Although the NHS has had a gastric band fitted, it is still morbidly obese. It's daily money intake is still too great – and the risks of diabetic scleroticism, enervation and the gangrenous loss of unmanaged outlying parts is great. Without further weight loss, the prognosis is not good.
I have written before about how my local south London hospital's maternity unit became dominated by Nigerian mothers. They were, I was told, the partners of the Nigerian fathers here on student visas on courses at the commercial universities. A very high proportion of Nigerian business studies students are married, it seems, and take advantage of being allowed to bring spouses to the UK. The hospital should have charged for all this maternity care but in practice didn't recover a penny; a culture in the NHS of free treatment for all, and a misplaced sense by NHS staff that they own the health service rather than are employed by it has always killed any effort at cost recovery.
The suggestion made to MPs yesterday by a senior Department of Health mandarin that hospitals should check ID before treatment is nothing new. The statutory duty of hospitals to check eligibility of patients already exists – it is simply ignored by NHS staff. I received the following from my local hospital in response to an FOI request;
In fact they were collecting bugger-all revenue from overseas patients. In the few instances where invoices were raised, no action was taken to secure payment. Unpaid bills were written off after three years as bad debts. So how will yesterday's announcement change anything?
Not at all. Staff are entrenched in non-co-operation and will simply continue to ignore whatever instructions come from the DoH. The only way to secure change is to withhold a part of the budget equivalent to the estimated amount each hospital should be recovering in charges – and to pay it out only on evidence of income secured on a pound for pound basis.
Sometimes you really need the stick as well as the carrot.
Note: Where a story is carried by more than one broadsheet I will generally offer a link to the Guardian. This is to encourage the maximun use of that newspaper's bandwidth at the greatest cost by as many people as possible.