The Daily Mail and the Express have reported this week that the Government has shelved its plans to crackdown on health tourism, amid accusations that “MPs have caved in to left wing doctors” – so what are the facts?
Pilot schemes have been running at 18 hospitals, introducing charging into some community services, with NHS Trusts having a duty to check the eligibility of all patients before providing treatment in hospital, including many in London. The schemes, which were begun following an expansion of regulations in October 2017 have now been abandoned after continuous campaigning and complaints about the impact of the policy. Some patients were being asked to pay upfront or risk being turned away. At the end of April, the Guardian reported on the death of an anti-FGM campaigner and asylum seeker from Gambia, known as Saloum, who was diagnosed with terminal cancer after collapsing in the street last December. Following initial NHS treatment he was sent away because he was not eligible for free NHS care as an undocumented migrant.
However, the charity Doctors of the World, argued that treatment for his cancer was urgent and immediately necessary, which under the regulations should have meant he was treated. Eventually he was given some treatment at the University Hospitals of Derby and Burton NHS foundation trust. Other stories include a woman with advanced breast cancer denied potentially life-saving therapy for six weeks and one of the Windrush generation, who was denied NHS radiotherapy for six months due to uncertainty over his immigration status.
Campaigns spearheaded by groups such as Docs not Cops have questioned the effectiveness and safety of the pilot schemes. Action by campaigners prompted England’s biggest NHS trust, Barts Health, to stop photo ID checks and remove posters warning: ‘NHS hospital treatment is not free for everyone.’
What do the figures say? In May 2018, the Evening Standard reported that figures from London hospitals found that of 8,894 people asked for two forms of ID prior to treatment only 50 actually had to pay for their care.
Media outlets, such as the Daily Mail and The Express, have stated that ‘health tourism’ costs the NHS £280 million, but there is no reliable evidence to support this figure. The organisation Full Fact last looked at the figures for health tourism in 2016 and noted that any estimate will be very rough. All the figures used by Full Fact and other organisations come from a 2013 Government report.
The 2013 report estimated that ineligible people cost the NHS almost £2 billion a year, but those that possibly fall into the category of ‘health tourist’ cost the NHS £100 to £300 million a year or 0.3% of annual health spend.
The report makes it clear that it is extremely difficult to calculate a health tourism figure and that it can only provide a rough estimate. Two reasons why;
Firstly, it is very difficult to track patients who are not eligible to use the service as no charge is made for GP and emergency services.
Secondly, there are flows in both directions. The UK creates its own health tourists from people who move to Europe but then come back to the UK to use the NHS, including seeing a GP for repeat prescriptions.
Although the pilot checking schemes seem to have been abandoned, the regulations put in place in the Immigration Act 2014 are still in place. The Act expanded the group of people who can be charged and introduced an ‘immigration health surcharge’ for those seeking visas to enter the UK, and a charge of upto 150% of the cost of treatment in hospital.
Reaction to the scheme Groups, such as Docs not Cops and Doctors of the World, say the regulations have created considerable problems – wasting considerable time and money on checking and caused extensive human suffering.
These groups are not alone in condemning the regulations, but despite this at the end of 2018, Secretary of State for Health & Social Care, Matt Hancock stated that “there is no significant evidence that the 2017 amendment regulations have led to overseas visitors being deterred from treatment or that the changes have had an impact on public health”. As a result of his statement in December 2018, the Royal College of Physicians, the Royal College of Paediatrics and Child Health (RCPCH), Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Public Health (FPH) called upon the Department of Health and Social Care (DHSC) to suspend the charging regime (NHS Charges to Overseas Visitors) (Amendment) Regulations 2017, pending a full independent review of their impact.
The only evidence of the impact of the regulations comes in three reviews conducted for the DHSC: but none of these reports has been made public. In March 2019, MPs, Royal Medical Colleges, leading academics, healthcare professionals and unions wrote to Matt Hancock, calling for the publication of the three migrant healthcare policy reviews.
These reviews looked at the impact of the controversial policies, including withholding healthcare from migrants who cannot pay in advance. The letter claims the reviews received “evidence of deterrence and serious harm” caused by these policies “which we consider to be of the utmost seriousness”.
In an effort to help migrants and other groups caught in the confusion of the regulations, at the beginning of May, the organisations Docs not Cops, Medact and Migrants Organise, launched Patients Not Passports, an online toolkit “to support individuals to advocate for people who face towering advanced payments ahead of accessing NHS care, and to end immigration checks on those suspected of being “overseas visitors””.
The toolkit contains resources, such as who exactly is exempt from charges and aims to help end the confusion surrounding the regulations, which has led to delays to treatment.
Over the past year or so there have been numerous media reports of delays in NHS care for cancer patients in particular. Although few in the UK are affected by the regulations, as the organisation Docs not Cops notes, they could have a huge impact on us all and on overall public health; if people with infectious diseases are too scared to visit GPs due to irregular immigration status then this could be serious for society. They may wait until the disease worsens leading to much bigger problems in the long run.
Docs not Cops says the regulations represent a complete dismantling of the NHS’ founding ideals that “it be based on clinical need, not ability to pay.”