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At the heart of general practice since 1960

Jeremy Hunt won't solve the NHS's problems by focusing on 'health tourism'

Dr Kailash Chand

Jeremy Hunt, rather than working to meet the real challenges of the NHS is playing politics with NHS, by his side show of ordering a ’tough clampdown’ that would mean charging people from outside the European Economic Area (EEA) for emergency and primary care, including having broken bones reset, pre-admission stays in intensive care, and rides in ambulances.

Anyone seeking to access the NHS should be eligible to do so and proposals to improve the current system of recovering treatment costs from other governments must be considered. However, there is little evidence that health tourism is a significant burden on the NHS or that migrants and short-term visitors are consuming a large part of the NHS budget. Jonathan Portes of the Institute of Economic Research has said, the extent of deliberate health tourism has been ’hugely overstated’ and is in fact a ’very small part of NHS expenditure’. Estimates of the supposed costs of so-called ’health tourism’ vary dramatically from under £35m to more than £500m. These sums might sound substantial, but even the higher figure accounts for less than 0.5% of the overall NHS budget.

From its birth in 1948, migrant workers were crucial to building the NHS and 67 years on they are as crucial as ever to the functioning of our health service. Thousands of doctors emigrated from India, Pakistan, Bangladesh and Sri Lanka during the 1950s, 1960s and 1970s, to work for a health service afflicted by an acute post-war shortage of medical staff.

Denying treatment to people who need it is inhumane, impractical and could result in further costs to the NHS

In 1978, at the age of 25, I myself moved to England from Punjab, and I have worked for the NHS for 35 years. We know that, like me, 30% of NHS professionals were born overseas. Without them, the NHS would come to a standstill. Shortage of doctors and nurses is already having a huge impact on healthcare.

Most importantly, GPs and other healthcare professionals do not have the capacity or the resources to administer an extended charging system that could require them to extensively vet every single patient when they register with a new practice. At many GP surgeries, patients are already required to provide proof of residence. Anything more would result in another layer of bureaucracy chewing up time and resources that should be spent on treating the most important people in this – the patients.

GPs are already under pressure from soaring patient demand, declining resources and a proliferation of box-ticking targets. We should not be burdened further by having to verify every patient’s eligibility. The government has failed to address the cost of the new structure and it is far from clear that the proposed changes would recoup enough money to cover the costs of setting it up in the first place.

There are also wider risks. Timely treatment keeps people out of hospital, stops the spread of infectious disease such as tuberculosis, and ultimately saves money. Denying treatment to people who need it – including pregnant women, torture survivors, and those with communicable diseases – is inhumane, impractical and could result in further costs to the NHS should a patient’s condition deteriorate.

This proposal is not really about saving money. It is about deflecting the blame for the NHS crisis away from real challenges of resolving the junior doctor’s dispute, A&E crisis and pressures on the NHS due to massive funding cuts to social care and public health. The health secretary would be wise to concentrate on these challenges, rather than being distracted by imposing an unworkable system of charging for health tourism. If this plan comes to fruition it will at best reduce the role of doctors to debt collectors. At worst it will deter them from registering migrants and asylum seekers. Tampering with the core principle of the NHS, that it is free at the point of delivery, runs the risk of loading scarce resources on a minority issue, while the more meaty challenges remain unresolved.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP. 

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Readers' comments (3)

  • Why spend 2 minutes checking identitity, when we can just give them a 10 minute appointment they should not be entitled to!
    Do the math.

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  • Oh dear, oh dear: "the NHS is free at the point of delivery". Its not; it is very expensive, to the tune of billions of pounds a year.
    The contribution of doctors from the Indian subcontinent is acknowledged,but totally irrelevant to funding issues.
    If I fall ill in Dublin or Paris or Rome, or indeed anywhere outside the UK, I will have to contribute to the cost of my treatment. I see no evidence of the collapse of global healthcare as a consequence of administering this charging system, nor of swathes of tuberculous victims collapsing in the streets of Bonn or Bordeaux through lack of care.
    As GPs we cannot complain about constrained budgets and excessive workload on the one hand and yet expect the NHS to fork out when the world and his wife knocks on our door demanding comprehensive medical assistance but with not the slightest intention of contributing to the cost of providing this.

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  • Whether it's 0.5 per cent or 5 per cent of the budget is irrelevant. It's still millions of pounds and that's important. Only those who have contributed should get nhs healthcare. We take our insurance to travel. And so should others. Also anecdotally I do think it's larger than people say. As a GP I have treated and seen people get hospital care for both minor and major problems including cancers on the nhs when they have not been entitled to this. Eg a lady from Georgia here illegally , a gentleman from Nigeria with prostate cancer , several African ladies having abortions on the nhs. Yes, they were all lovely people and yes they were sad and upset . But had not paid into the nhs. And were in the black economy. It's ridiculous that this goes on. It makes no difference what the proportion is of the nhs budget. We need to sort it out.

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