Is there space for universal access to healthcare in the 2019 general election?

The NHS has been at the heart of political debate in this election campaign, but how are the NHS’s founding principles reflected in parties’ manifestos?

The NHS is one of the most inclusive healthcare systems in the world. In 1948 it was created out of the ideal that good healthcare should be accessible for all, regardless of wealth. Its founder, Aneurin Bevan, based it on three core principles: that it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.

More than 70 years later, the NHS remains an example of excellence around the world, one of the most beloved institutions in the UK, and a symbol of British values. The commitment to inclusive healthcare has also continued: in 2015, the UK committed to working towards universal health coverage within the Sustainable Development Goals, seeking to expand coverage to everyone in our country. 

The NHS’s founding values are at the root of why many people like me decided to become doctors, and why every day we are proud to go to work. Refugees and migrants living in the UK struggle to access healthcare when they need it. For this reason, I began volunteering with Doctors of the World to provide support to these patients, who often spend years without seeing a GP. At their clinic, I met Sara. She was so scared of being deported or having to pay a huge bill that she had waited as long as she could before asking a doctor about a lump in her breast. It had been so long that her lump was weeping, infected, and enormous. She didn’t have a GP, nor had she received any emergency care. A few months ago, her cancer might have been curable, but now I could only try to help her receive palliative care. 

In 2018, Doctors of the World clinics provided healthcare and support to over 2,068 people who were unable to access NHS services. A lack of understanding about how to register with a GP, language barriers, as well as restrictive laws and polices introduced by successive governments, mean that some of the most vulnerable people in our communities are effectively locked out of the NHS.

When the general election was announced last month, Doctors of the World called on all political parties to continue the global leadership shown when the NHS was founded, ensuring that those who are being shut out of healthcare services are instead welcomed into a genuinely universal system. Based on the experiences of the patients visiting our clinic, we identified key recommendations which we believe are essential components for immigration and health policy in the UK. 

Reading the manifestos, all parties commit to respecting the NHS and its principles, but how do their policies compare and differ in relation to universal access to healthcare?

The fundamental principle underscoring all of Doctors of the World’s recommendations is that the UK health system must be universal and designed to ensure that everyone can fulfill their right to health. While all parties’ manifestos praised the NHS as a free at the point of care service, only Labour and Green Party specified a commitment to providing a universal healthcare service. 

We called on all parties to ensure that everyone living in the UK has timely access to affordable healthcare. This includes ending the policy to charge undocumented migrants and people with unsuccessful asylum claims 150% of the tariff before receiving NHS treatment, and we recommended that everyone who has lived in the UK for three months or longer receives free NHS care. Only the Green Party made a specific commitment on NHS charging, promising to “scrap health charging for migrants” while Labour made a more general commitment to protect “the rights of EU workers, other migrants and refugees” as part of its guarantee to provide universal healthcare. The Conservative manifesto states that under a Conservative government, “migrants will contribute to the NHS—and pay in before they can receive benefits.” This pledge to continue to charge migrants is accompanied by a commitment to double the budget for the “health tourism enforcement unit.”

We also raised the issue of migrant workers’ access to NHS services. Currently, people on a working visa for six months or longer—including NHS employees—are required to pay an immigration health surcharge of £400 per year to receive NHS services. We called on all parties to protect the healthcare rights of EU citizens and, if the UK does leave the EU, to exempt EU workers from all NHS charges, including the immigration health surcharge. The Conservative Party announced their intention to increase the surcharge to £625 a year and apply it to EU citizens arriving in the UK after Brexit. Labour’s Manifesto promised to protect the healthcare rights of EU workers and abolish the 2014 Immigration Act which introduced the immigration health surcharge.  

Doctors of the World also called for a clear separation between the NHS and immigration enforcement, asking parties to commit to establishing a firewall between the NHS and the Home Office. This would ensure confidentiality for migrant patients and prevent Home Office enforcement teams using information collected by NHS staff to carry out enforcement visits at a patient’s home address. While the Labour and Conservative manifestos both did not mention a firewall, its likely Labour’s commitment to “end the ‘hostile environment’ that caused the Windrush scandal” would include abolishing the practice of sharing data between public services and the Home Office for immigration enforcement. The Green Party and the Liberal Democrats manifestos pledged to end this type of data-sharing, with the Liberal Democrats further committing to a firewall between all public agencies and the Home Office. 

Barriers to access to healthcare harm us all. They can cause harm and suffering to patients whose treatment is delayed or withheld. They hurt our NHS and drive patients to expensive emergency care rather than preventative treatment. And they hurt public health, creating an excluded population missing out on public health programmes. My hope is the next government will uphold the founding principles of the NHS, and promote access to healthcare for all. 

Peter Gough is a NHS GP and family doctor. He is a volunteer GP and Trustee at Doctors of the World UK. @khandel_light

Competing interests: None declared.