| Chapter
9: Notes for Stage 2 Officers Conducting Patient Interviews |
Statutory/Manual
References |
| Action before Stage 2
Interview |
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| 1. The Stage 2 interview should
take place only when it has been assessed as clinically appropriate to do so. If it is not
clinically appropriate the Stage 2 interview should be deferred until the patient’s
condition and care plan permit. |
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| Duties of Stage 2 Officers |
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| 2. Stage 2 officers should be
supervisory or of equivalent grade and should: |
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i. apply the procedure set out in this Manual; and
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ii. convey the terms of this guidance sensitively and
tactfully to the patient concerned.
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| 3. For planned out-patient
attendance the patient should be seen, if possible, by the Stage 2 officer immediately
after the Stage 1 procedure, ie before seeing the doctor or dentist (when it has been
assessed as clinically appropriate to do so). |
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| 4. For patients admitted as
in-patients direct or through an NHS A&E Department (or in pre-treatment 'holding'
wards attached to these departments), Stage 2 procedure should be carried out when it has
been assessed as clinically appropriate to do so. |
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| Exemption for patients
referred to Chest Clinic |
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| 5. In chest clinics, the Stage 2
procedure should not take place until the patient has been diagnosed and
found not to be suffering from a notifiable infectious disease. Patients
with a notifiable infectious disease will be exempt from NHS charges. |
Chapter 10 |
| Procedure |
|
| 6. No assumption
should be made about patients referred for a Stage 2 interview. There will be those who
did not understand the questions or were otherwise unable to give clear
answers at Stage 1. |
Appendix G |
| 7. The Stage 2 interviewer,
should establish quickly whether an exemption from NHS charges applies.
Stage 2 officers’ consideration may be assisted by reference to Appendix F(1-4). |
Appendix F |
| 8. Where the patient is liable
for NHS charges this decision should be recorded as soon as possible. |
Appendix F |
| 9. Where a patient is from a EEA
or a reciprocal health care agreement country or is a UK overseas pensioner, clinical
advice should be obtained as to whether the need for treatment arose during the visit. |
Appendix C |
| Assessment |
|
| 10. Questions contained in the
flow charts in Appendix F(1-4) should be expanded, when necessary, to include the
patient’s husband/wife or (for children) parents. |
Appendix F |
| Note: It is not
sufficient for a patient to simply state that he or she has come to the UK to take up or
resume residence. Patients who come as visitors will need to apply to the Home Office. The
hospital needs to be reasonably satisfied that the patient meets the criteria for
exemption from NHS charges. It is legitimate therefore for Stage 2 officers
to seek documentary or other evidence to support a patient’s statement. A
letter of application to reside is not sufficient to entitle the applicant
to exemption from NHS charges. Acceptable forms of supporting documentation are set out in
Appendix G. |
Chapters 12,
13 &14 Appendix F & G |
| 11. HBs, NHS Trusts and DMUs may
adopt a policy that patients be asked to support their answers by a signed statement. If
such a policy is adopted, it should be applied to all Stage 2 patients other than those
mentioned above from whom external documentary evidence has been obtained. |
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| Decisions |
|
| 12. There may be cases where the
patient will not be able to provide proof of his or her status (for example,
a sudden decision to return to reside in the UK because of terminal illness and where
there has been no time to sell property abroad or to make the normal
arrangements for moving to the UK). Each case should be considered on its merits. |
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| 13. The reasons for reaching a
decision to charge, or otherwise, for NHS treatment should be recorded and
filed with the case papers. |
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| 14. A patient’s entitlement
to exemption from NHS charges may change during the course of their care (for example,
where the length of stay in the UK subsequently exceeds 1 year and their stay in this
country is both legal and lawful or where the patient decides to be treated
privately). |
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| Charging |
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| 15. If entirely satisfied that
the patient is liable for NHS charges the patient, next of kin, representative or sponsor
should be told without delay and given an estimate of the likely cost. |
Chapter 7
& Appendix D |
| In-patients |
|
| 17. On admission the patient
should be told and be given written confirmation that a daily charge will be made.
Accounts should be presented to patients (or third party) on a weekly basis and again on
discharge irrespective of whether a deposit has been paid. |
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| Out-patients |
|
| 18. For Stage 2 interviews, which
take place before the patient has seen a doctor or dentist, the patient should be asked to
pay at that time for the NHS out-patient consultation, and told that there will be NHS
charges for any subsequent related tests and procedures. |
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| Patients placed on Waiting
Lists |
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| 19. Existing arrangements that
apply for charging private out-patients for diagnostic tests and other procedures should
be adopted for overseas patients liable to a NHS charges. |
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| Change to Private Patient
status |
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| 20. When an overseas patient
subsequently agrees to be treated as the private patient of a consultant, the doctor or
dentist should inform the Stage 2 officer as soon as possible. The Stage 2 officer should
pass this information on to the Director of Finance or appropriate finance officer again,
as soon as possible. The patient’s written undertaking must be obtained to pay NHS
charges already incurred and levied in accordance with section 57 of the 1978 Act. |
S.57 of the 1978 Act |
