Until May 2014, if you were a migrant living in the UK on a ‘settled basis,’ you were eligible for free NHS treatment, just like a UK citizen.
Here’s the government’s implementation of the new Immigration Act and here is our guide to it [pdf]. The Act makes healthcare access more restrictive in two main ways:
1) Anyone from outside Europe who is lawfully applying to work or study here will be forced to pay an extra ‘NHS surcharge’ of up to £200 per year before they are given a visa
2) Charging rules, which used to apply only to secondary care, will now be extended into primary care (GPs) and A&E departments
For many reasons, these changes are a bad idea, not only for migrants but for all of us. They:
- Will cause harm to the nation’s health.
- Will delay and block treatment.
- Unfairly penalise migrants.
- Are based on dubious claims.
When immigration enforcement enters the health service, many people will become scared and deterred from seeking care. Some migrants may not be sure of the healthcare access they are actually entitled to. They may be afraid of having to pay or of having their movements reported to the Home Office and will not seek treatment. Their health conditions will worsen and conditions that could have been more simply treated at an early stage will bring them to A&E at a much greater cost to the entire system (with an even smaller likelihood that they will be able to pay).
Infectious diseases (like TB and HIV) are identified and treated through regular doctors’ visits. If many people are avoiding doctors, then infection rates will rise rapidly. While the Government has made assurances that treatments for such diseases (like HIV medications) will remain free, that doesn’t do much good if people are deterred from going to the doctor and thus don’t know they have been infected. They will only learn this when their conditions have become much more severe.
Since migrants will be treated differently than everyone else, NHS staff will now have to check the immigration status of everyone who uses the NHS whenever they register for a GP practice or go into A&E for emergency treatment.
A&E departments are already very busy and people often have long waiting times. If immigration status checks are forced upon overburdened A&E staff, delays will be more common and all patients will suffer by having to wait longer.
Additionally, a database linked to the Home Office will need to be created, to check who has paid. Immigration statuses change rapidly and the Home Office is notorious for bad record-keeping. If the database is not kept up to date, there is a strong likelihood that people may be denied necessary treatment.
The NHS surcharge forces migrants to contribute more than the rest of us in order to access treatment. Migrants who come to the UK to work or study already pay into the system in many ways – through taxes, National Insurance and VAT. Many migrants even work for the NHS itself. Overall, migrants contribute £630,000,000 to the UK economy (Migration Observatory, Oxford University). Why should they have to pay more on top of all that they already pay?
With the new law, these extra contributions will last every year until the people concerned become permanent residents, which generally takes five years or more. The Act indicates that the health surcharge will go into the Consolidated Fund, so in fact there is no guarantee that the charges collected will directly fund the NHS.
The NHS has never been a contribution or insurance-based system, and this surcharge is a move away from the universal principles on which it was founded. It brings us closer to the American model where certain people are denied care because of their inability to pay.
The Government has made the claim that these measures are necessary to combat the perceived problem of so-called ‘health tourism’, yet their their own report (Qualitative Assessment of Visitor and Migrant use of the NHS in England) acknowledges that their conclusions were drawn from ‘incomplete data, sometimes of varying quality, and a large number of assumptions’ (p. 14). Another Government-commissioned study surveyed over 1,000 migrants accessing healthcare in 15 NHS trusts and found only 4 cases (p. 43) of potential health tourism.
The Government’s own claims of the amount of money lost to ‘health tourism’ have varied widely. Their estimate of the cost jumped from £10m to £2b in the space of 3 months in 2015, based on one of their questionable reports, but that figure misleadingly lumped together a range of groups. The New Statesman has estimated that the cost is somewhere between £70m and £300m, which amounts to at most about 0.3% of the NHS’s total budget.
The benefits of recouping such costs hardly seem worth the financial cost, let alone the risk these measures pose to public health, and the breach of basic medical ethics.
- The Immigration Act passed in May 2014
- An NHS surcharge for migrants was introduced in April 2015
- Hospitals will be required to check identity and bill migrants in advance from April 2017
The DocsNotCops Coalition, along with prominent doctors organisations, advocacy groups, and concerned citizens, is fighting to get the Department of Health to drop these misguided, discriminatory policies before they do too much damage.