NHS charges for migrants and the myth of health tourism
This week, the TUC commented on Department of Health proposals to introduce charges for the use of the NHS by non-EEA migrants. These are deceptively termed ‘visitors’ by the Home Office but this category includes anyone who does not have ‘permanent residence’ in the UK, this could be a nurse from the Philippines working in a hospital in London or a PhD student from Ghana studying in Manchester. If Health Secretary Jeremy Hunt gets his way, they will both have to pay hundreds of pounds before they can get so much as a cough checked out by their GP.
At preset non-EEA visitors who can demonstrate a connection with the UK through residence, study and work are classed as ‘ordinary residents’. This means they are all entitled to free health care. This seems logical, as they contribute to the NHS as much as any UK citizen. The NHS is funded through general taxation, so every item they buy with VAT added, as well as the tax they pay on income, contributes to the NHS. And as our nurse from the Philippines suggests, non-EEA workers also contribute to the NHS directly as health workers. In 2005 IPPR estimated 40% of nurses were non-EEA citizens.
The Government is proposing non-EEA citizens should be forced to pay additional charges to use the NHS due to the mythical problem of the ‘health tourist’. Hunt likes to conjour the image of the health tourist walking among us like a B-movie monster, secreting money from our beloved NHS. The Department of Health consultation states:
‘the NHS struggles to identify and recover the cost from those not entitled to free treatment…We know that this is a significant problem.’
But in July Hunt admitted he didn’t know whether this was a problem at all, saying in Parliament:
‘The truth is that we do not know the cost [of unpaid NHS charges], which is why we are carrying out an independent audit this summer.’
The Department of Health has announced the results of this audit will only be published in the Autumn. So in a strange move the DoH is consulting on a problem that it doesn’t actually know exists.
NHS data certainly suggests non-payment of NHS fees by overseas visitors is not a considerable cost. It currently represents 0.011% of the NHS budget. The impact of this cost is small in comparison to the £20 billion of savings that the Government’s austerity cuts have imposed on the NHS.
Introducing charges for overseas visitors to use the NHS would do even more damage to the service. An entirely new IT system would need to be implemented to check every patient was eligible for healthcare. The visa system for non-EEA citizens would have to be overhauled. Health and UKBA staff would have to be retrained in these new systems.
And if you think that sounds expensive, just wait till you’ve added in the cost to the NHS of non-EEA citizens who can’t afford health fees waiting until their conditions are life-threatening and having to use Accident and Emergency (which would still be free to use). Maternity Action estimate that the cost of an emergency caesarean section and the cost of inpatient care for a very premature baby that could result from lack of antenatal care would be £59, 273 whilst the cost to the NHS of providing antenatal care and a normal birth would be just £3,560.
And then you have the unquantifiable cost of a TB or HIV spreading through the country when non-EEA citizens who might have such infectious diseases cannot afford to go to the doctor to get them checked out.
The health service will also be considerably slowed down if documents checks have to be made before patients can receive care. More importantly, this would turn health staff into immigration officials, impeding their basic obligation to provide care to patients. No wonder health professionals have condemned these proposals across the board – in the BMA, Unison, the Royal College of Midwives, Unite and the Royal College of Nursing.
Discrimination is likely to increase as non-white people and those who do not speak English fluently will particularly targeted for document checks when they go to the doctor.
Already marginalised groups will be excluded even further. Women who are victim of domestic abuse and have little income of their own will not be able to afford treatment or support. Pregnant women who can’t afford antenatal care will develop serious conditions that go undetected until it is too late and both baby and mother’s lives hang in the balance in A+E. Disabled people and those with mental health problems who can’t afford the fees will be left to suffer.
The damages wrought by the proposals make clear the Government’s concern is not the health of society, as I blogged last month. The Tories are unashamedly trying to win votes by claiming to ‘solve’ mythical problems and achieving the illogical and impossible task of limiting the numbers of migrants entering the country, as Owen Tudor blogged yesterday.
The Government’s plans to introduce health charges show that their tactic to score points on migration issues is to target people it thinks are easy to scapegoat – non-white people, migrants, pregnant women. But the targets are themselves taking aim at the Government, forming alliances and fighting back. The calls for everyone to have their basic right to health care respected will only get louder as these proposals are debated in Parliament in the autumn.