From the TUC

What to do when you have an accident. If you’re foreign.

30 Dec 2013, by in Public services

The Government is apparently going to announce later today that they are changing their plans to restrict NHS access for foreigners. It’s good news that they have listened to concerns from Doctors’ groups, unions and migrants’ rights advocates and dropped plans to demand proof of entitlement before accessing GP surgeries. But their plan B – requiring people attending A&E to pay if they aren’t registered with the NHS – is probably worse.

The impact – as Ministers are likely to claim – is likely to deter people from attending A&E. But it won’t necessarily deter the people Ministers want to deter, and it will deter many for the wrong reasons, such as fear of the cost, fear of having their immigration status questioned, and fear that their treatment will be based on something other than clinical need, like race, colour or religion.

It will mean people who need treatment not getting it – even children. And it will turn a different group of NHS staff into border police and debt collectors when Government cuts have made the NHS desperately short of clinical staff.

This isn’t to say that there aren’t people cheating the NHS – although the Government has been totally unable to prove how many people are doing so, or at what cost. It’s about a proportionate response to a rather nebulous problem. Is it worth preventing people who are entitled to free treatment from seeking it, just to deter an unknown number of cheats?

Many of those who are deterred will be people who would still be entitled. Some people don’t actually know whether their immigration status – which can be very confusing – entitles them to free NHS treatment. Parents may well not understand the immigration status of their own children, especially in those moments of panic when you need to decide whether to head to A&E or call an ambulance.

Some people who should pay and could pay will be deterred  but don’t know how much it will cost or whether they can afford it. And levying a charge on an A&E patient isn’t the same as making them pay. Until people are actually made to empty their wallets or frog-marched to a cashpoint before treatment, you can’t make people pay, so bills will remain uncollected and cheats will still be able to evade charges. The Telegraph says that:

“Failure to present the correct identification could see them chased for any debts by a new central recovery system which will work across the NHS.”

Just what the NHS needs – more bureaucracy, and more unpaid bills!

At the moment, as the website for Parliament’s nearest hospital says, patients arriving in A&E are asked questions about their medical situation, asked for personal details and then treated according to need. Charges aren’t mentioned, because although the NHS does charge for some treatments, A&E isn’t one of them. And presumably the unconscious ones, and the ones requiring immediate medical attention, aren’t asked for their NHS number and still won’t be, whatever the Government says.

On balance, this is probably just another example of a policy designed to give the impression of being tough on immigrants. It suggests that the tonal change called for by the modernising Conservative think-tank Bright Blue over Christmas hasn’t been taken on board.