NHS Charges for Foreign Visitors

Over the last couple of days you have probably heard Health Secretary Jeremy Hunt has been talking about introducing an ‘NHS fee’ for non-EU nationals. It has been suggested that this will be two hundred pounds per year, payable when visas are applied for or renewed. This is required, it is suggested, to help combat ‘health tourism’, or unpaid use of the NHS by those who are not entitled to free treatment.

Is such a fee reasonable? The NHS does, of course, already have systems in place for charging those who are not entitled to free treatment, either by claiming the fees back from the health system of the country where the person is from, or from their insurer. Even so, because in GP surgeries and (especially) in hospitals there is not a culture of having to prove who you are before you get treatment, some of these people slip through without paying. The cost of this to the NHS is estimated to be between ten and thirty million pounds per year.

That sounds like a lot, but is it really? One must consider the cost of implementing some sort of identity checking system at all GP surgeries (there are 8,230 in England) and hospitals (there are 168 run by acute trusts in England, plus a few dozen more run by CCGs and other organisations). Let’s consider the GP surgeries first. Let’s say some sort of ID-checking system or contract costs the surgery 10,000 pounds a year, that’s 82,300,000 pounds. Woah! Suddenly we’re paying at least 2.5 times the ‘lost’ money. Let’s be generous to the government and say the system is a tenth of that - 1,000 pounds. That’s still 8,230,000 pounds. Let’s face it though, it’s certain to be more. Then there is someone’s time to run every new patient through the system. If that takes half an hour or so and that member of staff is earning the national average salary, that’s 8 pounds per new patient. That might not sound much, but it soon adds-up as this is all new patients, not just immigrants or people on visas. And then, of course, we have to add the cost of checks in hospitals.

All in all we can be fairly sure that the cost of implementing the checks will cost considerably more than the supposed savings we can make. But is the ‘health tourism’ cost real anyway? Anyone here on a visa is paying their taxes, just as a resident is. In fact, if they’re on a working or tourist visa they’ve probably paid more tax and claimed less in benefits during their time in the UK than many born-and-bred UK residents. Why shouldn’t they receive NHS care?

Of course, even though Hunt’s sums are almost certainly wrong, that’s not really what he cares about. It’s nothing to do with charging immigrants, it’s about introducing a charging system full stop. Yes, it will start with immigrants, and the Tories will use the rise in UKIP-style xenophobia to justify spending more on stopping foreigner’s receiving NHS care than they can save by doing so. “It’s not about the money, it’s about fairness!” they’ll cry. And then there will be a charging system in place for NHS care. Before you know it, UK citizens will start to be expected to pay towards NHS treatment, or ‘top up’ certain payments. This isn’t speculation - we must always remember that Jeremy Hunt has put his name to a number of books and papers that advocate the end of the NHS being state funded and a move to it being a system of delivery run by private insurance. Then there are Tories such as Oliver Letwin, who is Minister of State remember, who famously said in 2004 that the NHS will “cease to exist within five years of a Conservative victory”.

So no, the charges for holders of visas don’t make sense, but then they are not really the objective. The real agenda here is the longstanding Tory ambition to charge us all for healthcare and end universal coverage, and this is simply a way they can use the xenophobia stoked-up by people like Farage to achieve this end without too much public outcry.

I will leave you with the thoughts of Nye Bevan, creator of the NHS, on foreigners using the NHS. It’s as true today as it was then:

“One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous … The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities … They make no direct contribution to the cost of the Health Service any more than does a British citizen. However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together …” (In Place of Fear, 1952)