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UC & NHS charges exemption - NHS BSA doesn’t understand UC?

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Peter Turville
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We are all familiar with the problems with exemption and ESA-IB & ESA-C and confusing ESA award notices. Latest from the NHS Business Services Authority. Client was on ESA-IB and then UC (lone parent with LCFW and no earnings).

“The award notice you sent shows the client did not meet [any of the] conditions, so she was not entitled to claim free NHS prescriptions.”

Client met every criteria for exemption!

How many other claimants are receiving penalty charges because the BSA do not understand UC payment notices (or info. from DWP they can access)?

Issue raised with clients MP.

     
ClairemHodgson
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it’s more a case of UC hasn’t been added to the form (and links to similar issues round free school meals).  MP’s need to raise it, of course, and it’s yet another (? unintended or intended?) consequence of UC being NFFP

     
Daphne
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We raised the lack of a box for UC on the prescription forms at stakeholders forum again yesterday for what it’s worth…

     
Phil R
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Daphne - 06 June 2018 10:12 AM

We raised the lack of a box for UC on the prescription forms at stakeholders forum again yesterday for what it’s worth…

This was an issue when I worked in Ashton JC in 2013 on the pilot. 5 years later and no change.

     
Peter Turville
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In our case the issue is not the lack of an appropriate tick box on the prescription (which arguably is pointless without info. on the actual qualifying criteria for a person receiving UC) but the BSA having been provided with clear evidence that the client met (all of the possible) criteria still determining that she did not! The only evidence a claimant can provide to the BSA is the relevant UC payment statement.

Maybe the issue is that older versions of the payment statement did not include info about exemption from NHS charges etc.  whereas the current version does. But it still does not state that the individual is eligible so BSA would still have to undertand the full statement to check eligibility.

      [ Edited: 6 Jun 2018 at 02:00 pm by Peter Turville ]
AMuller
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I had to check UC and prescription charges for a client and found the NHS website rather confusing.

The prescription page has a link to a UC page:  https://www.nhs.uk/NHSEngland/Healthcosts/Pages/universal-credit.aspx 

It says there that you should present your award notice but then it also seems to suggest that you should tick a box for Income based JSA:

“You should present a copy of your Universal Credit award notice to prove your entitlement. You’ll need to have met the eligibility criteria in the last completed Universal Credit assessment period before your health costs arose.”

” Not all help with health costs claim forms have a tick box for Universal Credit. If that’s the case, you should tick the box for income-based Jobseeker’s Allowance instead.”

I don’t know what the pharmacist is supposed to do when processing the prescription, but unless they have to add some information about having seen the UC award, ticking a JSA box when in receipt of UC does not sound a good idea to me

 

     
Mike Hughes
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I hadn’t really twigged to this before but does this means that someone who slips on and off UC thanks to the vagaries of either payment dates or income changes could be faced with the prospect of being able to claim prescription exemption one month but not the next?

I am of course assuming they get the topic of this thread correct but in the context of https://www.theguardian.com/society/2018/mar/10/nhs-falsely-accuses-thousands-patients-prescription-fraud even that doesn’t seem especially likely.

     
Andyp5 Citizens Advice Bridport & District
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Mike Hughes - 13 June 2018 03:38 PM

I hadn’t really twigged to this before but does this means that someone who slips on and off UC thanks to the vagaries of either payment dates or income changes could be faced with the prospect of being able to claim prescription exemption one month but not the next?

I am of course assuming they get the topic of this thread correct but in the context of https://www.theguardian.com/society/2018/mar/10/nhs-falsely-accuses-thousands-patients-prescription-fraud even that doesn’t seem especially likely.

Looks that way, as with slipping in and out of the benefit cap from one assessment period to another.

See page 9 of the attached.

‘Help with Health Costs (Department for Health and Social
Care/NHS):
NHS implemented earnings thresholds for Help with Health Costs under Universal
Credit in December 2016. These are £935 per month for claimants with children or
limited capability for work, and £435 per month for all other claimants.
Claimants self-declare entitlement for Help with Health Costs, e.g. by ticking on the
back of the prescription form. UC is currently not included on the form and claimants
are advised to tick the box for income-based Jobseeker’s Allowance. DHSC plan to
introduce a UC box on the prescription form by the end of the year.
If they are not sure whether they meet the criteria, claimants should pay for their
health costs and can claim a refund once they confirm entitlement’.

 

     

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Jon (CHDCA)
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For free school meals, there’s some convoluted way of looking at UC passporting over 3 assessment periods rather than one. I wonder if something similar might work for prescriptions, to smooth out entitlement?

Ref: https://www.rightsnet.org.uk/forums/viewthread/12459/

     
Mike Hughes
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“If they are not sure whether they meet the criteria, claimants should pay for their health costs and can claim a refund once they confirm entitlement”.

Yes sirree, people will be queuing up for that option!

     
shawn
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Universal Credit rollout bungle blamed as over 1million people are fined for mistakenly claiming free prescriptions

https://www.mirror.co.uk/news/politics/universal-credit-rollout-bungle-blamed-12955235.amp

     
Peter Turville
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Our client has now received two further penalty notices (for seperate charges) despite remaining exempt!
A strongly worded complaint has been sent!!

     
Billy Durrant
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I have to say that the letter cancelling the fine is also pretty graceless. No apology for wrongly issuing a large fine just a lecture about not everyone on UC being entitled to free prescriptions and how the onus is on you to check entitlement. This my latest one, it refers to your take home pay being “below a certain amount” but doesn’t even specify what that amount is! This whole business of not providing a box to tick UC and issuing fines first then asking questions later is indicative of an organisation treating sick and disabled people with utter contempt.

Dear X,

Thank you for your email.

Being entitled to Universal Credit doesn’t automatically entitle you to free NHS prescriptions as you must meet additional qualifying criteria, such as your take home pay being below a certain amount.

Your entitlement is based on your Universal Credit statement for the last complete assessment period prior to collecting your prescription and it is your responsibility to check your entitlement before claiming it for free.

This Penalty Charge Notice (PCN) has been closed and you don’t need to pay anything.

If you qualify for free NHS prescriptions via Universal Credit in future, please select box K (Income Based Job Seekers Allowance) on the back of your prescriptions.

Please give us your views on the service you received today by taking part in our survey http://ow.ly/gZxx30fVVsv

If you have any queries regarding the Prescription Exemption Checking Service you can visit our ‘Ask Us’ page at http://www.nhsbsa.nhs.uk

If you require any further assistance please contact us by email or telephone us on 0300 330 9291.

Yours sincerely,

Customer Contact Agent
Prescription Exemption Checking Service
Website: http://www.nhsbsa.nhs.uk/nhs-penalty-charges

     
Mr Finch
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Hmm. Attached is an example from Google. Does an invitation to ‘contact us as soon as possible if…’ properly comply with the requirement that the notice must state :

(g)that a person is not liable by virtue of a penalty notice—
[...]
(ii)to a penalty charge, or a surcharge, if he shows that he did not act wrongfully, or with any lack of care

especially given the threatened increase if payment isn’t made.

http://www.legislation.gov.uk/uksi/1999/2794/regulation/2/made

     

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Peter Turville
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The ‘lack of care’ is on the part of the NHS BSA for not making proper checks before issuing penalty notices. They are acting ‘wrongfully’ by not providing clear information about ‘exemption’ criteria either in their own information or with DWP on the UC payment notice and finally by advising claimants to give incorrect information by ticking the JSA(IB) box.

     
Peter Turville
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We have now received a reply from the NHS BSA which includes:

“A PCN [penalty charge notice] requesting the unpaid NHS charge as well as an additional NHS penalty charge is sent to a patient where entitlement to the exemption claimed, cannot be confirmed.”

“To explain further, the DWP do not currently check agaisnt the UC database so a patient would need to send evidence to show that they were exempt at the time of their NHS prescription or NHS dental treatment should they receive a PCN. Regrettably the NHSBSA have no control over the checking process with the DWP”

“Exemption checks are carried out at random and as such, we are unable to prevent further checks being carried out.”

“The qualifying criteria will be checked upon receipt of the UC award or statement to confirm the patient’s eligibility”

“....each FP17 patient declaration form should now include the option to indicate UC. Where this option is not present on NHS prescription forms, patients in receipt of UC are advised to declare Income-based Jobseekers Allowance ...”

Brilliant! - DWP do not currently check against UC database so claimants need to send the NHS the evidence! - another fine example of joined up thinking / action within government and passing ‘compliance costs’ onto claimants / other organisations.

Perhaps claimants / advisers should send the NHS BSA a PCN every time we have to do their job for them? What will happen once managed migration begins? How many UC claimants are paying the charge & penalty when they are exempt following receipt of a PCN?

Daphne - one for stakeholders?