Passports for NHS access plan: what are the implications?

Patients could be told to bring two forms of identification including a passport to get treatment at hospital, according to the most senior civil servant in the Department of Health. Chris Wormald told MPs on Monday night: “On the general question of, are we looking at whether trusts should proactively ask people to prove their identity – yes we are looking at that.

“Individual trusts like Peterborough are doing that and it is making a big difference. They are saying, ‘Please come with two forms of identity, your passport and your address,’ and they use that to check whether people are eligible. It is quite a controversial thing to do, to say to the entire population you’ve got to prove your identity.”

If that happens, what are the implications?

Q. Could British people be denied access to treatment if they fail to produce a passport?

A.The latest figures show that 13% of British citizens do not have a passport so it could be a very serious problem if they were denied NHS treatment for failing to produce a passport. The current NHS Choices advice to overseas visitors says that “if you do not have valid documentation, you may be charged for treatment”.

So a British citizen who cannot provide a passport to prove their nationality or country of residence will be treated but may later face a hospital inquiry about the possibility of being charged. This could be dealt with by providing a birth certificate or other proof of British citizenship or residence short of a passport. The NHS describes itself as a “residence-based system, unlike many other countries, which have insurance-based healthcare systems”.

Q. What happens to people from outside the European Economic Area who want NHS treatment at present?

A. The rules changed in April last year as part of the Immigration Act 2016 which was designed to ensure Britain has “a national health service, not an international health service”.

Non-European migrants who have permanent residence in Britain, ie indefinite leave to enter or remain, continue to be eligible for the same NHS care as a resident British citizen.

But those who are temporary migrants or students and intend to stay more than six months are now required to pay a health surcharge when they apply for their visa. This is £200 a year or £1,000 for a five-year visa. In the past year £164m has been raised from the immigration health surcharge.

Q. What happens to people from inside the European Union or elsewhere in European Economic Area who want NHS treatment?

A. EU citizens who are resident in Britain can access the NHS on exactly the same basis as British citizens. The difference is that as a result of an EU directive the NHS can claim back the cost of treating EU visitors, students or temporary migrants to Britain from their home governments.

MPs are concerned that while the UK paid out £650m last year to cover the treatment of British citizens in other EU countries, it only managed to recoup £49m for the NHS treatment of EU citizens here. The government thinks that an annual target of £300m is possible if hospitals do more to identify EU citizens being treated in British hospitals.

The NHS is thinking of asking everyone to prove their identity so they can identify EU citizens so their governments can be charged. EU citizens without European health insurance cards (EHIC) may be asked to pay the charges upfront and then to recover them from their own government. The NHS might do better to ask EU citizens to produce their EHIC card rather than ask the whole population to provide a passport or other form of identity.

Q. Is this a national ID scheme by the back door?

A. A national identity scheme is about having a single government searchable database on which the whole UK population is listed. Asking for a passport or other form of ID card, such as a driving licence, to prove British residence does not mean the proposal is introducing an ID card by the back door.

Passports for NHS access plan: what are the implications?

Study showing decline in dog fertility may have human implications

Britain’s dogs are becoming less fertile. Researchers who have systematically examined canine sperm over a span of 26 years say that overall sperm quality has been in decline.

Environmental chemicals are implicated. And the study may throw light on the fertility changes in male humans.

Richard Lea, of Nottingham University’s school of veterinary medicine and science, and colleagues collected samples of semen from a carefully monitored population of labradors, border collies, German shepherds and golden retrievers used as stud to breed dogs intended to help the disabled. They tested 1,925 samples of ejaculate from a total of 232 different dogs at the rate of between 42 and 97 dogs every year.

And they found a drop in sperm motility – the ability to swim in a straight line – of 2.4% per year from 1988 to 1998. Even once some dogs were excluded from the study because their fertility was in some way in question, from 2002 to 2014 the scientists still measured a decline of 1.2% per year.

They also confirmed the presence of environmental chemicals known as PCBs and phthalates in the canine semen, and in testicles of dogs castrated by veterinary surgeons in the course of routine neutering treatment. These chemicals are ubiquitous, and have been linked to both fertility issues and birth defects.

At the heart of the research is not the dog, but the question of male human fertility. Repeated tests over more than 70 years have shown a downward trend in male fertility, but there has always been argument about the consistency and accuracy of the findings.

“Why the dog?” said Dr Lea. “Apart from the fact that it is a great population of animals to work with, dogs live in our homes, they sometimes eat the same food, they are exposed to the same environmental contaminants that we are, so the underlying hypothesis is that the dog is really a type of sentinel for human exposure.”

One analysis of human sperm counts examined 60 separate studies over a 50-year span. But different research teams used different techniques, and in any case the advances in laboratory equipment over many decades meant that it would always be difficult to compare like with like.

There has been much less doubt about measured increases over the decades in rates of testicular cancer, and a condition known to affect a proportion of boy babies at birth: cryptorchidism, in which the testicles do not descend normally to the scrotum.

The Nottingham canine study group resolved a number of problems of consistency. All the dogs were healthy and well cared for. The semen sampling was supervised by Professor Gary England, Nottingham’s foundation dean of veterinary science, who launched the project, and all the samples were handled by just three technicians in the 26-year study. The researchers also looked at the dog’s food, and the chemicals in the food.

The decline in canine sperm quality does not, for the moment, augur the end of the dog as a species. “It’s very unlikely” Dr Lea said. “It’s very difficult to say at what point this becomes a problem.”

The researchers saw increases in cryptorchidism in the study dogs’ pups over the years. They also saw a clear connection between environmental chemicals and declining fertility. How this might work, however, is not so clear.

“If you think about it, we are exposed to a cocktail. Who knows how many chemicals are out there and what they are doing? It gets even more complicated when you start to look at the effects of mixtures of chemicals,” Dr Lea said.

“What we have been able to do here is just to pull out ones that we know are present, and we have tested those in terms of their effects and it does suggest there is an impact. The next stage – and it is a big next stage – is trying to tease out what else is there and how those chemicals are interacting.”

Study showing decline in dog fertility may have human implications