Scoping of NHS visitor charging under Labour government

The request was refused by Department of Health and Social Care.

Dear Department of Health and Social Care,

I would like to request the following under the FOI Act.

At a hearing of the Health & Social Care Committee yesterday (25 July 2019), Ben Bradshaw MP made reference to "advice" received by the ministry during his tenure as Minister of State in the Department of Health which suggested that healthcare charging for migrants/overseas visitors would lead to harm and therefore led him not to adopt a policy similar to the current NHS Overseas Visitor Charging Regulation.

He said: "When I was in the ministry we had the same policy put before us and all the advice we had said it would lead to exactly the harm we're hearing about now". (Link here: https://www.parliamentlive.tv/Event/Inde...)

My understanding is that Mr Bradshaw's term in office was 28 June 2007 – 5 June 2009.

Therefore, using this time period as the range, I would like to request a copy of all materials (including documents, powerpoint presentations, and emails) held by the department from this period related to the proposal, consideration, and assessment and rejection of such a policy.

Please note, if this proves too large a request within the time/cost limit, I'd like to narrow the scope to one year only, specifically June 2008 - May 2009 inclusive.

I would like this information digitally.

Yours faithfully,

Hilary Aked

Department of Health and Social Care

1 Attachment

Dear Ms Aked

Please find attached the Department of Health and Social Care's response
to your recent FOI request (our ref: FOI-1181312  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

-------------------------------------------------------------

Please do not reply to this email. To contact the Department of Health and
Social Care, please visit [1]www.gov.uk/dhsc

show quoted sections

Please note: Incoming and outgoing email messages are routinely monitored
for compliance with our policy on the use of electronic communications.

--------------------------------------------------------------------------

This email was scanned by the Sophos anti-virus service.

References

Visible links
1. file:///tmp/www.gov.uk/dhsc
2. https://emea01.safelinks.protection.outl...

Dear Department of Health and Social Care,

Thank you for your email.

To clarify, for the purposes of this request, could you please interpret "such a policy" to mean proposals for the expansion of NHS charging for migrants and overseas visitors generally, rather than any specific amendments.

I hope this allows you to continue processing the request. Please don't hesitate to contact me if you have further questions.

Yours faithfully,

Hilary Aked

Department of Health and Social Care

This is an acknowledgement - please do not reply to this email.
Where a reply is appropriate, we aim to send one within 18 working days,
or 20 working days if your query is a Freedom of Information request or
complaint.

If your enquiry is about a medical matter, please contact NHS 111 or visit
the [1]NHS website, or contact your GP surgery.

You can find general health information on [2]GOV.UK, which includes the
Department’s [3]About Us section.

The Department of Health and Social Care does not process complaints about
the NHS or social services. If you wish to make a complaint about a
healthcare professional, an NHS organisation or a social care provider,
please visit the [4]Complaints Procedure page on GOV.UK.

If you have contacted the Department about a current health or social care
campaign, please visit [5]GOV.UK where a response may have been published.

You can find out more about the Department’s commitments from our
[6]Personal Information Charter.

show quoted sections

Please note: Incoming and outgoing email messages are routinely monitored
for compliance with our policy on the use of electronic communications.

--------------------------------------------------------------------------

This email was scanned by the Sophos anti-virus service.

References

Visible links
1. http://www.nhs.uk/
2. https://www.gov.uk/government/organisati...
3. https://www.gov.uk/government/organisati...
4. https://www.gov.uk/government/organisati...
5. https://www.gov.uk/government/announceme...
6. https://www.gov.uk/government/organisati...
7. https://emea01.safelinks.protection.outl...

Dear Department of Health and Social Care,

Please could you acknowledged receipt f the clarification I sent on 11 July 2019, and let me know whether the request is now sufficiently clear?

Assuming it now is, could you also please give me a new date on which you will reply? I estimate that this should be 8 August.

Yours faithfully,

hilary aked

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked

I can confirm that we received your request on July 11th, and according to our system an acknowledgement went out to you to confirm this, but I apologise if it did not reach you. Yes, we will respond to your request by 8 August (20 working days from 11 July). The reference number for this request is FOI 1182897.

Yours sincerely
Dorothy Crowe
Freedom of Information

show quoted sections

Dear Ms Crowe,

Many thanks for confirming receipt of my FOI request, reference FOI 1182897.

As your email mentioned, a response was due by today, 8 August 2019.

Please could you update me as to the department's progress in providing a response?

Yours sincerely,

Hilary Aked

Department of Health and Social Care

1 Attachment

Dear Ms Aked

Please find attached the Department of Health and Social Care's response
to your recent FOI request (our ref: FOI-1182897  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

show quoted sections

Dear Ms Crowe,

Firstly, thank you for your response. It's helpful to know the name of the review - ‘Review of access of the NHS by foreign nationals’ - that happened during the time frame I am interested in and this is certainly the relevant review.

Secondly, yes I would like to narrow the request please in order to limit its scope and hopefully fall within the section 12 time/cost limitation. To that end, please use the following key words as search terms:

1. harm
2. discrimination
3. vulnerable
4. risk
5. racism

If the first key word listed above already produces too much documentation, please let me know. Otherwise please continue down the list until the limit is reached. I hope that's possible and makes sense - if not, please do let me know.

Yours faithfully,

Hilary Aked

Dear Ms Crowe,

I'd be grateful if you could acknowledge receipt of my amended FOI request including key word search terms?

Yours faithfully,

Hilary Aked

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked

Thank you for your message. Yes, we received your request on 20 August, and I'm sorry you did not receive the automatic acknowledgement that you should have done.

You will hear back from us with a response to your query by 18 September (20 working days from 20 August). The reference number for your new request is FOI-1187641.

Yours sincerely
Dorothy Crowe

show quoted sections

Department of Health and Social Care

1 Attachment

Dear Ms Aked

Please find attached the Department of Health and Social Care's response
to your recent FOI request (our ref: FOI-1187641  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

show quoted sections

Dear Department of Health and Social Care,

Thank you for your response and for explaining that the boundaries of the request are at present too broad.

Instead, I'd like to follow your suggestion and narrow the search to the first 3 key words.

I hope that will solve the problem posed by the section 12 time/cost limit.

Please note that if it does not, I'd request that you narrow it to 2 key words and then if it still doesn't please narrow it to the first word only.

Many thanks and best wishes,

Hilary Aked

Department of Health and Social Care

This is an acknowledgement - please do not reply to this email.
Where a reply is appropriate, we aim to send one within 18 working days,
or 20 working days if your query is a Freedom of Information request or
complaint.

If your enquiry is about a medical matter, please contact NHS 111 or visit
the [1]NHS website, or contact your GP surgery.

You can find general health information on [2]GOV.UK, which includes the
Department’s [3]About Us section.

The Department of Health and Social Care does not process complaints about
the NHS or social services. If you wish to make a complaint about a
healthcare professional, an NHS organisation or a social care provider,
please visit the [4]Complaints Procedure page on GOV.UK.

If you have contacted the Department about a current health or social care
campaign, please visit [5]GOV.UK where a response may have been published.

You can find out more about the Department’s commitments from our
[6]Personal Information Charter.

This e-mail and any attachments is intended only for the attention of the
addressee(s). Its unauthorised use, disclosure, storage or copying is not
permitted. If you are not the intended recipient, please destroy all
copies and inform the sender by return e-mail. Any views expressed in this
message are not necessarily those of the Department of Health and Social
Care. Please note: Incoming and outgoing email messages are routinely
monitored for compliance with our policy on the use of electronic
communications.

References

Visible links
1. http://www.nhs.uk/
2. https://www.gov.uk/government/organisati...
3. https://www.gov.uk/government/organisati...
4. https://www.gov.uk/government/organisati...
5. https://www.gov.uk/government/announceme...
6. https://www.gov.uk/government/organisati...

Department of Health and Social Care

1 Attachment

Dear Ms Aked

Please find attached the Department of Health and Social Care's response
to your recent FOI request (our ref: FOI-1190511  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

show quoted sections

Dear Department of Health and Social Care,

Thank you for your response.

When I narrowed down my request I already stated explicitly a request for you to narrow it down further to one word if necessary, should 2 key words still prove too much and I would have hoped that you would have done this as requested.

I would like to request an internal review of the handling of this FOI request.

I am not satisfied that due care and attention is being paid to it, to help me find the information I am looking for and I feel that unnecessary delays have been caused as a result.

It is clear enough that I am trying to find out what internal assessment was made about the possible harms of NHS charging and a review of the relevant documents should, I feel, be able to relatively easily locate key pieces of information I am interested in.

Please could you confirm in writing that an internal review will take place and that the outcome will be provided in 20 working days?

Thank you for your assistance.

Yours faithfully,

Hilary Aked

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked

Thank you for your email.

The Department has received your request for an internal review of FOI-1190511, and will aim to reply within 20 working days.

Yours sincerely,
Dorothy

Dorothy Crowe
FOI team

show quoted sections

FreedomofInformation, Department of Health and Social Care

1 Attachment

Dear Ms Aked,

Your requested internal review of FOI-1190511 is now complete. Please see the attached letter for the outcome.

Yours sincerely,

Charlene Carter
Freedom of Information Casework Manager
Department of Health and Social Care
39 Victoria Street, London SW1H 0EU

show quoted sections

Department of Health and Social Care

This is an acknowledgement - please do not reply to this email.
Where a reply is appropriate, we aim to send one within 18 working days,
or 20 working days if your query is a Freedom of Information request or
complaint.

If your enquiry is about a medical matter, please contact NHS 111 or visit
the [1]NHS website, or contact your GP surgery.

You can find general health information on [2]GOV.UK, which includes the
Department’s [3]About Us section.

The Department of Health and Social Care does not process complaints about
the NHS or social services. If you wish to make a complaint about a
healthcare professional, an NHS organisation or a social care provider,
please visit the [4]Complaints Procedure page on GOV.UK.

If you have contacted the Department about a current health or social care
campaign, please visit [5]GOV.UK where a response may have been published.

You can find out more about the Department’s commitments from our
[6]Personal Information Charter.

This e-mail and any attachments is intended only for the attention of the
addressee(s). Its unauthorised use, disclosure, storage or copying is not
permitted. If you are not the intended recipient, please destroy all
copies and inform the sender by return e-mail. Any views expressed in this
message are not necessarily those of the Department of Health and Social
Care. Please note: Incoming and outgoing email messages are routinely
monitored for compliance with our policy on the use of electronic
communications.

References

Visible links
1. http://www.nhs.uk/
2. https://www.gov.uk/government/organisati...
3. https://www.gov.uk/government/organisati...
4. https://www.gov.uk/government/organisati...
5. https://www.gov.uk/government/announceme...
6. https://www.gov.uk/government/organisati...

Dear Department of Health and Social Care,

Thank you for sending through the outcome of the internal review on 25 October.

I note that you point out "it is not for the Department to assume what information you are seeking but to search for, and provide if appropriate, everything that is within the scope of the request as it is phrased." I believe by initial request was phrased very clearly, however, perhaps it would be possible if we could speak on the phone to ensure what I am looking for is crystal clear. I'd like to remind you of your section 16 duty to assist the person requesting information. Please let me know if such a phone call would be possible. My number is 07756 977167.

Thank you for letting me know that you are now processing a new FOI based on the word (“harm”), and have assessed that you will be able to respond to within the cost limit. I look forward to the response and in the mean time hope that whoever is processing that request can give me a call at some point to ensure this request does not continue to experience necessary delays which could perhaps be avoided by better clarity of communication.

Yours faithfully,

Hilary Aked

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked,

Thank you for your email.

I appreciate your concerns. However, FOI requests are a written process and we are therefore unable to discuss requests in a phone call. We are now processing a request based on a search of the word 'harm', and a response will be issued in due course.

I hope this reply is helpful.

Yours sincerely,

Lauren Der
Freedom of Information Officer
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care

show quoted sections

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked

 

Thank you for your request under the Freedom of Information Act (our ref:
FOI-1195121).  The Department holds information relevant to your request.

 

I am writing to inform you that the Department's consideration of the
balance of the public interest with regards to your request is not yet
complete, and requires further time to complete in line with Section 10(3)
of the FOI Act.

 

The Department is currently assessing the public interest in release under
Section 36 (prejudice to the effective conduct of public affairs).

 

We anticipate this process will take no longer than a further 20 working
days to complete. We therefore aim to respond fully to your request by 20
December.

 

Please accept my apologies for this delay.

 

Yours sincerely,

 

Dorothy Crowe

 

Freedom of Information Officer

Department of Health and Social Care

39 Victoria Street

London SW1H 0EU

 

This e-mail and any attachments is intended only for the attention of the
addressee(s). Its unauthorised use, disclosure, storage or copying is not
permitted. If you are not the intended recipient, please destroy all
copies and inform the sender by return e-mail. Any views expressed in this
message are not necessarily those of the Department of Health and Social
Care. Please note: Incoming and outgoing email messages are routinely
monitored for compliance with our policy on the use of electronic
communications.

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked

 

Thank you for your request under the Freedom of Information Act (our ref:
FOI-1195121).  The Department holds information relevant to your request.

 

I am writing to inform you that the Department's consideration of the
balance of the public interest with regards to your request is still not
yet complete, and requires further time to complete in line with Section
10(3) of the FOI Act.

 

The Department is currently assessing the public interest in release under
Section 36 (prejudice to the effective conduct of public affairs).

 

We anticipate this process will take no longer than a further 20 working
days to complete. We therefore aim to respond fully to your request by 22
January 2020.

 

Please accept my apologies for this further delay.

 

Yours sincerely,

 

Dorothy Crowe

 

Freedom of Information Officer

Department of Health and Social Care

39 Victoria Street

London SW1H 0EU

 

This e-mail and any attachments is intended only for the attention of the
addressee(s). Its unauthorised use, disclosure, storage or copying is not
permitted. If you are not the intended recipient, please destroy all
copies and inform the sender by return e-mail. Any views expressed in this
message are not necessarily those of the Department of Health and Social
Care. Please note: Incoming and outgoing email messages are routinely
monitored for compliance with our policy on the use of electronic
communications.

Department of Health and Social Care

1 Attachment

Dear Ms Aked,

Please find attached the Department of Health and Social Care's response
to your FOI request (our ref: FOI-1195121  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

show quoted sections

Department of Health and Social Care

1 Attachment

Dear Ms Aked,

Please find attached the Department of Health and Social Care's response
to your FOI request (our ref: FOI-1195121  ) 

Yours sincerely,

 Dorothy Crowe 

Freedom of Information team
Department of Health and Social Care

show quoted sections

Dear Department of Health and Social Care,

Thank you for your email containing the Department's response.

I would like to request an internal review on the following grounds.

1. No specific evidence demonstrating likelihood of prejudice
a) The exemption to the FOIA set out in Section 36 is prejudice-based and the public authority must be able to demonstrate precisely how the particular kinds of specified prejudice would or would be likely to arise.
b) DHSC has not provided any specific evidence to demonstrate that prejudice to the conduct of public affairs would likely arise from disclosure of the information.
c) Absent further specific detail about the reasoning of the qualified person as to why the information requested could have the alleged effect, and how their view was reached, it is not clear to me that their view constitutes a “reasonable opinion”.

2. Insufficient consideration given to public interest arguments favouring disclosure.
a) Even if the qualified person’s belief that disclosure would, or would be likely to, prejudice the conduct of public affairs, is indeed “reasonable”, this potential harm does not automatically outweigh, in a public interest test (PIT), the good that would come from disclosure.
b) The response from DHSC suggests that it has not given sufficient consideration to the arguments in favour of disclosure. It gives only a one sentence account of the public interest arguments for disclosure, saying: “There is public interest in openness as well as understanding how the government plans and implements its strategy for selection of its policies.”
c) However, there are several other important public interest arguments favouring disclosure which it appears DHSC has failed to take into account.
d) Beyond the general democratic and public interest in the principle of transparent government, the public needs to be confident about whether policy decisions are taken based on the best evidence available
i. If they are, then such openness can increase public trust in government.
ii. If they are not, this is a problem which the public deserves to know about as it might expose government wrongdoing and/or allow the government to be held accountable.
e) There is a particularly pronounced public interest in disclosure of this specific information to increase public knowledge and inform public debate because the issue to which it relates has already generated public concern.
i. A recent academic study from Oxford University researchers found concerning evidence indicating that the policy may be harmful, including potentially contributing to the deaths of three pregnant women [1].
ii. The Health and Social Care Committee last summer requested information on the Government’s review of NHS overseas visitor charging and subsequently called then Secretary of State for Health to appear before it to explain his refusal to provide it [2].
iii. A number of civil society bodies including the British Medical Association have called for upfront migrant charging to be scrapped [3].
iv. A coalition of academics and health professionals, in a letter to the British Medical Journal last, called for greater transparency on the policy [4].
f) Furthermore, a general point is that by ensuring that all evidence is known and being taken into account, disclosure could actually improve policy making, which is clearly in the public interest.
g) Finally, there is a public interest in knowing that ministers are adhering to the Code which regulates their conduct.

3. Argument stressing “ministerial accountability” in fact favours disclosure
a) DHSC states that “[th]ere is a stronger public interest in maintaining the existing constitutional convention of Ministerial accountability. The integrity of the system underlying the convention must be preserved.”
b) However, this is by no means obviously an argument in favour of non-disclosure.
c) As outlined above, the public need to be able to assess whether government ministers have made wise policy decisions based on the best evidence available and to this end the relevant evidence needs to be transparent.

4. Argument concerning protecting advisers from public scrutiny not relevant
a) DHSC states that advisers need to be “free of any inhibitions in providing Ministers with detailed, frank and candid advice” and adds that “It would not be in the public interest for officials to be made publicly accountable for the advice they gave in this formal manner.”
b) While this is a generic point, I do not disagree with it. However, I do not believe it is relevant given that the names and job titles of any advisers, and any other personal details such as contact information, can easily be redacted.
c) The same applies for any external parties who have proffered advice.

5. “Premature” exposure of advice argument not relevant
a)DHSC states that the quality of advice could be inhibited by “the apprehension that the advice will be exposed prematurely to public scrutiny or comment.”
b) The information requested constitutes advice given at least 11 years ago, under a different government and quite possibly by different civil servants. The MoJ’s advice [5] on Section 36 states: “In many cases, information will become less sensitive as time goes by. A time span of two administrations (that is, governments of different political parties) is often a good rule of thumb about whether information held by central government is likely still to be sufficiently sensitive that its disclosure would have the effects referred to in section 36(2).”
c) The policy to which it relates is already in place and is not under review. The ICO’s advice [6] is clear: “Once the public authority has made a decision, a safe space for deliberation will no longer be required.” (61).
d) Furthermore, the nature of the information requested is certainly not of the type that could be considered to warrant application of the thirty-year-rule (since amended to 20 years).
e) As such disclosure of the information could not be considered premature. In addition, taking account of the timing of this request, I would argue that any potential prejudice to the conduct of public affairs “would not be severe or widespread”, echoing the ICO’s view in its decision notice FS50264783 [7].

Conclusion

It seems DHSC has not given sufficient consideration to the arguments in favour of disclosure in weighing up the public interest. On the other hand, undue weight has been given to arguments favouring non-disclosure, some of which are not relevant such as the suggestion that disclosure would be premature.

As a result, I believe the conclusion - that the balance of the public interest lies with non-disclosure - to be erroneous and I would appreciate it if you could reconsider disclosing the information requested.

Yours faithfully,

Hilary Aked

FOOTNOTES

[1] See: Shaun Lintern, “Pregnant women died after fears Tory crackdown on ‘health tourism’ would bankrupt them, report delayed until after election reveals”, The Independent, 13 December 2019, https://www.independent.co.uk/news/healt... and Marian Knight et. al., (2018) Saving Lives, Improving Mothers’ Care, MBRRACE: iv, https://www.npeu.ox.ac.uk/downloads/file....

[2] https://www.parliament.uk/business/commi...

[3] https://www.theguardian.com/society/2019...

[4] https://blogs.bmj.com/bmj/2019/05/13/cre...

[5] https://web.archive.org/web/201102011652...

[6] https://ico.org.uk/media/for-organisatio...

[7] https://ico.org.uk/media/action-weve-tak...

FreedomofInformation, Department of Health and Social Care

Dear Ms Aked,

Thank you for your email.

The Department has received your request for an internal review of FOI-1195121 , and will aim to reply within 20 working days.

Yours sincerely

Dorothy Crowe
FOI Team

show quoted sections

Department of Health and Social Care

This is an acknowledgement - please do not reply to this email.
Where a reply is appropriate, we aim to send one within 18 working days,
or 20 working days if your query is a Freedom of Information request or
complaint.

If your enquiry is about a medical matter, please contact NHS 111 or visit
the [1]NHS website, or contact your GP surgery.

You can find general health information on [2]GOV.UK, which includes the
Department’s [3]About Us section.

The Department of Health and Social Care does not process complaints about
the NHS or social services. If you wish to make a complaint about a
healthcare professional, an NHS organisation or a social care provider,
please visit the [4]Complaints Procedure page on GOV.UK.

If you have contacted the Department about a current health or social care
campaign, please visit [5]GOV.UK where a response may have been published.

You can find out more about the Department’s commitments from our
[6]Personal Information Charter.

This e-mail and any attachments is intended only for the attention of the
addressee(s). Its unauthorised use, disclosure, storage or copying is not
permitted. If you are not the intended recipient, please destroy all
copies and inform the sender by return e-mail. Any views expressed in this
message are not necessarily those of the Department of Health and Social
Care. Please note: Incoming and outgoing email messages are routinely
monitored for compliance with our policy on the use of electronic
communications.

References

Visible links
1. http://www.nhs.uk/
2. https://www.gov.uk/government/organisati...
3. https://www.gov.uk/government/organisati...
4. https://www.gov.uk/government/organisati...
5. https://www.gov.uk/government/announceme...
6. https://www.gov.uk/government/organisati...

FreedomofInformation, Department of Health and Social Care

1 Attachment

Dear Ms Aked,

Your requested internal review of FOI-1195121 is now complete. Please see the attached letter for the outcome.

Yours sincerely,

Charlene Carter
Freedom of Information Casework Manager
Department of Health and Social Care
39 Victoria Street, London SW1H 0EU

show quoted sections