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Move to recoup EU patient costs
New financial incentives are to be used to encourage NHS trusts to report treatment of EU nationals, as part of a drive to recoup up to £500 million a year from overseas patients.
Health Secretary Jeremy Hunt announced that trusts will be offered a premium of 25% on top of the tariff which they receive for providing treatment if they report that it was given to a citizen of one of the 27 other EU member states.
Mr Hunt said that the move would "more than pay for itself" because the NHS is able to reclaim the cost of treatment from other member states under long-standing reciprocal arrangements known as EHIC (the European Health Insurance Card).
At present, the UK pays other EU countries more than £800 million a year to cover the cost of Britons receiving health care on holidays and other visits abroad, but receives back only £29 million for nationals of the EU and European Economic Area treated here.
When patients from outside Europe are included, the NHS takes in only £73 million of the £500 million a year which is believed to be due - around 16% of the total, said Mr Hunt.
Speaking at a Westminster lunch, the Health Secretary said the shortfall stemmed from the fact that recording treatment of foreign nationals represents an extra administrative burden for hospitals and surgeries, but they receive the same payments under the NHS tariff scheme as they would if the patient was British.
Mr Hunt said: "Independent research suggests there is about half a billion quid in money we should be collecting from international visitors who use the NHS. We only collect around 16% of that money - £73 million a year.
"I have no problem whatsoever with foreigners using our NHS, as long as they contribute to it either through taxes or through paying charges. We need to be much better at collecting that revenue."
Mr Hunt added: "We should be receiving a lot more money, but we don't. The reason is because trusts have no financial incentive to report someone as an EU visitor. It's an extra complication and if they don't report it they get the NHS tariff.
"Today, we are announcing a premium on the tariff for trusts who report EU visitors using their services, to pay for the extra administrative costs and to create financial incentives so we get proper reporting and we get the money.
"My target is that by this and subsequent measures we will announce for non-EU visitors, we will raise around half a billion pounds a year to pay for additional doctors and nurses on the frontline."
The new 125% tariff for treating EU nationals will be available to NHS trusts in England.
Mr Hunt said he could "rule out completely" any charging for GP appointments or visits to casualty departments under the current government.
"We are not considering that for a very good reason," he said. "If we are going to transform the NHS and make it sustainable, we need to make it easier for people to see their GPs, not more difficult.
"One of the problems of the last couple of decades has been the way that resources have been sucked into hospital care - because that is where the targets are, so that's what politicians really care about being accountable for - and haven't gone into primary care in corresponding amounts.
"That is not sustainable, we need to have better primary care. With an ageing population, the real issue is making sure we have good GP care for vulnerable older people with complex long-term conditions. I think charging would take us in the wrong direction. The same goes for A&E."
Mr Hunt said he wanted more transparency about GPs' salaries, as a means of persuading voters that additional funds for general practice will not simply be swallowed up in pay.
The Department of Health is currently in negotiations with the British Medical Association over his plan to publish GPs' salaries from next April.
"I absolutely want a system where there are no loopholes," he said. "The reason is very simple. I want to spend more on general practice, because I think we need better funded general practice with more GPs. But I will never be able to persuade the Treasury or taxpayers to do this until we can be confident it isn't just going to translate into higher salaries for GPs.
"My intention is that we should know how much GPs are taking home, but the precise way in which it is going to be done is going to be negotiated this year."
He said that the BMA was open to greater transparency to counter perceptions that GPs are overpaid.
Mr Hunt also said he had "no plans for a sugar tax" to tackle obesity.
But he indicated that he wanted more patients to be charged for cosmetic treatments.
"We shouldn't be doing cosmetic work on the NHS," said Mr Hunt.
"The decisions are taken on the basis of clinical need locally, but I have made it very clear that I am against purely cosmetic work being done. There will be times when there is a mental health need that a local doctor has said is very serious, but I do completely understand people's reservations about some of the things that have happened."
Mr Hunt said he was "more confident" than some observers of the sustainability of the NHS model in the future.
He cited a report from the US-based Commonwealth Fund think tank, which yesterday ranked the NHS top out of a list of healthcare systems in 11 leading countries around the world.
With the second-lowest cost per head of the 11 countries - at 3,405 US dollars (£2,005) a year, compared to 4,118 dollars (£2,425) in France, 4,495 (£2,647) in Germany and 8,508 (£5,010) in the US - the UK ranked first in 2013 for effective, safe, co-ordinated and patient-centred care, access and efficiency, found the Mirror, Mirror report.
Mr Hunt said one of his priorities, in the wake of the Francis Report into excess deaths at the Mid-Staffs NHS trust, was to promote a culture in which clinicians feel able to speak out if they see failings in the system.
"Still in the NHS, 5% of all hospital deaths are avoidable," he said. "That is about 12,000 deaths a year - equivalent to a jumbo jet falling out of the sky once a fortnight.
"We will only correct that if we create a culture in the NHS where people feel able to speak out about poor care. We don't have that culture yet in the NHS."