£1 million to help NHS reclaim debts from overseas visitors

Health and Social Care Secretary Matt Hancock has announced plans to expand the NHS’s existing team of cost-recovery experts, backed by £1 million.

Since 2018, a dedicated team of cost-recovery experts has been established to work with trusts. The expansion of this team will help the NHS to reclaim outstanding debts from overseas visitors who are required to pay for their care. These experts will work with existing cost-recovery managers in NHS trusts to:

  • provide additional time and human resource to help identify patients who should be charged, easing the administrative burden and speeding up the process
  • ensure the rules and exemptions are universally understood and consistently implemented in hospitals across the country, including making clear that urgent treatment should never be withheld
  • help improve the reporting of income and debt collection, ensuring chargeable tourists pay debts in full

The team will also help the NHS understand and implement the charging rules and processes for EEA visitors and migrants as part of preparations for leaving the EU. After Brexit, EEA nationals living lawfully in the UK can continue to use the NHS as they do now.

The NHS has already made progress in ensuring patients not ordinarily resident in the UK are identified and charged appropriately for access to NHS services, recovering more than £1.3 billion since 2015. However, there is still a significant amount of unpaid debt.

Only people who are ordinarily resident in the UK are eligible for free care, with non-EEA visitors required to pay a health surcharge when they apply for a visa to live temporarily in the UK. 

The government remains committed to protecting the most vulnerable people in our society, including refugees, asylum seekers, victims of modern slavery and children cared for by local authorities.

NHS rules state that trusts must never withhold treatment from patients who require urgent healthcare while they are in the UK, even if they cannot afford to pay. This means any care clinicians say should not wait until a visitor’s departure from the UK, and recovery of charges can take place after the care has been provided. Where treatment is non-urgent and it can wait until they leave the UK, it must not be provided unless fully paid for in advance.

Health Secretary Matt Hancock said:

Our beloved NHS is renowned around the world for providing high quality health care and it is able to do so thanks to the valuable contributions made by hardworking taxpayers – so it is only fair we ask overseas visitors to pay their way as well.

Today, we’re backing the NHS and giving them the support and the tools they need to ensure the rules are applied fairly and consistently.

This new drive will help recoup millions in unclaimed funds for our NHS which can go back into frontline patient care, so the NHS can be there for all of us when we need it most.

Jason Dorsett, Chief Finance Officer, Oxford University Hospital Foundation Trust said:

We have had huge support from NHSI’s overseas visitors improvement team. Being part of the programme, we have learnt alternative ways to identify chargeable overseas patients.

The implementation of digital tools has reduced the administrative burden on previous methods resulting in a rise of income and cash recovery. We would recommend other Trusts if given the opportunity to be a part of the programme.




Secretary of State speech at the Ambrosetti Forum: Intelligence on the World, Europe, and Italy

You opened with the reference to ‘order’ ‘order’ and I’m very conscious, as we go through an uncertain period, that often in the House of Commons there does not seem to be much order despite the speaker’s proclamations to that effect.

Ladies and gentlemen, it probably comes as no surprise after the week in Westminster to say, what a pleasure it is to be here. And also a pleasure to follow on from Minister Kurtika, not least because of his successful Presidency of COP24 which we in the UK very much hope to follow with the 26th COP in 2020, which we have bid to jointly host with Italy. This joint bid reflects the outward looking, globally facing approach the UK and Italy have always shared.

In March, a reflection of that was in the sharing of the Magna Carta. It was taken to Italy for the first time as part of a cultural exchange between our two countries. So, it may be more than 800 years old but I hope that Mr Barnier and I can take inspiration that a political treaty can in fact be negotiated, agreed, and indeed stand the test of time. I’m here with you today because I want to be clear as to what the UK’s position is at this critical time and in particular, our commitment to leave the European Union on the 31st October.

And the reason for that is any refusal to honour the biggest vote in our history would create long-term negative consequences for the UK and indeed our partners, in particular weakening trust in our democracy. So my mandate is to lead the political negotiations to secure a new deal with Europe. A deal that acknowledges the political reality within the UK, a deal which reflects the reality of the relationship we want with the European Union; one that is close, but separate. A deal that respects my country’s constitutional integrity. And a deal that can be accepted by my Parliamentary colleagues. Because if we cannot pass a deal, the UK’s departure from the EU will be more painful for both of us than it needs be. I hope to shed more light on these issues today and to reassure just how much the United Kingdom values the bilateral relationship we have with Italy, as indeed with all of our European partners and friends.

In recent years, some voices have shouted loudly to try and frame all UK relationships, including the UK-Italian relationship, through the prism of Brexit. But that ignores the strength of the ties between us and no more so than in terms of our citizens. There’s over 700,000 Italians citizens who have chosen to make their homes and lives in the United Kingdom, contributing greatly to our culture and our economy. And those who do indeed follow the House of Commons will know for example, my colleague Alberto Costa is a very frequent champion of this huge contribution that is made. And indeed, around 70,000 UK nationals have made their homes here in Italy. If one looks at trade, with what I appreciate is very much a business audience, trade between Italy and the UK is close to 50 billion Euros. And these numbers are increasing. This morning I flew over Milan, the home of €1.2bn of service exports to the UK every year, that totals 20% of Italy’s service market. And indeed, many of the people here will know our renowned London Stock Exchange and Milan’s Bors Italiana joined forces a decade ago to create Europe’s most diversified Exchange Group together.

Key products, which are well known. Italian pasta holds 70% of market share in the UK. Perhaps less well known, precision engineering accounts for 16% of total exports from Italy to the UK.

But to me it’s about much more than the weight of our economic ties. We work together to defend our values and our way of life through NATO. Our Armed Forces work closely together. Just in July this year, Italy and the United Kingdom signed a Statement of Intent to deepen our bilateral defence relationship.

And I’m sure in an audience like this there are many who are football fans who will well know Gazza’s experience at Italia 90 or the many footballers of Italian background like Zola that played at Chelsea and many other clubs in the Premiership. So we have a deep connection between the UK and Italy.

But in a deal situation, so take for example citizens’ rights, the UK has made a clear offer in a deal situation – it’s within the implementation period. In a no deal situation the UK has guaranteed the rights of those 700,000 Italian citizens in the UK. The UK citizens have not been offered the same rights here. For example, we have said Italians and other EU citizens living in the UK will have until the end of December 2020 to register for settled status. But our citizens here are told they need to do so by the 31st of October this year.

One of the key things I really want to emphasise today is our commitment, the Prime Minister’s commitment, to securing a deal. I spoke with Michel Barnier on Thursday. The Prime Minister’s Europe Advisor, David Frost, and his team were in Brussels on Wednesday and Friday having lengthy discussions. As the UK prepares to enter into an election, there is a view among the 17.4 million British people who voted to leave that their wishes have been denied and that their concerns dismissed. We must not ignore the democratic decision and my job is to fight for them as well as the whole country. And that is why we are so committed to securing a deal. Failing to address the concerns of voters will inevitably store up greater problems over time. That would, in turn, damage the close and valued ties between the UK and European Union and its member states that I and the Prime Minister want to preserve. We are leaving the institutions of Europe but remain a European country, with shared values and common goals like on climate change. So it is crucial that Brussels and Member States appreciate the very real political pressures and how a failure to act now will only see those grow during a General Election campaign. Just as we in turn in the United Kingdom recognise the political pressures that apply within the EU27 Member States. We need to recognise that the UK cannot ignore the frustrations of the British public, nor should our partners. And indeed in my conversations with European counterparts, they tell me that they want to see a deal. But the risk is that the Commission sets a test that is impossible to meet. What they are in reality asking for is a UK commitment to remain in large parts of the Single Market by continuing to insist on the inclusion of the backstop. This is politically impossible in a country that has voted to leave and indeed Parliament has rejected the backstop three times. So whatever solution we present will always fall short of these Commission demands. We are trapped in a zero sum game which is no way to conduct a negotiation. We need the EU to recognise this and to think with us creatively, not remain rigid or inflexible.

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As the Prime Minister made clear to Donald Tusk, Parliament will not allow the people of Northern Ireland to be required to accept laws over which they have no consent. I know that any politician can understand what I would mean if, say, the people of Sardinia or Sicily overnight became citizens with different rights to the rest of Italy. It would mean Northern Irish voters – UK citizens – being governed by large numbers of rules in which they have no say. And since we can only leave the backstop by the agreement with the EU, once it is triggered we could be locked in it forever making it harder to leave the backstop than it is to leave the European Union itself. That is what the UK Attorney General in his legal advice to Parliament made clear. To achieve a deal, we need greater creativity and flexibility from all sides and for Member States to give their negotiators room for negotiation. I fully understand why Member State’s commitment to the Commission’s request for unity is as it is, but to reach a deal there has to be room for detailed and creative discussions. If behind the public comments there is no scope for a genuine negotiation then any creative and flexible solutions will always be quickly shot down.

Now the EU says on one hand it wants to look for “creative and flexible solutions on the border in Northern Ireland” – in fact those were the very words used by the European Council in their own guidelines. Yet at the same time the Commission has refused to progress work on alternative arrangements until after the Withdrawal Agreement has been ratified, waiting five months when we could have been working together. That rigid approach is neither creative nor flexible. The Commission accepted at Strasbourg that alternative arrangements have merit as an alternative to the backstop. And European capitals have said they will be happy to explore the details of such arrangements. In public, the EU position has suggested flexibility – from being clear there can be no change to the Withdrawal Agreement, to being open to changes if “legally operative text” on alternative arrangements can be made. But the private briefings strike a different note. To coin a phrase, with them, nothing has changed. The responsibility sits with both sides to find a solution with genuine cross-party consent. When politicians ask the people to make a choice, it is the responsibility of the elected representatives to deliver on that choice. It is not, as the Prime Minister has said, for politicians to choose which votes they want to act upon and those they would prefer to ignore.

People voted for Brexit and it is important to our democracy that we deliver it. As a result, we have stepped up our preparations in the United Kingdom significantly under the new Government in the event that we do have a no deal that neither of us desires. So we will be prepared, despite the media stories that seek to unnerve, and it is important that our friends and partners across Europe are also prepared. But the reality is that no deal is not in either sides’ interests. Two thirds of Irish medicine comes through Great Britain, while 60% of Irish exports go through Dover the other way. These are reciprocal issues where we have a shared desire to get it right.

So it’s far better for us to agree a mutually beneficial deal if not for the sake, for example, of Geographical Indicators. There are more than 3,000 European Union Geographical Indicators. In the UK, there’s only 88. Italy holds three of the top ten most valuable GIs in the EU.

With a deal, these are protected in the implementation period. But this is not the case in no deal. There are similar impacts in other key areas, security or data sharing. We will be ready within the United Kingdom for no deal if it happens but from the meetings I have had across the Continent, one thing is absolutely clear, businesses want certainty. They want to have the confidence to continue to invest in the UK which remains the number one destination for inward investment within Europe.

Our citizens want their elected representatives to honour the democratic decision and move forward. We risk crystallising disruption in November because of an all weather absolute test for the end of the implementation period at the end of 2020. So our shared ambitions are of a deal. A deal which honours the Belfast/Good Friday Agreement to which the UK is unconditionally committed but without the backstop that the UK Parliament has rejected three times. And it requires a commitment to a creative and flexible approach in finding solutions.

That is what our Government seeks, that is what our Prime Minister seeks and ladies and gentlemen, with goodwill on all sides it is what I know we can deliver. Thank you very much.




Royal Navy deploys medics to support humanitarian efforts following Bahamas hurricane

A team of 18 military medical staff will arrive in the region this evening and will provide emergency care, surgery and intensive care to those in need.

They join Royal Navy support ship RFA Mounts Bay, which is delivering aid to the Bahamas following the destruction caused by the devastating hurricane. Mounts Bay was prepositioned in the region for hurricane season, a task it fulfils each year.

Another Royal Navy ship, HMS Protector has been re-tasked to the Bahamas. It is currently in Bermuda taking onboard supplies such as food, water and clothing. On Monday it will sail to the Bahamas where it will provide further support to the disaster relief efforts.

The UK is also working with other partners in the region, including the US Coast Guard, whose helicopters have refuelled on RFA Mounts Bay.

Defence Secretary Ben Wallace said:

The devastation wrought by Hurricane Dorian has required an urgent response and the UK’s commitment to the Caribbean means that our Royal Navy is on hand to help.

They have acted swiftly to deploy an extra 18 medical personnel from the UK to the Bahamas, where they will provide desperately needed expertise.

As part of this quick response we’re working closely with our US counterparts in delivering assistance to the Bahamas.

Our thoughts remain with those affected and those who have lost loved ones and homes.

Fleet Commander Vice Admiral Jerry Kyd said:

The shocking level of devastation which Hurricane Dorian has caused to the Bahamas is now becoming clear. The men and women embarked in RFA Mounts Bay, drawn from across Defence, are giving their all to provide assistance on the ground.

I am hugely proud of their achievements so far, and I’m pleased they have been reinforced by a further medical capability. This is core business for the Royal Navy, deployed worldwide and ready to respond whenever and wherever we are needed.

The extra 18 medical personnel deployed this weekend are military personnel who maintain their skills by working among the NHS in the UK. They are held at short notice to deploy anywhere in the world to provide medical help where it is needed.

They are able to provide a higher tier of medical support – known as a Role 2 capability. A Role 1 team, which can deal with everyday illnesses and injuries, is already embarked.

Lieutenant Commander Anna De-Saint is the officer commanding the team deploying to the Bahamas.

She said:

It is absolutely essential that teams like us and the humanitarian teams already in the region are ready to respond to an emergency like this at short notice.

I know we can add value to the team already out there in the Bahamas. The Role 1 medical team is there to support personnel on the ship with everyday illnesses and undertake emergency care whereas we are there for life-saving damage-control surgery and resuscitation.

A lot of our kit is already on the platform, including all the medical equipment, drugs and surgical equipment. One of the most important thing we are taking out there is blood.

We are held at 48 hours’ notice to move so we are a high-readiness unit who are available to go at short notice anywhere in the world.

During hurricane season, we know there is a higher chance of us being needed but we have not had to deal with a situation like this since Operation Ruman – the UK’s military response to Hurricane Irma in the Caribbean in 2017.

The Royal Navy medics were most recently mobilised to support a peacekeeping mission in South Sudan. The medical team took the equivalent of a hospital – with 78 doctors, nurses, dentists, physiotherapists and others – to a UN camp there in 2018.




New physical activity guidelines issued by UK Chief Medical Officers

New guidance issued today by the UK Chief Medical Officers emphasises the importance of building strength and balance for adults, as well as focusing on cardiovascular exercise.

Falls are the main reason older people are taken to A&E, and could be avoided through daily activities such as brisk walking, carrying heavy shopping, climbing stairs, swimming and gardening.  

There is strong evidence that physical activity protects against a range of chronic conditions. Meeting the guidelines can reduce the risk of:

  • type 2 diabetes by 40%
  • coronary heart disease by 35%
  • depression by 30%

The new guidelines are an update to those released in 2011, but the overall message remains the same: any activity is better than none, and more is better still.

Under the new guidelines, adults are advised to undertake strength-based exercise at least 2 days a week. This can help delay the natural decline in muscle mass and bone density that starts from around age 50. It is believed that this is a major reason why older people lose their ability to carry out daily tasks.

The guidance advises on safe levels of activity for pregnant women and new mothers, and the many benefits that this can bring as long as they listen to their body and speak to their health professional. A moderate amount of exercise for new mothers is proven to help them:

  • regain strength
  • ease back pain
  • reduce the risk of gestational diabetes

New advice is also available to encourage good development in babies and children, with the UK Chief Medical Officers recommending lots of ‘tummy time’.

As much active play as possible in children under 5 is encouraged, and older children are recommended to be active for an average of 60 minutes a day across the week. To support this, the government will work with nurseries to find fun opportunities for young children to exercise during the day through the new Daily Toddle initiative.

Chief Medical Officer for England, Professor Dame Sally Davies, said:

Physical activity is an under-appreciated asset in our clinical arsenal. It is cheap and brings a long list of health benefits.

As we age, our muscles weaken and we can become stiff, leading to falls and difficulty performing everyday activities. Physical activity can prevent fragility and support mobility in old age. By keeping active, both throughout the day and also through hobbies, we can slow muscle and bone decline, ultimately keeping us independent for longer.




£1 million to boost haulage sector and combat long-term unemployment

  • new training programme will support the haulage industry to drive Britain forward for generations to come
  • scheme aims to support and upskill the unemployed, veterans, and re-offenders to take up a transport career
  • funding to help those struggling to find a job into long-term employment

A £1 million boost to help the diverse haulage sector bolster its workforce and recruit new talent has been announced by Transport Secretary Grant Shapps.

The nationwide Road to Logistics programme aims to support those who may find it difficult to get permanent jobs, such as veterans, ex-offenders and the long-term unemployed, by putting them on a path to a career in transport.

Today’s (7 September 2019) investment by the Department for Transport will enable logistics companies to run essential skills training for these groups, including within the prison system, and help the industry to solve a nationwide shortage of drivers.

Haulage video

Employment in the transport and logistics sector has risen since 2010, but has seen a recent fall. There are currently almost 1.5 million people working in the industry.

Transport Secretary Grant Shapps said:

Our dynamic road transport sector moves more than 1.4 billion tonnes of goods across the country every year, so we need to make sure it is fit for the future.

Not only will this new programme help make this industry even stronger, but it will help pave the way for those who may be struggling to secure a permanent job and turn their lives around.

Founded by the Road Haulage Association and Microlise, Road to Logistics is a not-for-profit organisation open to all hauliers that will help them find new logistics professionals by offering support and training to those that struggling to find permanent employment.

Road Haulage Association Chief Executive Richard Burnett said:

Road to Logistics provides a framework for candidates to gain their entitlement to drive a HGV and fully support and mentor their transition into a career in logistics.

It is fantastic that government is supporting an initiative that will help to resolve the shortage of drivers whilst providing a helping hand for those that need it the most.

Following a successful trial with HM Prison Sudbury, the scheme aims to train up to 300 drivers in the first year as part of a pilot. The first-of-its-kind plan for the industry will see serving prisoners linked with potential employers, undertake crucial training and gain qualifications, including taking their driving test. They will have a guaranteed job on release, helping them turn their back on crime and transform their lives.

The new programme will join a range of existing government interventions in place to remove the barriers faced by people who may find it difficult to secure long-term employment.