Jump to content
House Price Crash Forum

Archived

This topic is now archived and is closed to further replies.

Will!

Nhs 'can Save £500M' On Foreign Care

Recommended Posts

I used to be an Emergency Department doctor. This not-very-new-news story caught my eye:

The story turns upon people who fraudulently claim to be living in the UK permanently and thus entitled to free NHS treatment when in fact this is not the case, and the feeble way in which the NHS checks this. Don't be distracted by the stuff about declared overseas visitors, asylum seekers etc; they declare themselves and there are well defined rules for their treatment. Also remember that there are rules about emergency treatment being free for all.

The solution is simple: stop using NHS numbers (unique identifier numbers for patients within the NHS) and use National Insurance numbers instead. IT cockups notwithstanding it would be trivial to send an automated enquiry to HM Revenue & Customs to establish whether a patient is resident in the UK for tax purposes (note not whether they pay any tax, or how much, just residency) and thus entitled to free treatment.

It's worth pointing out this doesn't involve any Orwellian ID cards or new databases. The government already knows if you're resident for tax purposes. It's still possible to abuse this system (using someone else's NI number and identity for example) but it would be considerably more work for the would-be fraudster.

I might just write to the Department of Health about this. Can anyone see any flaws?

Share this post


Link to post
Share on other sites

I worked on an IT project once that wished to create a single sign-on portal for, well, everything. Doctors, nurses and patients would be able to access a patient's records from any location.

The first major problem was that every health board in the UK was using its own unique identifier to identify its patients - some were using the NI number, some were using NHS numbers and some were using their own made up numbering system.

No problem for IT - you simply decide on the best solution, which was the NI numbers, and you gradually move every health board over to using them and gradually move all their bespoke systems over to using them as well. It would take time and money but it could be done and would make a better system.

Alas, at which point small-minded politics entered stage right.

Basically, everyone was in to protecting their own little empires and a huge war broke out between boards, trusts, etc, and, of course, each ran off and got their local politicians on board, Loss of jobs and loss of power and loss of control being their worry.

Us IT bods came up with the solution a decade ago - the NHS pen pushers and politicians stopped it.

I know there have been attempts since to sort this out but, boy, much more fun in the private sector where things get done.

Edit:

So, yes, there are flaws - it has been tried, it did not work not because it was impossible but because the NHS is a hotbed of egoes, fat salaries, egoes, people protecting their little bit of empire, etc, etc ,etc IMPO.

Share this post


Link to post
Share on other sites

There are different requirments for residency for tax purposes and normal residency for NHS purposes; this would need to be realigned. e.g. a family moves from the EU, and only the father seeks employment and gets an NI number. What do you do about the mother and the children?

NI numbers are not unique; in a proportion of cases, the same number is (legitimately) used by multiple different people.

Share this post


Link to post
Share on other sites

I used to be an Emergency Department doctor. This not-very-new-news story caught my eye:

The story turns upon people who fraudulently claim to be living in the UK permanently and thus entitled to free NHS treatment when in fact this is not the case, and the feeble way in which the NHS checks this. Don't be distracted by the stuff about declared overseas visitors, asylum seekers etc; they declare themselves and there are well defined rules for their treatment. Also remember that there are rules about emergency treatment being free for all.

The solution is simple: stop using NHS numbers (unique identifier numbers for patients within the NHS) and use National Insurance numbers instead. IT cockups notwithstanding it would be trivial to send an automated enquiry to HM Revenue & Customs to establish whether a patient is resident in the UK for tax purposes (note not whether they pay any tax, or how much, just residency) and thus entitled to free treatment.

It's worth pointing out this doesn't involve any Orwellian ID cards or new databases. The government already knows if you're resident for tax purposes. It's still possible to abuse this system (using someone else's NI number and identity for example) but it would be considerably more work for the would-be fraudster.

I might just write to the Department of Health about this. Can anyone see any flaws?

I dont know any immigrants who abuse the system (i am sure there are some) but i do know two friends who are white british and have emmigrared to canada and oz and who have brazenly walked into casualty in the uk and got treatement for free. They have not paid tax in the uk in 20 years. Indeed it is a good way to avoid medical insurance in the us/oz as they have to treat you if you have an emergency, but they themselves can fly back for other treatment to he uk if it is so serious that the bills are unaffordable

Share this post


Link to post
Share on other sites

I worked on an IT project once that wished to create a single sign-on portal for, well, everything. Doctors, nurses and patients would be able to access a patient's records from any location.

The first major problem was that every health board in the UK was using its own unique identifier to identify its patients - some were using the NI number, some were using NHS numbers and some were using their own made up numbering system.

No problem for IT - you simply decide on the best solution, which was the NI numbers, and you gradually move every health board over to using them and gradually move all their bespoke systems over to using them as well. It would take time and money but it could be done and would make a better system.

Alas, at which point small-minded politics entered stage right.

Basically, everyone was in to protecting their own little empires and a huge war broke out between boards, trusts, etc, and, of course, each ran off and got their local politicians on board, Loss of jobs and loss of power and loss of control being their worry.

Us IT bods came up with the solution a decade ago - the NHS pen pushers and politicians stopped it.

I know there have been attempts since to sort this out but, boy, much more fun in the private sector where things get done.

Edit:

So, yes, there are flaws - it has been tried, it did not work not because it was impossible but because the NHS is a hotbed of egoes, fat salaries, egoes, people protecting their little bit of empire, etc, etc ,etc IMPO.

Surely every patient comes equipped with a set of unique biological identifiers! I suppose there'd be security issues about using DNA fingerprints in such circumstances but then there must be security issues with NI numbers?

Share this post


Link to post
Share on other sites

Surely every patient comes equipped with a set of unique biological identifiers! I suppose there'd be security issues about using DNA fingerprints in such circumstances but then there must be security issues with NI numbers?

Go over to the gold bug thread and ask them to have their DNA sampled - just for medical purposes. :lol:

Share this post


Link to post
Share on other sites

I worked on an IT project once that wished to create a single sign-on portal for, well, everything. Doctors, nurses and patients would be able to access a patient's records from any location.

The first major problem was that every health board in the UK was using its own unique identifier to identify its patients - some were using the NI number, some were using NHS numbers and some were using their own made up numbering system.

Getting NHS organisations (I use that word in the loosest possible sense) to talk to each other - a nightmare.

Getting each NHS organisation to talk to HMRC individually in whatever manner seems best to them - I hope might be more straightforward.

There are different requirments for residency for tax purposes and normal residency for NHS purposes; this would need to be realigned.

True, HMRC's Statutory Resident Test and the NHS's permanent residence requirements aren't exactly the same, but they are very similar and I think the NHS could adopt the Statutory Residence Test without too much upheaval. (Especially as a number of NHS hospitals I've worked in have had no idea what the permanent residence requirements were.)

e.g. a family moves from the EU, and only the father seeks employment and gets an NI number. What do you do about the mother and the children?

I guess new immigrants to the country would have to be advised that it's a good idea to apply for an NI number. If they don't emergency care does remain free, of course.

NI numbers are not unique; in a proportion of cases, the same number is (legitimately) used by multiple different people.

Really? Under what circumstances?

Share this post


Link to post
Share on other sites

Really? Under what circumstances?

Where the same number has been issued multiple times (some ranges are like this), but it hasn't happened for a long time.

It's one of the reasons why HMRC doesn't use the NI number as your primary identifier; they have a unique taxpayer reference (UTR) number as well.

Share this post


Link to post
Share on other sites

Where the same number has been issued multiple times (some ranges are like this), but it hasn't happened for a long time.

It's one of the reasons why HMRC doesn't use the NI number as your primary identifier; they have a unique taxpayer reference (UTR) number as well.

Interesting. Didn't know that, thanks.

Share this post


Link to post
Share on other sites

Well, I wrote to the Department of Health (with the benefit of your comments - thanks) and they're going to think about it.

The Department of Health ran a consultation last summer on access to free NHS care. Like any straw poll, it tells you which way the hot air blows, but one of the more unconventional ideas that came out of it was that, in addition to being resident in the UK, patients should need a couple of recent years of National Insurance contributions or credits to their name in order to be entitled to free NHS care. Clearly NHS care would have to be free for children and young adults to give them time to make their NI contributions or receive their NI credits.

The big stumbling blocks seem to me to be:

1) What to do about patients who've not been able to amass the required recent NI contributions or credits because they've been sectioned under the Mental Health Act for a while? If a special exemption is made for them then practically how do they go about proving they've been sectioned? There's no central record of who's been sectioned under the MHA.

2) A similar problem to the above for patients who've been in prison.

3) Privacy issues to do with patients having to declare that they've been sectioned under the MHA or been in prison in order to receive free NHS care.

4) IT disaster trying to get NHS hospitals, HM Revenue & Customers, Department of Work & Pensions and the Prison Service computers to talk to each other.

Luckily I don't think it will ever happen.

Share this post


Link to post
Share on other sites

Some of the disabled people in my local group for people with Neurological diseases don't have a NI number. They became disabled before they were able to get their first job. Also people who earn under the ceiling for paying tax. Families would need to register children but some of them would never go on to pay tax so it in effects becomes a "NHS registration" but one at birth rather than when they meet the system for the first time later in life.

Then there would be the costs to administer the system and any compensation paid for mistakes made.

As I understand it the NHS currently will admit foreign nationals if they agree to pay for treatment but the money isn't being collected or people are giving false details? What would happen if someone visiting the UK attended the hospital A&E unconscious after a RTA, if they were determined to be a foreign national should they be dumped on the street or what should happen to them?

I have spent time in London A&E so I'm well aware of the diverse range of people there. The staff seem unable to cope with the current system. What would it be like if they had to check the credentials of people there? One A&E I went to could not cope with the number of homeless people, stoned addicts and drunks coming in and had what were in effect bouncers there. I was mistaken for an addict by one of these (my neurological disease leaves me until to walk or speak at times). There would be huge altercations at A&E if more people would be turned away (at least in the medium term until the message got across) and A&E's would need to employ security staff and use the local Police).

I am guessing as well that the UK NHS has reciprocal agreements with other countries? What should happen to a UK resident if they were injured in NZ or Australia?

I'm not defending the current system, A&E would be better for me if there were less people in it, but it's the practical and ethical things I am considering.

Share this post


Link to post
Share on other sites

I worked on an IT project once that wished to create a single sign-on portal for, well, everything. Doctors, nurses and patients would be able to access a patient's records from any location.

The first major problem was that every health board in the UK was using its own unique identifier to identify its patients - some were using the NI number, some were using NHS numbers and some were using their own made up numbering system.

No problem for IT - you simply decide on the best solution, which was the NI numbers, and you gradually move every health board over to using them and gradually move all their bespoke systems over to using them as well. It would take time and money but it could be done and would make a better system.

I think Italy solved the problem by having computers dial up into a central system and talk to each other through the internet. You didn't need one complete system as long as they could share the info online.

Share this post


Link to post
Share on other sites

This has no chance of getting off the ground, sorry - not that it's wrong, but in the UK the IT systems are too sh1t, simple as that.

In theory that could be rectified, the technology is there, but it would require :

1. Someone in just one government department somewhere to be competent to run a major IT implementation. :lol:

2. The tendering process for the contract to be fair. :lol:

3. The company that won the contract to have a semblance of honesty and willingness to do a good job. :lol:

4. The civil liberties people to not try to sabotage the project. :lol:

5. The government themselves to undertake not to use the information in a way that negatively affects civil liberties. :lol:

Share this post


Link to post
Share on other sites

Some of the disabled people in my local group for people with Neurological diseases don't have a NI number. They became disabled before they were able to get their first job. Also people who earn under the ceiling for paying tax. Families would need to register children but some of them would never go on to pay tax so it in effects becomes a "NHS registration" but one at birth rather than when they meet the system for the first time later in life.

If they claim benefits or their parents ever claimed child benefit for them then they have an NI number.

As I understand it the NHS currently will admit foreign nationals if they agree to pay for treatment but the money isn't being collected or people are giving false details? What would happen if someone visiting the UK attended the hospital A&E unconscious after a RTA, if they were determined to be a foreign national should they be dumped on the street or what should happen to them?

The issue is people who fraudulently claim to be living in the UK permanently and thus entitled to free NHS treatment when in fact this is not the case.

Emergency care in A&E is always free. Life and limb saving treatment outside of A&E is not free, but is always provided without checking ability to pay.

I am guessing as well that the UK NHS has reciprocal agreements with other countries?

Yes, visitors from some countries are entitled to free NHS care.

Share this post


Link to post
Share on other sites

There are different requirments for residency for tax purposes and normal residency for NHS purposes; this would need to be realigned. e.g. a family moves from the EU, and only the father seeks employment and gets an NI number. What do you do about the mother and the children?

My experience when elsewhere in Europe is, I get treated anyway. Noone bothers to check eligibility.

Though I do recollect taking out medical insurance in Germany before crossing into Switzerland.

NI numbers are not unique; in a proportion of cases, the same number is (legitimately) used by multiple different people.

Huh? How does that work???? :blink:

Share this post


Link to post
Share on other sites

Huh? How does that work???? :blink:

When introduced, and for a period thereafter, they were not intended as unique identifiers, instead as supplementary identifiers. A substantial quantity of NI number were issued multiple times to different people, but at the time, this was not considered a show stopper problem, and the duplicates were not cancelled and corrected.

The legacy of this, is that the NI number cannot be used as a unique identifier.

Share this post


Link to post
Share on other sites

  • Recently Browsing   0 members

    No registered users viewing this page.

  • The Prime Minister stated that there were three Brexit options available to the UK:   220 members have voted

    1. 1. Which of the Prime Minister's options would you choose?


      • Leave with the negotiated deal
      • Remain
      • Leave with no deal

    Please sign in or register to vote in this poll. View topic


×

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.