Patient exemption

Question

I refer to your amended request of 30 January 2019 in which you asked for information under the provisions of the Freedom of Information (Scotland) Act 2002, as follows:

1. The total number of exemptions from charges payment sought, by year from 2010-present. 

2. The total number of patients who receive a letter in the initial 28 day period querying their entitlement, by year from 2010-present. 

3. The total number of patients who respond to the letter documenting their exemption, by year from 2010-present. 

4. The total number of payments made by patients before a PCN was issued, by year from 2010-present. 

5. The cash value of payments made by patients before a PCN was issued, by year from 2010-present. 

6. The total number of patients who fail to respond to the letter, by year 2010-present. 

7. The total number of the above exemptions sought that were subsequently issued with Penalty Charge Notices (PCNs) by year from 2010-present. 
8. The total number of Penalty Charge Notices that were paid, by year from 2010-present. 
9. Total revenue generated by Penalty Charge Notices, by year from 2010-present.  
10. Any breakdown of the number of PCNs issued for exemptions rejected according to evidence surrounding each of the following by year from 2010-present:

• A. Income support
• B. Income-based Jobseeker's Allowance
• C. Income-related Employment & Support Allowance
• D. Pension Credit Guarantee Credit
• E. Universal Credit
• F. HC2 Certificate
• G. NHS Tax Credit Exemption
• H. HC3 Certificate. 

11. Of the figures identified in 7 (above) how many of the penalty charges issues were appealed against, by year, 2010-Present? 

12. How many of these appeals identified in 11 (above) resulted in overturning of the charge 2010-present? 

13. The number of patients receiving a surcharge by year 2010-present. 

14. The number of patients actually paying surcharge by year 2010-present. 

15. The revenue raised via the surcharge by year 2010-present.

Response

As background, the Patient Claims Team of NHS Scotland Counter Fraud Services (CFS) undertake a national patient exemption checking programme to confirm patients’ entitlement to exemption from NHS patient charges in line with the National Health Service (Penalty Charge) (Scotland) Regulations 1999. 

The answers to questions one to 10, and 13 to 15, are provided in the attached documentation. 

As regards questions 11 and 12, this information is available.  However, CFS would be required to undertake a detailed audit of 56,341 cases.  We estimate that the cost of this would exceed the fees limit as set out in the Freedom of Information (Fees for Required Disclosure) (Scotland) Regulations 2004.  Therefore, CFS is not obliged under Section 12(1) of the Freedom of Information (Scotland) Act 2002 to provide a response.  For information purposes, the fee limit set down by the Scottish Ministers is £600.  We have estimated the cost involved in this audit as follows: 

• 56,341 cases were identified in response to question seven of your request.
• It would take approximately two minutes to audit each individual case which equates to 1,878 hours.
• Applying the Fees Regulation staff cost cap of £15.00 per hour x 1,878 = £28,170. 

In general terms, there is no formal appeal process within the legislation against the Penalty Charge Notice as the process is very definite.  A patient is either exempt at the time they received the treatment/service or they are not.  In certain circumstances, the patient claims team follow a policy and can make a decision to waive Penalty Charge Notices.  It would be inappropriate to make the policy public as it would substantially undermine the national patient exemption checking programme.