{"id":37873,"date":"2016-11-25T12:17:05","date_gmt":"2016-11-25T11:17:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37873"},"modified":"2016-11-25T12:31:17","modified_gmt":"2016-11-25T11:31:17","slug":"amar-mashru-passports-smokescreens-and-the-vanishing-nhs-budget","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/25\/amar-mashru-passports-smokescreens-and-the-vanishing-nhs-budget\/","title":{"rendered":"Amar Mashru: Passports, smokescreens, and the vanishing NHS budget"},"content":{"rendered":"<p class=\"Body\"><span lang=\"EN-US\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-37877\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/11\/amar_mashru.jpg\" alt=\"amar_mashru\" width=\"150\" height=\"150\" \/>Chris Wormald, senior civil servant at the Department of Health, has suggested that patients should prove their <span class=\"Hyperlink0\"><a href=\"http:\/\/www.bbc.co.uk\/news\/uk-38062546\"><span style=\"color: black\">eligibility<\/span><\/a><\/span> for NHS care by showing their passport to receive treatment. The proposal was presented as a solution to &#8220;health tourism,&#8221; a problem which may be responsible for around 0.5% of the total NHS spend.<\/span><\/p>\n<p class=\"Body\"><span lang=\"EN-US\">The cost of deliberate abuse of the NHS in this way is estimated at <span class=\"Hyperlink0\"><a href=\"https:\/\/fullfact.org\/health\/health-tourists-how-much-do-they-cost-and-who-pays\/\"><span style=\"color: black\">around \u00a3200m per year<\/span><\/a><\/span>. This is a cost that the NHS can\u2019t afford. Recovery of such money, however, is itself expensive. Passports do not confer NHS eligibility. The issue creates intrigue, discussion, and controversy. Intentionally so.<\/span><span lang=\"EN-US\">\u00a0<\/span><!--more--><\/p>\n<p class=\"Body\"><span lang=\"EN-US\">This week, in the days leading up to the Autumn Statement, the media was dominated by the same message; passports for patients, and the morality and pragmatism of such an endeavour. At the end of an unpredictable, un-poll-able and bizarre 2016, two days before its most critical funding decisions were made, we were denied an honest debate about NHS finances. The spotlight was diverted to the newly familiar rhetoric regarding immigrants, outsiders, the non-contributors, and the non-entitled. The smokescreen won. <span class=\"Hyperlink0\"><a href=\"http:\/\/www.independent.co.uk\/news\/uk\/politics\/autumn-statement-nhs-philip-hammond-missing-document-a7434261.html\"><span style=\"color: black\">The Autumn Statement <\/span><\/a><\/span>pledged no extra money for the NHS.<\/span><\/p>\n<p class=\"Body\"><span lang=\"EN-US\">NHS funding increases are about to drop from 3.8% this year to 1.4% next year and 0.3% in 2018-19 with that final year being the first ever that we will see a per capita <span class=\"Hyperlink0\"><a href=\"http:\/\/data.parliament.uk\/writtenevidence\/committeeevidence.svc\/evidencedocument\/health-committee\/department-of-health-and-nhs-finances\/oral\/41613.html\"><span style=\"color: black\">fall in NHS spend<\/span><\/a><\/span>. The next few years are unsustainable. There is a palpable fear that basic levels of safety are no longer manageable. There is <span class=\"Hyperlink0\"><a href=\"https:\/\/www.kingsfund.org.uk\/press\/press-releases\/kings-fund-responds-autumn-statement\"><span style=\"color: black\">little suggestion<\/span><\/a><\/span> that the Government recognise this, let alone have a strategy for remedying it.<\/span><\/p>\n<p class=\"Body\"><span lang=\"EN-US\">&#8220;We are providing <span class=\"Hyperlink0\"><a href=\"https:\/\/goo.gl\/iiq8AO\"><span style=\"color: black\">\u00a310 billion of extra funding<\/span><\/a><\/span> to the NHS,&#8221; repeated Prime Minister May in Parliament this week, despite Dr Sarah Wollaston, Conservative MP, and the <span class=\"Hyperlink0\"><a href=\"http:\/\/data.parliament.uk\/writtenevidence\/committeeevidence.svc\/evidencedocument\/health-committee\/impact-of-the-comprehensive-spending-review-on-health-and-social-care\/written\/28159.pdf\"><span style=\"color: black\">Health Select Committee<\/span><\/a><\/span> she chairs, revealing that the <a href=\"http:\/\/www.bmj.com\/content\/355\/bmj.i6356\">real figure sits at around \u00a34.5bn<\/a>. The definition of &#8220;extra&#8221; remains controversial at best. By 2020 the NHS deficit will be \u00a330bn. There is <span class=\"Hyperlink0\"><a href=\"https:\/\/www.theguardian.com\/commentisfree\/2016\/sep\/10\/impossible-for-nhs-to-provide-quality-service-something-has-to-give\"><span style=\"color: black\">no slack<\/span><\/a><\/span> left in the system. The only thing left to cut is care.<\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\n<p class=\"Body\"><span lang=\"EN-US\">The concept of a nationally provided, tax funded health service, free at the point of use is one that resonates deeply with the British public; an ideology which has so far survived politics and generations. Our NHS is something we treasure and value enormously, one we see the importance of and are so grateful for when it gives back to the ones we love. So how, in this time of political revolution, where the vote is driving change with unprecedented voracity, is the voice of the people not being heard? One explanation is simple\u2014we can only choose when we are given the choice. We can only answer the questions we are asked. We are not being asked whether we want to fund the NHS safely. That decision has been made. We are being asked what we think about passports. <\/span><\/p>\n<p class=\"Body\"><em><span lang=\"EN-US\"><strong>Amar Mashru<\/strong> is a junior doctor specialising in Emergency Medicine. He works in the NHS.\u00a0<\/span><\/em><\/p>\n<p class=\"Body\"><em><span lang=\"EN-US\"><strong>Competing interests<\/strong>:\u00a0No further interests declared.\u00a0<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Chris Wormald, senior civil servant at the Department of Health, has suggested that patients should prove their eligibility for NHS care by showing their passport to receive treatment. The proposal [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/25\/amar-mashru-passports-smokescreens-and-the-vanishing-nhs-budget\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-37873","post","type-post","status-publish","format-standard","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Amar Mashru: Passports, smokescreens, and the vanishing NHS budget - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/25\/amar-mashru-passports-smokescreens-and-the-vanishing-nhs-budget\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Amar Mashru: Passports, smokescreens, and the vanishing NHS budget - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Chris Wormald, senior civil servant at the Department of Health, has suggested that patients should prove their eligibility for NHS care by showing their passport to receive treatment. 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