19 December 2017 Sarah Wilkinson Chief Executive NHS Digital 1 Trevelyan Square Boar Lane Leeds LS1 6AE Dear Sarah, The Cost Recovery Collection, Processing and Dissemination of non-eea, EEA and UK Patient-Level Data Directions 2017 I am writing to provide a Direction to NHS Digital to establish and operate a system for the collection and/or analysis of additional data to support chargeable status decisions to be made for any NHS patient, including NHS patients receiving NHS-funded services provided by non-nhs providers of NHS-funded care, and secondary and community care delivered outside a hospital setting. This supports the Government in ensuring that the NHS remains free at the point of use, for those that are entitled to use it, and supports any relevant bodies (as defined by section 5(4) of The National Health Services (Charges to Overseas Visitors) Regulations 2015 1 as amended by The National Health Services (Charges to Overseas Visitors) (Amendment) Regulations 2015) and The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 ( the Charging Regulations ) to comply with their obligations under the Charging Regulations, to make and recover charges for any relevant services it provides to an overseas visitor. The NHS is a residency-based healthcare system and eligibility for free NHS services is based on the concept of ordinary residence. An overseas visitor is any person who is not ordinarily resident in the UK. A person will be ordinarily resident in the UK when that residence is lawful, adopted voluntarily, and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration. A person who is ordinarily resident in the UK must not be charged for NHS services. The Charging Regulations place a legal obligation on NHS Trusts, NHS foundation Trusts, NHSfunded services provided by non-nhs providers of NHS-funded care, and secondary and 1 SI 2015/238 Page 1 of 9
community care delivered outside a hospital setting, and local authorities 2 in the exercise of public health functions in England, to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charge. This Direction is given in exercise of the powers conferred by sections 254(1) and (6), 274(2) and 304(9), (10), (11) and (12) of the Health and Social Care Act 2012 (the Act) 3 and Regulation 32 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013(b) 4. In accordance with section 254(2)(b) of the Act, the Secretary of State considers that it is in the interests of the health service for this Direction to be given. This Direction is to be known as the Cost Recovery Collection, Processing and Dissemination of non-eea, EEA, and UK Patient-Level data and comes into force on 19 th December 2017. Under section 254 of the Act, NHS Digital will: Establish and operate a system for the collection and analysis of data associated with a patient s eligibility for free NHS services; o Data (as per Annex 2) will be collected from NHS Trusts, with authorised service personnel updating patient records, or providing information directly to NHS Digital on NHS patients chargeable status; o Data, or attribute exchanges 5 will also be collected from other sources, and will be defined through separate MoUs, but would be expected to include, but not limited to, central Government data, data already owned by NHS Digital and the Department of Health, and data provided by Overseas Visitor Managers in Trusts; Check the data supplied is as expected and carry out validation and data quality checks for any significant issues; Trace any missing NHS Numbers (using NHS Digital datasets) and add these to the supplied dataset; For each dataset (see Annex 1), agree with the Secretary of State an appropriate outcome where a patient does not have an NHS record, or the record cannot be traced, i.e. destroy the data, create a new NHS record etc; Update an agreed dataset (Annex 2 as amended by NHS Digital and agreed by the Secretary of State and notified in writing by the Secretary of State to NHS Digital from time to time, in respect of each NHS patient in relation to whom information is collected) 2 A local authority within the meaning of section 2B of the National Health Service Act 2006 exercising public health functions (within the meaning of that Act) 3 2012 c.7 4 S.I. 2013/259 5 Attribute exchange asks questions of a database about a person, a yes/no response is returned, which can be used to verify the entitlement of an individual. This removes the need for personal data to be shared. Page 2 of 9
contained within the patient demographic record held on the Spine in respect of any patient registered with the NHS, and in possession of an NHS number. o The data would be stored by NHS Digital on the Personal Demographics Service and would inform the NHS of a patient s eligibility for free NHS services. This would be indicated through a chargeable status on the patient record. This would be used by NHS staff to support them in identifying potentially chargeable patients and seeking to recover charges. NHS Digital is directed to disseminate this information to authorised health service personnel 6 for the purpose of enabling those authorised health service personnel to exercise the functions of a relevant NHS body under regulation 3 of the Charging Regulations. Local Authorities will have local arrangements for data sharing preferences. NHS Digital shall have regard to such policies, advice or guidance of the Secretary of State as the Secretary of State may notify in writing to NHS Digital. This system and the collection, processing and dissemination of chargeable data may be extended in the future. This would be enabled through a further Direction. In accordance with regulation 32(2)(a) of the Regulations, the Secretary of State will make payments to NHS Digital for things done in connection with the exercise of the systems delivery functions referred to above. In accordance with section 254(5) of the Act, NHS Digital has been consulted before this Direction has been given. NHS Digital is directed to not publish information collected or produced by complying with this Direction, in accordance with section 260(2)(d). By virtue of section 261(3), NHS Digital is required to disseminate information generated as a result of compliance with this Direction. For the avoidance of doubt, the Health and Social Care Information Centre (Immigration Health Charge) Directions 2015 will continue to apply. Yours sincerely Claire Stoneham Director, Provider Efficiency & Productivity..Ends 6 Authorised health service personnel means staff working within the health service in England who are authorised by NHS Digital to access the Spine for the purposes of these Directions. Page 3 of 9
Annex 1 Directed Visitors and Migrants data-shares (to be updated as appropriate by the Programme Board) Data Source Process EHIC and S1 data Home Office flow data Type 4s Bulk checking of SCRa data by OVM to PDS Bulk uploads of chargeable Department of Health, from data submitted by Trusts for recovery from EEA member states From GP practices as part of the patient registration process from 1 October 2017 Home Office maintains a database of migrants who no longer have a right to reside in the UK. On registration with a GP, a patient indicates if they are from abroad. Where a patient completes this section of the form, they are identified as a Type4. MESH is an NHS Digital system that allows for bulk queries to be run against the Patient Demographic Service. By bulk querying all referrals in, OVMs will be able to quickly establish which patients are most likely chargeable, and therefore direct limited resources more effectively. OVMs collect information about a patient s chargeable status, Page 4 of 9 EHIC patient details will be matched to NHS records where they exist, and a chargeable status of Category C Charge Exempt Overseas Visitor/EEA Through self-declaration, a patient will provide EHIC or PRC details, and the practice will send these to NHS Digital to attach to the NHS record. Initial proof of concept to identify match rate of migrant details to NHS records. If successful move to full datashare, and update matched records with a chargeable status Category F Chargeable/non- EEA Attach a Decision pending chargeable status to the patient record to indicate to Overseas Visitor Managers in Trusts that the patient s status needs to be established. Bulk query is sent to MESH, full data set made up of data that is already available to the OVM will be returned to the OVM to review. OVM would be able to send a list of NHS numbers via a MESH
Data Source Process status by OVMs IHS payees residing outside of England but do not always have the time to add this to the patient record through SCRa. The information is therefore collected but not currently processed. Home Office Immigration Health Surcharge payment data. query to PDS for patients who they identified as Ordinarily Resident and for the associated records to be updated with the Category A chargeable status Home Office to include all those paying the IHS in their weekly feed, irrelevant of where they indicate they will collect their BRP. Page 5 of 9
Annex 2: Visitors and Migrants & Patient Charging Data Set The following data set represents the Visitors and Migrants patient charging information which an OVM would be able to record and which NHS Digital is required to collect. Data Grouping Data Item Description Format Origin System Organisation Id Organisation Id of the user who created/last updated the entry System Organisation Organisation of the user who created/last updated the entry System derived System derived System User ID User Id of the user who created/last updated the entry System derived System User Name of the user who created/last updated the entry System derived System Date Updated Date and time that the entry was created/last updated on Spine YYYYMMDDHHMMSS System derived Patient Data Date Patient Seen Date that the patient was seen YYYYMMDD (date control) Patient Data Country of Nationality Country selected from country list Display Country Patient Data Purpose of Entry to UK Selected from a list of options including Other tbc but may include e.g. Study Work Leisure Intend to settle Dependent Visiting family Other Page 6 of 9 30 chars store as code
Data Grouping Data Item Description Format Origin Patient Data Other Purpose of Entry to UK Free text entry only available if Other selected above numeric 30 chars Patient Data Date of Entry to UK Date the patient entered the UK on this visit YYYYMMDD (date control) Patient Data Home Country Address 4 lines of home country address numeric 4 * 40 chars Patient Data Home Country Address - Country Patient s home country Display Country EHIC EHIC Personal Id No. Individual s Personal Id Number from EHIC numeric EHIC EHIC Card Number Number of the patient s EHIC card numeric EHIC EHIC expiry date Date the EHIC card expires YYYYMMDD (date control) EHIC EHIC Institution Id Institution Id on EHIC card numeric 30 chars EHIC EHIC country of issue Country selected from country list Display Country PRC PRC Personal Id No. Individual s Personal Id Number from PRC numeric PRC PRC EHIC Card Number EHIC Card No. on PRC numeric Page 7 of 9
Data Grouping Data Item Description Format Origin PRC PRC EHIC expiry date EHIC expiry date on PRC YYYYMMDD PRC PRC Institution Id Institution Id on PRC numeric 30 chars PRC PRC country of issue Country selected from country list Display Country PRC PRC valid from date Date the PRC is valid from YYYYMMDD (date control) PRC PRC valid to date Date the PRC is valid to YYYYMMDD (date control) S1 S1 Status Selected from a list of options e.g. None No S1, confirmed by patient S1 presented, not confirmed registered S1 confirmed registered by OHT 40 chars store as code S2 S2 country of issue Country selected from country list Display Country S2 S2 valid from Date the S2 is valid from YYYYMMDD (date control) S2 S2 valid to Date the S2 is valid to YYYYMMDD (date control) Passport Passport Number Number of the patient s Passport numeric Page 8 of 9
Data Grouping Data Item Description Format Origin Passport Passport country of issue Country selected from country list Display Country Passport Passport expiry date Date the Passport expires YYYYMMDD (date control) HO Contact HO E&E contacted Indicator to state if the Home Office Evidence and Enquiries team were contacted Y or N User selected HO Contact HO E&E reference If HO contacted, a reference for the call numeric HO Contact HO E&E contact date If HO contacted, the date of the contact YYYYMMDD (date control) Chargeable Status OVM Chargeable status Chargeable status outcome selected by OVM from a coded list e.g. None Decision pending Cat A: Standard NHS Cat B: Surcharge Payee (or exempt) Cat C: Charge exempt (EHIC/PRC/S2) Cat D: Chargeable EEA Cat E: Charge exempt overseas/non-eea Cat F: Chargeable overseas/non-eea 40 chars store as code Page 9 of 9