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Doctors must not be agents of border control



Last month, delegates at the BMA’s Annual Representative Meeting in Belfast voted overwhelmingly in favour of abandoning the practice of charging overseas patients for NHS services. The right-wing media had a field day condemning the motion, but conveniently forget that we, as doctors, are committed to dealing with the wellbeing of humanity.

An emergency (life or death) presentation in a GP surgery or A&E draws on the skills of medics who are expertly trained and indeed must adhere to a professional code to preserve life. We are not in the profession to ask:  ‘Where is your wallet please?’

Of course, we must ensure that those seeking to access healthcare in the UK are eligible to do so. 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. The extent of deliberate health tourism has been ’hugely overstated’ and is in fact a ’very small part of NHS expenditure’.

The NHS is wasting billions of pounds a year through inefficient use of staff, paying over the odds for supplies, ‘bed-blocking’, missed appointments, marketisation and undue reliance on agency workers. The cost of hospital litigation and defensive medical practice is high, and now runs at £5 billion per year.

There is insufficient evidence that ‘health tourism’ is costing the NHS  large amounts of funding

By its very nature, it is impossible to put a figure to how much this ‘health tourism’ costs, but experts put it at anywhere between £200 million and up to £2 billion. This is a lot of money, but it is a drop in the ocean of NHS England’s budget of more than £100 billion a year.

Even if we can find a way to identify and charge these people – and this wouldn’t be easy – it would make no real difference to the strains on your local hospital or GP surgery.

The NHS has been obliged to collect money from foreign patients since 1982, when charging regulations were first introduced. These state that only patients who are ‘ordinarily residents’ in the UK – and have lived here for at least six months – are eligible for free treatment, operations and scans. This excludes GP and A&E services, which are currently free for all.

I agree that those accessing NHS services should be eligible to do so, and that we recover the costs for treating overseas visitors. There is a legal requirement for hospital trusts to verify the eligibility of accessing healthcare. The systems to do this need to be practical, economic and efficient, and must not jeopardise access to healthcare for those who need it.

What matters is that doctors should not be asked to be agents of border control and become an arm of the immigration service. All doctors have a duty of care to all people seeking healthcare, and should not be expected to police access to it, and turn people away when they are at their most vulnerable. It is important to protect individuals and public health.

In my view, any charging systems should not prevent sick and vulnerable patients from receiving necessary care. Otherwise, there may be serious consequences for both their health and that of the public in general.

If the Government is concerned about ‘health tourism’, it should change the law, and require all visitors to have health insurance cover before they are granted a visa.

Dr Kailash Chand OBE is a retired GP in Tameside