Audit Office uncovers extent of healthcare penalty notices

Audit Office uncovers extent of healthcare penalty notices

A report from the National Audit Office has revealed 30% of healthcare fines issued since 2014 – 1.7 million notices, with a cash value of £188 million – were withdrawn because a valid exemption was confirmed to be in place following a challenge. The BDA has welcomed calls for clarity on NHS penalty charges and says it has hit innocent NHS patients.

The NAO launched their report into fines covering both NHS dental and prescription charges in response to campaigning from the BDA highlighting that 400,000 dental patients a year – including those on very low incomes, the elderly, and those with learning disabilities – have received £100 fines, some for simply ticking the wrong box on a form.

The report identifies multiple sources of mistakes and confusion, including issues facing Universal Credit and income-based Jobseeker’s Allowance recipients, and different criteria for eligibility for exemption between prescriptions and dental treatments. The report acknowledges that the NHS Business Services Authority (BSA) is unable to reduce the likelihood of vulnerable patients receiving fines – as it relies on recipients identifying themselves as vulnerable and challenging the fine, when many do not feel able to do so. 
The BDA has expressed alarm over revelations revealed in the NAO research that the BSA spent £1.6 million on its ‘Don’t Run the Risk’ initiative, warning patients about misclaiming. The BDA has accused the campaign, featuring messages like Don’t Assume you’re entitled’, of simply discouraging patients unsure of their exemption status from seeking the help they need, rather than providing much needed clarity.

Charlotte Waite, Chair of the BDA’s England Community Dental Services Committee said: “There can be no excusing the fact innocent people, fully entitled to claim free care, have been slapped with over £180 million in fines. Patients deserve real clarity when making a claim. Sadly all the government has done is spend a fortune on campaigns simply discouraging them from seeking the help they need and are entitled to.  

“England has a system built on a presumption of guilt, which offers few signposts, and has left vulnerable patients chased by debt collection agencies. Other UK nations have chosen a different path. Change can begin by ending this blind ‘fines first’ approach, with a simple letter, asking patients to spell out their entitlement.”

The BDA has deep concerns that the increasingly aggressive approach to penalty charges has fuelled a drop in attendance among low income and vulnerable patients. There has been a fall of two million treatments delivered to patients exempt from NHS charges since 2013/14 – a drop of 23% in 4 years.
The BDA has backed NAO calls for clarity for patients claiming exemptions. The Association says at the very least England must end its ‘fraud first’ approach to patient communications. Scotland and Northern Ireland do not operate on a presumption of fraud, with letters sent to patients querying their status should their entitlement to free care be in doubt.


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