I remember trying to talk to a teenager from Afghanistan whose family were killed in front of him and who had been imprisoned, subjected to torture and probable sexual assault. He had tried on repeated occasions to throw himself from the balcony of his cousin’s house. He had received no psychiatric help and had no GP.
I remember seeing two women in one day who were both 39 weeks pregnant, who’d had no antenatal care because they were refused GP registration.
I’ve seen women who have given birth at home, unassisted, because they couldn’t access care. I’ve seen individuals with advanced cancer, heart failure, diabetes, and other conditions -all denied access to care.
These are just a few of the hundreds of cases I dealt with while volunteering for Doctors of the World’s drop-in clinic in east London. Despite the situation already being critical for many here in the UK, this year the government published two consultations to extend current provisions for charging migrants accessing the NHS based on alleged costs of ‘health tourism’.
Some of the proposals in the consultations are reasonable and sensible, such as strengthening mechanisms to recoup charges from other European countries and ensuring that those who should be insured – such as tourists, foreign students and economic migrants – use their insurance to pay for their healthcare costs.
But the economic and ethical justifications fail in the proposal to charge those in clinical need who have no way of paying the £200 levy, or any other costs for that matter. These include vulnerable groups such as undocumented migrants (who have no access to public funds), trafficked people (usually women and children), visa over stayers and domestic slaves.
We need to get the facts straight and debunk the two main myths propagated by the media, politicians and even some healthcare professionals around this subject: the myth of ‘health tourism’, and the myth of the UK’s ‘soft touch’ on asylum seekers.
Firstly, there is little evidence that access to healthcare services plays a significant role for attracting migrants to the UK and ‘health tourism’ is being deliberately conflated with forced migration. Seven years of data from Doctors of the World’s walk-in clinic in London shows that on average service users wait more than three years before trying to access healthcare and less than two percent come here for health reasons.
The actual sum lost treating foreign nationals is around £12 million, around 0.01% of the NHS budget compared to the £16.3 billion contribution made by migrants to the UK economy. A sobering comparison is the £10 billion (and rising) cost of taxpayers’ money spent on failed IT schemes in the NHS.
Secondly, Britain is a low provider for asylum compared to the rest of Europe and there has been a sharp decline in asylum applicants to the UK since 2002. The UK has less than two percent of the world’s refugees, 0.33% of the UK population. Two-thirds of asylum applications fail here and only one-fifth of appeals are successful.
The economic case against charging migrants
Ascertaining who should be charged for care would represent an enormous and expensive administrative burden and a huge imposition on a large number of UK residents. It would not be legally permissible to only ask some residents for proof of eligibility, as this would be discriminatory.
Moreover, prevention is better and cheaper than cure. By denying access to primary care, more sick people will be driven to presenting at hard-pressed A&E departments where care is much more expensive. Untreated infectious diseases can spread in communities and lead to more serious illnesses requiring costly secondary care. A Doctors of the World study showed that a timely diagnosis and treatment of Type 2 diabetes amongst irregular migrants would save the NHS £1.2 million.2
Thankfully, the argument has finally been made for HIV with treatment free to anyone diagnosed with the virus in England regardless of their eligibility for NHS care, which was not the case prior to October 2012.
The UK, despite the recession, is not a poor country and this state of affairs is shocking and unworthy of a civilised nation. Even if we believe some individuals should not be in the country, are we independent professionals or border agents of the state?
Refugees and asylum seekers represent a burden of care for busy practitioners. Many practices already offer them a wonderful service, but CCGs, local authorities and NHS England should ensure there are adequate resources to cover vulnerable people. They should indeed reward, not penalise, practices for their hard work, enabling them to deliver culturally sensitive, competent and compassionate care.
Dr Paquita de Zulueta is a GP working as a volunteer in Doctors of the World’s clinic in Bethnal Green, London.
1 Doctors of the World. “The truth about “health tourism”. 16 August 2013.
2 Economic evaluation of extending entitlement to healthcare to irregular migrants. A case study of Type 2 Diabetes. Final report October 2011 by Matrix Evidence.