Passport checks at hospitals: it’s hard to see how it could work

    23 November 2016

    ‘Every NHS patient could be asked to show their passport before they receive healthcare,’ ran the stories yesterday. They reported that Chris Wormald, the permanent secretary at the Department of Health, had told MPs that officials were ‘looking at whether trusts should proactively ask people to prove their identity’.

    Such an initiative, he explained, is likely to be targeted in areas with high immigrant populations. The NHS already attempts to recoup costs for non-urgent care — but this is not deemed to be sufficiently effective. It seems that the introduction of charges for overseas patients who use emergency departments, ambulance services and maternity units is now being considered.

    There are obvious practical problems. For instance, plenty of people, British born and bred, don’t have a passport (24 per cent), have never learned, needed or afforded to drive and so don’t have a driving licence (32 per cent) and still live with family and so don’t have any utility bills or similar in their name (20 per cent). Will they be denied care? Or humiliated in the process?

    Vulnerable groups such as the homeless often won’t have any of the above documentation, and have health needs just like the rest of us. And what about British expats who fall ill when returning to the UK — will they be excluded from treatment too?

    What if I am knocked off my bike, without carrying a form of identification, and am then taken to my local emergency department but refused care because I can’t prove my identity? Or if individuals are acutely unwell and unconscious, confused, psychotic or intoxicated — clearly any such meaningful conversation to determine identity will be impossible, and inappropriate.

    One tricky question raised by such a policy is whose responsibility it would be to check the ID is legitimate and, if it isn’t, to start the process of charging the patient. Will these staff be present 24/7? Will the default be to charge until proven otherwise? Is this really a soft way of health service staff acting as border control? Eye scanners and contactless devices seem very Orwellian in a hospital setting.

    Of course, the NHS is under huge financial pressure and, where appropriate, costs should be recovered. But the NHS must remain free at the point of need — otherwise we may end up with an American system with acutely unwell patients being inappropriately denied care. In my opinion, recouping costs at the point of use in such cases is unworkable.

    The modified Geneva convention states: ‘I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.’ That is still a good principle to follow.