The government this week announced the first part of its planned crackdown on health tourism, with the Home Office unveiling a host of measures, including plans for a health levy on the visas of migrants seeking to settle in the UK.
The debate around this issue often focuses on the misconception, sadly sometimes repeated by politicians, that migrants, overseas visitors, and illegal immigrants are costing the NHS vast amounts of money. There is little doubt that we need to ensure that all those seeking to access care in the UK need to be eligible to do so, especially at a time of financial difficulty. That is why there is already a system in place where the government can claim money back from EU countries for the treatment of their citizens by the NHS, although it is possible this framework could be tightened up.
But in truth, there is scant evidence that health tourism is genuinely consuming large amounts of NHS revenue. It is a similar situation when it comes to the suggestion that there is a substantial cohort of overseas visitors who come to the UK specifically to seek out free treatment—the facts to back up the oft used assertion are simply not there.
There are further problems with some of the proposals that the government is now pursing. The health levy announced this week runs the risk of starting a trend where we begin to put up financial barriers to highly skilled migrants entering our workforce. In the case of the NHS, we are dependent on highly trained doctors coming to the UK to plug staff shortages in key services, such as emergency care and geriatric medicine. If we start making it less attractive for these workers to join the NHS workforce—after years of positively encouraging them to move to the UK—then we run the real risk of damaging patient care.
Further unintended consequences could result from the government’s other proposals which we are likely to hear about soon. The Department of Health consultation, which hopefully will be heavily amended after pressure from organisations like the BMA, included proposals for a vetting system for patients before they access NHS care and draft measures that could lead to the denial of treatment to some groups that fail to provide proper evidence of their residency or proof that they can pay for care.
Dealing with the first matter, patients are already required to provide proof of their residency in the area when they register with their GP. Anything more would result in another complicated layer of bureaucracy being introduced into general practice that is likely to chew up time and resources that should be spent on treating patients. GPs are already under pressure from soaring patient demand, declining resources, and a proliferation of tick box targets: they do not have the time to act as border guards as well as doctors. It is also questionable whether the money recouped from any system would actually cover the cost of setting it up in the first place. More worryingly, this cumbersome approach could directly impact on patient care. All patients could face delays when they sign up to a practice as everyone will need vetting.
There are also wider implications of discouraging or charging for access to care. Timely treatment keeps people out of hospital, stops the spread of infectious diseases such as tuberculosis, and ultimately saves money in future treatment costs. Denying healthcare to people who need it—including pregnant women, torture survivors, and people with communicable diseases—is simply inhumane and unpragmatic.
At the moment, the government has only given us the first course of this supposed crackdown on health tourism. I hope that when we get the rest of their proposals, they have listened to health professionals and ensure that policy is driven by practical, clinical evidence.
Kailash Chand has been a GP for last 30 years. He is deputy chair of the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. The views he expresses in his blog posts are entirely his own.