Andrew Moscrop: Should we extend NHS charges for overseas visitors and migrants?

Jeremy Hunt has been talking “tough measures.” Not junior doctors’ contracts, but migrants. Overseas visitors and migrants who get sick in Britain should be charged for using A&E and primary care health services, the Health Secretary says. Until now, non-UK residents have only ever had to pay for non-urgent hospital care. Jeremy Hunt proposes that foreigners should start paying for their own ambulance call-outs, diagnostic blood tests, chest x-rays, plaster casts, and so on. This, he thinks, might recoup “up to £500 million per year” for the NHS.

It all resonates emotively with public concerns about protecting scarce NHS resources and foreigners taking what is rightfully ours. And it recalls the dismal nadir of last year’s televised election debates. “You can come to Britain from anywhere in the world and get diagnosed with HIV and get the retroviral drugs that cost up to £25,000 per year per patient,” pronounced Nigel Farage, leader of the right-wing UK Independence Party (UKIP). “We’ve got to put our own people first,” he said, calling attention to the cost to the British taxpayer. His comments were vehemently denounced by leaders of all the other parties, except the Conservatives. Hardly surprising. When UKIP asserted that the NHS is a “national health service, not an international health service,” they were simply repeating word-for-word Jeremy Hunt’s own sentiment and sound bite.

Hunt’s proposals have been reported uncritically in The Daily Telegraph as part of the Health Secretary’s plan to root-out “health tourists“—people who allegedly visit Britain in order to take advantage of our health services. Elsewhere, Hunt’s plans have been censured for complicating healthcare, adding to the workload of NHS staff, and turning hospitals into “24-hour supermarkets.” The BMA’s Mark Porter has pointed to the large numbers of migrants and visitors residing in Britain who, in the event of becoming unwell, might be put off seeking healthcare by the proposed charges. He also highlights the public health risk of people being disincentivised to access diagnostic tests and treatments for infectious diseases.

But the NHS is “overly generous” to non-UK residents, says Hunt, “particularly in comparison with what UK residents can expect when they travel abroad.”

It is a sad appeal to pursue the lowest standards possible. And it concedes to the wretched truth that many people, in many countries, are not fortunate enough to have a public health service that is free at the point of delivery. We do in Britain, and to withhold its benefits is churlish and divisive. Drawing lines around healthcare entitlement creates a device of social exclusion, one felt most keenly by the vulnerable and the sick. To draw these lines on the basis of citizenship or residency turns healthcare into a tool for immigration control.

“The principle of fairness” is cited by Hunt. “We want to make sure that everyone makes a fair contribution to services,” he says. But there is nothing fair about a system in which some people may be unable to afford healthcare, or may become impoverished by its cost. And these outcomes are no less unfair if those people happen to be migrants or visiting from overseas. It was to combat this unfairness that the NHS was created. Instituting financial barriers to healthcare and burdening individuals with the cost of their care is antithetical to the very founding principals of the NHS. More wealthy visitors and migrants may not suffer from the proposed changes, but less wealthy ones will. Jeremy Hunt’s proposed policy creates a mechanism of injustice that will worsen health inequities. That the NHS is at risk of becoming a vehicle for these outcomes reveals its real crisis. To save the NHS we must hold fast to its values. Without them it will not be worth preserving.

Public consultation on the proposed NHS charges for overseas visitors and migrants began on 7 December 2015 and remains open until 7 March. The proposals can be reviewed in depth and views can be submitted online.

Andrew Moscrop is a general practitioner.

Competing interests: None declared.