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.