days beforehand, I got a letter advising me of the date and time of the appointment; this was accompanied by a form, asking for details about nationality etc, that they requested me to fill in and return to them when I attended. I didn’t take any notice of the form, put it not completed, in in my pocket, and just forgot about it. At the hospital there was absolutely no check or request for me to hand in the completed form.
    The answer is for hospitals and GPs’ surgeries to be compelled to ask for details, this could then be presented to the apropriate countries for payment. This is much simpler that requiring that individual foreign visitors to have their own private health insurance and doesn’t discriminate between rich and poor.

  48. Iain Gill
    Posted April 4, 2018 at 2:32 pm | Permalink

    I never understood how a national of another EU country when coming here, immediately they get their student flat (qualify as a resident I suppose) or whatever apply for a British EHIC card and then when travelling around Europe the UK gets charged for their care.

    While Brits abroad tend to keep their UK EHIC card, so while being resident mainly abroad the UK gets charged for their care.

    So UK seems to come off worse in both cases, getting hit with the bill for both.

    Surely there is a more sensible way ahead.

    Indefinite leave to remain in the UK should be much harder to obtain, and should not be available so easily, and EHIC cards should be tied to that, so anyone who just rocks up randomly from elsewhere in the EU for a few days does not qualify so easily.

    • stred
      Posted April 4, 2018 at 8:25 pm | Permalink

      Am I dreaming or pissed? The UK issues EHIC cards to visitors from the EU?

      • Iain Gill
        Posted April 4, 2018 at 9:03 pm | Permalink

        A EU citizen who is resident in the UK is entitled to a EHIC card issued by the UK. From day one in this country.

      • Peter D Gardner
        Posted April 4, 2018 at 10:05 pm | Permalink

        No, to residents, not visitors.

        • Original Richard
          Posted April 5, 2018 at 6:40 am | Permalink

          That is true but they can use the card for up to 5 years back in their own country for medical treatment charged to the UK until they need to renew the card.

    • Peter D Gardner
      Posted April 4, 2018 at 10:04 pm | Permalink

      I think that is also true of non-EU residents in UK, like my Australian relatives. UK pays for their treatment all over the EU. They do pay their taxes though!

  49. Iain Gill
    Posted April 4, 2018 at 3:00 pm | Permalink

    Anyways the Conservative party have lost the plot completely today, with the discredited leftist version of equal pay nonsense being pushed out as new policy.

    A casual glance at the actual scientific evidence, as so well summarised by Jordan Peterson, will destroy the social justice warrior fake science being used to justify this nonsense.

    Maybe the Conservatives want a few years of Corbyn in power, they seem to be doing everything they can to be even worse than him.

    What next? females on submarines? Oh theyve already done that… complete and utter madness

  50. DaveK
    Posted April 4, 2018 at 3:44 pm | Permalink

    According to an article I read last year, certain EU nationals were applying for NI numbers and then using these to apply for an EHIC as the only information to apply was NI Number and an address. These cards were then being used in the home EU countries to charge the UK for the healthcare.

  51. Iain Gill
    Posted April 4, 2018 at 4:01 pm | Permalink

    householder stabs burglar in self defence and gets arrested for murder, only in this country…

    the home secretary should be on every news channel condemning this arrest

  52. Nig l
    Posted April 4, 2018 at 4:41 pm | Permalink

    Following on from a previous blog, an update on today in a major southern NHS trust. 8 bills sent to insurers to reclaim private fees, 4 turned out to be incorrect.

    Come on JR it is about time we had your insight in to such inefficiency.

  53. mancunius
    Posted April 4, 2018 at 4:44 pm | Permalink

    The obvious reason for this discrepancy is that in continental insurance systems the money follows the patient and his/her use of the system, so for every treatment the doctor/nurse/therapist needs to raise a payment code, alerting them to the need to charge back the treatment of a foreign national to the relevant country.
    In the NHS, the money comes in a wodge from the state out of general taxation, regardless of patient use. There is no trigger, and no motivation, for a GP or hospital to identify or charge a foreign patient. In fact, illegitimate patient use adds to the statistically demonstrable ‘burden’, allowing the system to demand more money.

    Clearly, this covers a great degree of abuse of the system, some of it fraudulent on a large scale.

  54. John
    Posted April 4, 2018 at 4:49 pm | Permalink

    I liken this to when UK businesses complain to the Government that their contracts are tendered out across the EU but that does not happen in return.

    The Government response is that those are the EU rules and they should get reciprocal tenders. What the Government response could be is that they will ensure the EU fines those governments that aren’t tendering to other nations.

    Likewise in the NHS they should hold back X amount of funding from Trusts that don’t ask patients if they are eligible and if not for the bank details.

    They are too weak. I want out of the EU but part of this is self inflicted and wonder whether its the Civil Service?

  55. Norman
    Posted April 4, 2018 at 5:05 pm | Permalink

    Could a brave Civil Servant, standing for truth, bring down the Government? What an own-goal that would be! I doubt he’d survive in Russia – which all goes to show there’s still something to contend for in our once great country. But things are wearing very, very thin!

  56. Writer
    Posted April 4, 2018 at 5:47 pm | Permalink

    Something has gone wrong with the EU’s ( France) state-owned SNCF railway.Strikes by the comrades. But what can they possibly want? They already have Socialist Utopia all the way from the back end of the coal bunker, carriage, by carriage, by carriage, by an overstaffed guards van with only one whistle between them full of one another’s spit.
    Why also do they need railway trade unions? The “workers rights are underpinned by the EU ” Mr Corbyn’s front bench, one batch of them, three redundant batches of them ago,said that.

  57. Posted April 4, 2018 at 7:47 pm | Permalink

    I do wish we could hear your remedy for this anomaly, Dr Redwood. There are so many opinions here as to what ought to be done about these obviously unfair figures.

    But what is YOUR solution?

  58. Mr V.D. Psephologist
    Posted April 4, 2018 at 7:53 pm | Permalink

    BBC UK Security Minister: It is “beyond reasonable doubt” Russia is responsible”
    “Britain earlier said Russia’s call for an inquiry with the UK was “perverse”.

    Russia lost the vote at OPCW by 15 votes to six, while 17 member states abstained.”

    Reasonable or not, quite alot of doubt in the world.

    If you do a population count of the countries, there are an overwhelming number doubting Thomases. Did the British delegation carry proof of identity in the vote. No, of course not. The British (THEM ) are against ID cards for voting.
    So, it is highly likely THEM lost the vote.

    • APL
      Posted April 7, 2018 at 7:21 am | Permalink

      Mr V.D. Psephologist: “Reasonable or not, quite a lot of doubt in the world.”

      The thing about this whole, this agent ( chemical / biological ) can only have come from Russia routine.

      This chemical / biological agent has a chemical formulae. It can be synthesised.

      No one has the only way to make a chemical compound. That’s as stupid as saying, only Porton Down knows the chemical formulae of Salt.

      Margaret Thatcher, who was a chemist, would never have made an utter bloomer like that.

      We now know for sure, the novels by John le Carrier were complete fiction.

  59. May Day
    Posted April 4, 2018 at 8:57 pm | Permalink

    I am more anti-Russia that the ghost of a Polish Officer buried deep, deep, deep, at Katyn but Mrs May, Mr Johnson & Co cannot be trusted with our international defence, security and relationships.
    It comes to something when bike-clipped Corbyn certainly without his trying, is a better option. And, he is.

  60. Peter D Gardner
    Posted April 4, 2018 at 9:58 pm | Permalink

    There are three reasons for the imbalance. First is the NHS mentality. Healthcare is free at the point of delivery as of right. Nobody, except managers, is aware of costs. the Government believes taxation to fund the NHS is popular. Nobody living in UK, whether British or not, expects to pay for treatment.
    Second, very few GPs surgeries or hospitals are equipped to receive payment, again because healthcare is free at the point of delivery. Not only is it free but there is no linkage between internal accounting for use of facilities and medicines and who the patient is – they are are all just patients no matter where they come from, regardless of their ability to pay.
    Third, most people working in the NHS are pro-EU and a high proportion of staff are not British but continental Europeans. Why would they want to charge European patients? We’re all Europeans now despite Brexit or, for some, because of Brexit and a venal desire to punish Britain.
    I now live in Australia. Every point of access to healthcare is equipped and incentivised to be paid for their services, either by the patient, the government or the patient’s insurance company or employer, or a combination of these. The payment facility is connected with databases with the patient’s details and with their funding agency, so all the relevant information is available to the receptionist receiving payment.
    If the UK were serious about funding healthcare properly it would introduce funding systems similar to those in Australia. It really is not very difficult. If a pip-squeak country like Australia, built on the export of the British criminal classes can do it, why can’t the 5th largest economy in the world?

  61. Brian Wolfe
    Posted April 4, 2018 at 10:19 pm | Permalink

    John, my German wife was not billed for treatment at my local London GP while we were both here on a visit from Germany despite her presenting her chip-based health insurance card to the receptionist. Then, after we moved to London and she subsequently spent two days in a German hospital, I had to phone the NHS to get them to pay for the treatment since we had left the EHIC card in London. The person I spoke to on the phone gave the impression that this was very routine. The German hospital made it very clear that we would personally be stumping up the thousands of euros if the NHS didn’t pay or we couldn’t get hold of the EHIC.

  62. Monty
    Posted April 4, 2018 at 11:53 pm | Permalink

    It isn’t just NHS treatment, it’s everything the state provides “free”, so that includes education, benefits, and housing.
    And we have to wrestle with three aspects of resolving the abuse of these services.
    1) How do you supply swift and easy identification to prove precisely who we are? (No more than that, the anti-ID brigade would go spare if you wanted to add anything more.) Implant technology might then be a realistic option.
    2) How do you prevent future administrations dishing out ID to folk who have no entitlement to it? After all, that’s the first thing a far left government would do.
    3) What are you going to do when folk with no ID or false ID present themselves and demand services they clearly aren’t entitled to, threatening to make a scene? Public sector unionised staff are going to cave in at the first challenge.

  63. Yawning Height
    Posted April 5, 2018 at 2:12 am | Permalink

    “…the Commons’ Defence Select Committee ” 5th/April /2018
    “”He (Kim Jong-un )was “ruthless, like other Communist dictators before him, but he is rational” and could be “dissuaded from the use of nuclear weapons, by means of a policy of deterrence and containment”, the report said.

    Well I could have stated exactly the same thing…though my information would be better sourced..and not charged a bean to the tax-payer. If the defence Select committee have nothing else then perhaps they can get some proper work done.Interesting they did not report “..like ALL other Communist dictators before him.”That would be to contradict the BBC and its propaganda at convenient times and that just wouldn’t do would it.

    • Yawning Height
      Posted April 5, 2018 at 2:19 am | Permalink

      PS “MPs, who have been investigating the threat posed by North Korea, added that such a strike seemed “highly unlikely”.” BBC
      Well if they are wrong on that one they will not have to suffer embarrassing questions about it in The House will they.!
      Let me add it is “highly unlikely” a terrorist will kill every single one of them at one go. That should put their minds at rest. Darn it, what will I say to them if I’m wrong?

  64. Ron Olden
    Posted April 5, 2018 at 6:29 am | Permalink

    I don’t like to hit a discordant note, but these numbers are not very helpful for analytical purposes.

    These Non EU Citizens are more often than not working and paying taxes here. The National Insurance take in particular from them is enormous, and East Europeans in particular, tend to spend much more on highly taxed things, e.g cigarettes.

    On the other hand, as a demographic group they are far less likely to need the NHS than are any random sample of British Citizens.

    There are far fewer UK citizens living on the continent than there are EU Citizens living here and UK Citizens receiving health care on the continent are less likely to be of working age and paying much tax.

    So these numbers still show a substantial profit for the UK Treasury, albeit not for the NHS itself.

    That however, is not to say the NHS isn’t as inefficient at recovering what owed to it, as it is at everything else it’s involved, in. I doubt whether it bothers much to try.

    This money is just the tip of the iceberg of NHS waste.

    Reply It costs the state a lot to provide housing, health, education and transport capacity

    • KZB
      Posted April 5, 2018 at 5:18 pm | Permalink

      Many UK citizens in EU are pensioners. Their pensions are paid from the UK and spent in Europe. Their healthcare costs are claimed back from the UK.
      EU people in UK are mainly in low paid jobs that “the British don’t want to do”. It is debatable if they are net contributors.

  65. a-tracy
    Posted April 5, 2018 at 9:16 am | Permalink

    Why isn’t your government responding to these London killings?
    Accusations are left flying around, gathering speed and permanence in the minds of people unchallenged.
    I have questions, David Lammy MP and the Mayor of Hackney say its due to cuts in Youth Services. I thought children in inner city London schools had a lot more spent on them per head then children in the Shires is this true or not? How much more is the pupil premium paid to each child in Hackney? What is this money being used for if not to improve their education and social awareness? If the agencies know social media is a big problem for this group why aren’t the groups monitored, why aren’t mother’s volunteering to do this? I would it was affecting my children’s social groups – in fact I didn’t allow my children social media until I felt sure they were grown up enough (and definitely not whilst at school) – perhaps we need to ban under 16’s in areas there are problems if they can’t control themselves using this medium and put social pressure on them to desist in this way.

    Can we see comparisons of youth spending in say Hackney with a similar sized Shire County? Because that’s where kids really don’t have much to do, unlike London where there are tons of free things to do and go to for enriching activities. You pile all of these people on top of one another, massive contributions from Council taxes, are they all paying? Aren’t these local taxes used for local teen services at all?

    Theresa May said ‘strong and stable’ she can’t just sit wringing her hands worrying about equal pay for women she needs to step up as a woman and speak about this violent crime and what SHE is going to do about it.

    • a-tracy
      Posted April 5, 2018 at 9:21 am | Permalink

      Perhaps we should get these teens involved in Raleigh international or similar and send them out to Africa to work with truly deprived youngers, distributing aid, helping in the schools, being put to proper work away from their gangs, in basic living accommodation just to shake them into realising just how lucky they are to be living and educated in the UK.

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    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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