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The waiting game

Charging migrants to use the NHS will cost more than it saves

The Government’s short-sighted plans to crack down on ‘health tourism’ will be detrimental to patients and could also affect the NHS workforce, many of whom are born overseas, writes BMA deputy chair Dr Kailash Chand

The debate around health tourism was front and centre last week when the Government published its proposed Immigration Bill, which includes plans for a levy on the visas of migrants seeking to settle in the UK. Sadly, the discussion often focuses on the mistaken belief that migrants, overseas visitors and illegal immigrants are costing the NHS vast amounts of money.

Of course, we must ensure that those seeking to access healthcare in the UK are eligible to do so and there is little doubt that the current system needs tightening up, but there is insufficient evidence that health tourism is genuinely consuming large amounts of NHS funding. Similarly, there is no significant data to support the suggestion that a substantial number of overseas visitors are coming to the UK specifically to seek out free treatment.

In addition, the health levy could start a trend where we put up financial barriers to highly skilled migrants who wish to enter the NHS workforce. We are dependent on highly trained doctors coming to the UK to plug staff shortages in key services, such as emergency care and geriatric medicine. If we start making it less attractive for these workers to join the NHS workforce – after years of positively encouraging them to move to the UK – then we will potentially damage patient care.

The NHS itself was developed with the help of immigrant workers and professionals from across the world. 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.

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.

I am hoping that when the Department of Health publishes its response to the consultation, its plans will be heavily amended after pressure from organisations like the BMA. Originally the DH proposed a vetting system for patients before they can access NHS care and measures that could lead to those who fail to provide evidence of their residency or proof that they can pay for care being denied treatment.

Already, patients are required to provide proof of their residency in the area where they register with a GP. Anything more would result in another complicated layer of bureaucracy being introduced into general practice - for a system where the money recouped is unlikely to cover the cost of setting it up in the first place.  

More worryingly, this approach could impact directly on patient care; as everyone will need vetting, and patients could face delays when they sign up to a practice. If patients feel unable to visit a GP for fear of cost it could lead to far more complex health problems and further costs to the NHS. Timely treatment is vital as it keeps people out of hospital, stops the spread of infectious diseases and ultimately saves money in future treatment costs.

At the moment, the Government has only given us a first look at its supposed crackdown on health tourism. I hope that when we get the rest of their proposals, ministers will have listened to health professionals and ensured that policy is driven by practical, clinical evidence.

Dr Kailash Chand is deputy chair of the BMA. You can follow him on Twitter @KailashChandOBE.

Readers' comments (14)

  • Patients do not have to provide proof of residence to register, it's an individual practice decision . There is no government rule about it.
    If a practice chooses to ask for proof of residency then it has to be applied to all patients to avoid discrminination.
    I would suggest you could change your practice policy if you are asking for proof.

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  • There is a distinct difference between 'migrants' and 'overseas visitors' that often sees the two groups confused with each other. The article states"........ there is no significant data to support the suggestion that a substantial number of overseas visitors are coming to the UK specifically to seek out free treatment." I suggest Dr Chand speak to the Overseas Visitors Manager at any major hospital (particularly in London) and ask them if overseas visitors are a problem - the answer will be an emphatic "yes". It is unfortunate that little data has been kept, but that is in part because the DH has not wished to acknowledge the problem for many years. The very grey guidelines for primary care encourage anyone from anywhere in the world, regardless of residency status, to register with a GP, whereas the guidance for secondary care is much more robust, and states that an overseas visitor (where not exempt) MUST be charged for care; however if a visitor has been referred by a GP, it is easier for the Trust to let the CCG pay than to invoice a chargeable patient. Part of the answer is to have consistency between primary and secondary care ie to charge overseas visitors in both settings. It is unfortunate that many people the world over believe that 'the NHS is free'; visitors to the UK should not expect 'free' to refer to them. The NHS can no longer afford to treat the world.

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  • I am confused by Dr Chand's comments. The fact that numerous migrants came to the UK across the decades and worked diligently to make the NHS what it is today is irrelevant to the issue in question. As an Overseas Visitor Manager of 8 years, I am supported very well by Migrant NHS staff, who see first hand the abuse of the NHS by visitors to the UK. These are often visit visa holders, visa over stayers and absconders. The NHS is a target for overseas patients, who can register at GPs without proof of residency and abuse the fact that hospital care is free at point of entry. Services paid for by UK citizens, whether indigenous or migrant. The definition of the word migrant is "a person who moves from one place to another in order to find work or better living conditions" it s not a person who goes to another country to obtain healthcare by deception at the cost of that country's lawfully settled residents wherever they came from in the world.

    A patient who requires immediate and necessary treatment is never denied they care they require. Establishing eligibility could be straightforward, it is the bureaucracy surrounding the fear of offending people that is the biggest problem.

    Would Dr Chand be kind enough to respond and confirm whether he would condone tourists coming to the UK to obtain healthcare. If not then he is starting to understand.

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  • Edoardo Cervoni

    I subscribe and very much welcome Dr Kailash Chand's letter. Politicians too often try to satisfy the "gut" of the voters, which would not be a problem if the "gut" had not been "ignited" by the press going after the "next scandal".
    Dr Chand has only been rational.

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  • The bottom line here is that 1) we are governed by 'emotional blackmail' because of the nature of the service and 2) in our minds we are not separating the genuine cases from the blatant abusers. If we focus on the genuine cases, then we look discriminatory and callous. If we look at the blatant abusers then we have to be practical and look at the huge negative impact this is having on the our healthcare system. I would ask any settled resident in the UK, do you want people coming from overseas solely to take advantage of the NHS, which you are relying on to be able to fund care for you and your family? Please someone answer the question. I am someone who is a second generation immigrant, working in healthcare and who has a huge heart, massive empathy but is practical.

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  • This comment has been moderated.

  • It seems that UK is out of step with the rest of the EU who charge UK and other visitors for health care despite the apparent rules.
    It also seems that there is a scarcity of facts to show what are the economic facts as how to act in the UK. All that I can see in these columns are very varied opinions some of which could have personal bias.
    If I lived in France I would like my compatriots and also relatives from non UK countries such as and Canada to have exactly the same unrestricted access to medical care as the French but I am not sure that this is so in France- or Spain, Germany, Italy etc.
    If charging is so uneconomical why are we so alone in providing free medical care for the whole world?

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  • "If I lived in France I would like my compatriots and also relatives from non UK countries such as ? and Canada to have exactly the same unrestricted access to medical care as the French.....".............and who do you suggest should pay for the treatment for all your compatriots and relatives who don't actually live in France? The French certainly don't agree with you on that utopian idea; and even if you have an EHIC in some other EU countries (Spain for eg), you may well be charged for care. and it's not that easy to get re-imbursed either.

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  • Dr Chand seems to conflate illegal immigrants with legal immigrants. His opinions are devoid of facts and sympathetic with the continued arrival of immigrants in an over-crowded island with a concomitant threat and damage to the UK's infra structure. He denies the drain on NHS funds by the well-known exploitation of our health services by overseas visitors, a fact that is staggeringly obvious, even to the man on the Clapham Omnibus. As for immigrants helping out the NHS, a minority through low training standards compounded by language issues, have done much harm to NHS patients.

    Sad to say that the article contains more heat than light!

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  • As a community nurse in an inner city area I must disagree with the arguments of Dr Chand. Unfortunately the issue of non residents accessing health service resources both in hospital and in the community has never been properly investigated. This is largely due to successive governments not wanting to appear 'racist' on such an emotive topic as health provision. I can assure Dr Chand that in my personal observations there are many people accessing NHS services both hospital and community who are not entitled to do so and I don't believe if these costs were correctly collated that the ammount lost to the NHS would be insignificant at all. I see many older people joining family who are already living here for a holiday but who never seem to return home due to health problems which are then treated free of charge coutesy of the NHS. We cannot continue like this when resources are so stretched with an ever increasing elderly population.

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  • It would be useful if Dr Chand responded to the comments above.

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