‘Identity checking’ in the NHS four years on

Four years ago the Department for Health launched a pilot, taking place in 18 NHS trusts across England, where the identity of people presenting to access healthcare was investigated to check they were eligible for free NHS treatment. One of the trusts was Barts Health NHS Trust which, campaigners discovered, carried out the pilot in one renal department and one maternity department. 

Despite efforts from campaigners to gain access to the report from the identity checking pilot which took place in 2017, their Freedom of Information request submitted in December 2018 was declined by the Department of Health.

Local Keep Our NHS Public campaigners from North East London Save Our NHS were concerned that the identity checking pilot was aimed not only at recovering money from patients who were not eligible for NHS treatment. They feared that the pilot would at best mean migrant patients would be harassed when trying to access NHS services and at worst would be put off seeking medical attention, with potentially lethal consequences.

Despite being unable to access the report, campaigners found out from further investigations that 739 women and their unborn children were refused free NHS maternity care at Whipps Cross Hospital, Newham Hospital and the Royal London Hospital in 2018/19, as they were deemed ‘not ordinarily resident’ by Barts NHS Trust. All hospitals are run by the Trust, and the figures were revealed by the Barts NHS Trust Board in response to a question by Keep Our NHS Public member group Newham Save our NHS. The total number of women invoiced represents approximately 5% of all pregnant women in the three north-east London boroughs concerned that year.

Even more concerning was that 290 women were incorrectly invoiced for maternity care and had been eligible for free treatment all along.

Similar findings were uncovered by campaigners from Save Lewisham Hospital campaign regarding the charging of migrant women for maternity care.

Then in August 2020 - nearly two years and repeated Freedom of Information requests and a complaint to the Information Commissioner later - the Department of Health & Social Care released the report to Keep Our NHS Public. You can download a copy here: Evaluation of Department of Health Cost Recovy ID Checking Pilot.

Here is what the report told us:

Ten things missing from the December 2017 Ipsos report:

1. The misleading title omits to mention it is about NHS patient charging and the ‘hostile environment’ to migrants trying to access NHS treatment. Despite the title emphasising' cost recovery’, the report does not include costs recovered by the NHS.
2. Patients were misled. There is no mention in the report of these NHS patients being invited to take part in the 2017 NHS Pilot. It appears to have been inflicted on them, but there is no evidence that they could, or did, opt out of this experiment. There is no evidence that patients were told what the pilot was designed to find out.
3. Charging Regulation ignored. The report omits to say that asking patients for ID is not part of the regulations on patient charging. Despite ID not being required under the NHS patient charging regulations, thousands of NHS patients were sent letters and told to bring ID to their appointments.
4. Why the emphasis on maternity units, with all Trusts in the 2017 pilot obliged to carry out ID checks there? This is not explained.
5. The patient experience is not a parameter of the report.
6. Ethnicity is not mentioned.
7. Health inequality is not mentioned.
8. Equality impact assessment is not mentioned.
9. Sex or gender is not mentioned despite the strong emphasis on maternity - despite paternity not being an issue. No men and fathers are asked for ID, or invoiced or charged when their baby is born in hospital. Women and mothers can be charged for pregnancy care and for childbirth.
10. No analysis is given on data in the report showing that one location of ID checking (maternity department) had a huge impact on the numbers charged at one unnamed Trust (Trust 9) compared to ID checking at the same trust (Trust 9) in a different location (renal.) Trust 9's ID checking was carried out on over 100% more patients in Renal ID checking than in maternity ID checking. But renal invoiced less than 10% of the numbers that maternity invoiced in the same trust .

What the pilot tells us four years on

In 2017, trusts encouraged 'normalisation' of NHS patient charging by suggesting they were laboriously asking every patient at reception the '12-month trigger’ question about length of time lived in the UK. This is not proof of being 'ordinarily resident,' but could lead to investigation by NHS staff of that patient's entitlement to free care.

We also know that it has not become the norm to require all patients presenting at hospital for treatment for proof of identity so what was the point in the pilot? While the report has now been published, there are still many questions remaining over why and how the pilot was held in the first place.

You can read more about the questions that still remain in the report by Newham Save Our NHS: 'Cease, Opt-out, Reduce.'  How government plans evolved, to make a more Hostile Environment in the NHS.