Freedom of Information Request: FOI 0231

University Hospitals Birmingham NHS Foundation Trust (UHB) completed a merger by acquisition of Heart of England NHS Foundation Trust (HEFT) on 1^st April 2018.   UHB includes Birmingham Heartlands Hospital, the Queen Elizabeth Hospital Birmingham, Solihull Hospital and Community Services, Good Hope Hospital in Sutton Coldfield and Birmingham Chest Clinic.

Due to historical differences in data collection/reporting across UHB and the former Heart of England NHS Foundation Trust some responses have been provided by hospital site.

Queen Elizabeth Hospital Birmingham

This request has eight questions. In this request, “NHS healthcare treatment” specifically excludes private patients seeking to use paid-for private services offered by the Trust. It includes non-urgent follow-ups to urgent healthcare treatment.

1. Does the Trust impose upfront charges for non-urgent NHS healthcare treatment to overseas visitors, migrants and former UK residents who are ineligible for free healthcare under government guidelines? If not, please explain why, in the context of those guidelines.

Yes – Overseas patients are charged upfront for elective treatment in accordance with the national guidelines and upfront charging operational framework.

If the answer to question 1 is ‘no’, the Trust need not provide responses to questions 2-8.

2. The number of overseas visitors, migrants and former UK residents who were charged upfront for NHS healthcare treatment by the Trust since October 2017 – please note this includes patients who did not subsequently proceed with the treatment

   Overseas patients are first provided with an estimate prior to treatment and if they are satisfied to proceed with payment an invoice is raised. 4 patients were invoiced upfront for NHS healthcare since October 2017.  

If the answer to question 2 is ‘zero’, the Trust need not provide responses to questions 3-8.

3. The total costs charged for the treatments referred to in question 2 (including where the patient did not proceed with the treatment)

   Cash payments received in advance of treatment totals £3,009.22. This does not include any patients who did not proceed with treatment as per the comments in question 2.

4. The number of overseas visitors, migrants and former UK residents who did not proceed with NHS healthcare treatment by the Trust after being quoted an upfront charge (timeframe is since October 2017).

We do not hold the required level of detail regarding estimates provided to overseas visitors to provide an accurate answer to this question.

Notes to question 4:

• Sending an invoice to a patient for an upfront charge counts as quoting an upfront charge
• Patients who did not proceed with treatment include those who declined treatment and those who simply did not attend scheduled treatment, as well as any patients who were refused treatment by the Trust

5. Of the number of patients provided in response to question 4, please state how many did not attend scheduled treatment/appointment (rather than cancelling in advance)
   As we do not hold the required level of detail for question 4, we do not hold this information.

Note to question 5:

• If the Trust does not record information in a manner that would enable question 5 to be answered within the section 12 cost limit, please state that the information is ‘not held’ for this question and process the remainder of this request

If the Trust has not provided information for question 5, or has responded with ‘zero’, please proceed to question 7.

6. What was the financial loss to the Trust caused by the missed scheduled treatment/appointments referred to in response to question 5?
   
   There would be no financial loss to the Trust as appointments would be cancelled if payment was not received in advance of treatment.

Note to question 6:

• If the Trust does not record information in a manner that would enable question 6 to be answered within the section 12 cost limit, please state that the information is ‘not held’ for this question and process the remainder of this request

7. Any data the Trust holds on the reasons for the refusal/inability of the patients referred in response to question 4 to pay the imposed upfront charges (such as preference to return home for treatment, or inability to meet the cost of treatment)

   As we do not hold the required level of detail for question 4, we do not hold this information.

8. Any data the Trust holds on the conditions the patients referred to in response to question 4 wished to be treated for (this may be provided as categories of healthcare, such as ENT and nephrology), or alternatively the treatments that were subject to the imposed charges (these may be grouped into over-arching categories for data protection reasons)

As we do not hold the required level of detail for question 4, we do not hold this information.

Heartlands, Good Hope and Solihull Hospital

This request has eight questions. In this request, “NHS healthcare treatment” specifically excludes private patients seeking to use paid-for private services offered by the Trust. It includes non-urgent follow-ups to urgent healthcare treatment.

1. Does the Trust impose upfront charges for non-urgent NHS healthcare treatment to overseas visitors, migrants and former UK residents who are ineligible for free healthcare under government guidelines? If not, please explain why, in the context of those guidelines.

Yes

If the answer to question 1 is ‘no’, the Trust need not provide responses to questions 2-8.

2. The number of overseas visitors, migrants and former UK residents who were charged upfront for NHS healthcare treatment by the Trust since October 2017 – please note this includes patients who did not subsequently proceed with the treatment
3. This is people who present for outpatient appointments who are not eligible for free treatment. This does not include people who arrive through the emergency care route.

If the answer to question 2 is ‘zero’, the Trust need not provide responses to questions 3-8.

3. The total costs charged for the treatments referred to in question 2 (including where the patient did not proceed with the treatment)

£7,084

4. The number of overseas visitors, migrants and former UK residents who did not proceed with NHS healthcare treatment by the Trust after being quoted an upfront charge (timeframe is since October 2017).

This number is very low because we do outpatient clinic pre-screening where potentially ineligible patients are contacted to advise of documents required at arrival, but this is before any prices are quoted.   There were 37 people who were given pre-screening information and did not turn up to appointments.  However, they had not been quoted a price at this stage.

Notes to question 4:

• Sending an invoice to a patient for an upfront charge counts as quoting an upfront charge
• Patients who did not proceed with treatment include those who declined treatment and those who simply did not attend scheduled treatment, as well as any patients who were refused treatment by the Trust

5. Of the number of patients provided in response to question 4, please state how many did not attend scheduled treatment/appointment (rather than cancelling in advance)

None

Note to question 5:

• If the Trust does not record information in a manner that would enable question 5 to be answered within the section 12 cost limit, please state that the information is ‘not held’ for this question and process the remainder of this request

If the Trust has not provided information for question 5, or has responded with ‘zero’, please proceed to question 7.

6. What was the financial loss to the Trust caused by the missed scheduled treatment/appointments referred to in response to question 5?

£0.

Note to question 6:

• If the Trust does not record information in a manner that would enable question 6 to be answered within the section 12 cost limit, please state that the information is ‘not held’ for this question and process the remainder of this request

7. Any data the Trust holds on the reasons for the refusal/inability of the patients referred in response to question 4 to pay the imposed upfront charges (such as preference to return home for treatment, or inability to meet the cost of treatment)

The Trust does hold the information you have requested, however we estimate that compliance with your request would exceed the appropriate costs limit under section 12 of the Freedom of information Act 2000. This is currently £450.

8. Any data the Trust holds on the conditions the patients referred to in response to question 4 wished to be treated for (this may be provided as categories of healthcare, such as ENT and nephrology), or alternatively the treatments that were subject to the imposed charges (these may be grouped into over-arching categories for data protection reasons)

4 outpatient appointments covering Anti Natal, Radiology, T&O Fracture Clinic, Ophthalmology and Breast Clinic.