8. Ms A says the Trust incorrectly charged her £530 for her admission to the ED. She says she was still in the ED and therefore should not have been charged.
9. Ms A attended the ED due to worsening symptoms of her connective tissue disorder. The Trust admitted Ms A to the same day emergency care unit (SDEC) on 24 November 2021 for intravenous fluids (IV), the Trust noted that this was in line with her care plan from her consultant.
10. NHS England describes SDEC as providing ‘in-hospital care within a stand-alone unit, a combined or co-located SDEC with the acute medical unit, acute surgical unit/surgical assessment unit, acute frailty unit or ED’. This means that in order to access this service the patient needs to be admitted.
11. After assessing Ms A in the ED the Trust decided to admit Ms A for IV fluids. As the ED is for emergency care only it admitted Ms A to the SDEC unit. Once Ms A arrived on the SDEC unit the Trust took steps to determine Ms A’s chargeable status (right to free healthcare).
12. DHSC guidelines step 6 says ‘if the patient is chargeable, apply the NHS Payment Scheme and recover the cost of treatment from them. If, following reasonable enquiries, a relevant body decides that the overseas visitor is not eligible to receive care without charge, they must:
• give the patient a written statement confirming why charges apply, what the charge is estimated to be in respect of any future treatment and how they can pay (as per the CQC Regulations) • take all reasonable measures to recover 150% of the cost of treatment (including the local market forces factor) under the NHS Payment Scheme (unless the patient is covered by the Withdrawal Agreement or a healthcare arrangement with a relevant country, in which case it is 100%) from the patient in advance of providing it (unless doing so would delay urgent or immediately necessary services) (as per the charging Regulations) • if treatment has already been given to a chargeable overseas visitor (either because they were not identified in time or treatment was urgent or immediately necessary), relevant bodies must still issue an invoice and make efforts to recover the charges (debt) afterwards (as per the charging Regulations).
13. The Trust interviewed Ms A the same day to determine her status. It found that as Ms A was not a UK resident, she would need to pay charges. We could not however see from the records the Trust gave Ms A a written statement telling her charges would apply. Ms A also told us she did not receive a letter when she attended the ED.
14. We brought this to the Trust’s attention, and after doing further work it gave us a letter apologising to Ms A and outlining improvements it had made to its service following our contact to make sure patients receive a written statement following enquiries.
15. We do note that the guidelines say (as per the charging Regulations) Trusts should not delay giving immediately necessary treatment to patients pending payment. It giving Ms A IV fluids before learning her status was likely due to that provision. The guidance goes on to say the Trust should still issue an invoice and make efforts to recover the charges afterwards. Therefore even with this communication shortfall the Trust would still need to issue Ms A with an invoice and attempt to recover the charges.
16. Overall, the charges the Trust charged Ms A are valid charges. As part of our consideration we found an incidental communication failing, we approached the Trust on this and it has undertaken further work to improve its services. We think this resolves this issue.
17. We are sorry to hear about what happened to Ms A when she needed treatment and are grateful to her for bringing her complaint to our attention.