By Alan Oakley
In a move that forms part of an extension of the NHS charging regime in England intended to deter so-called “health tourism”, a Tory peer has announced that the UK is to introduce charges for health care for all migrants.
Migrants and overseas visitors, as well as UK nationals resident abroad, will be expected to pay for prescriptions and for some emergency care. There will also be higher charges for services which are subsidised for patients entitled to free NHS treatment – such as optical and dental care.
Health minister Lord Howe told the BBC that patients will be able to go to a GP and to appointments with a nurse for free, while anyone taken to accident and emergency for genuine emergency treatment, such as those who have had a heart attack, will continue to be treated without having to show eligibility to free healthcare. He did not explain how any subsequent charge would be levied.
Lord Howe said: “Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hard-working British taxpayers who fund it.
“We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this.
“We are already looking at taking action and [this year] we will set out our detailed plans to clamp down on the abuse of our NHS.”
Describing the NHS as “a national health service, not an international health service” Lord Howe said that he expected the changes to save about £500m a year. Currently, the NHS treats people free if they are deemed to be ‘ordinarily resident’ in the UK.
The proposed charges will apply to people from outside the European Economic Area who:
• Have been living in the UK for at least 12 months when they begin treatment
• Have permanent resident status, even if they have been in the UK for less than a year
• Have come to the UK to work, either as an employee or in a self-employed capacity
• Normally work in the UK but are currently working abroad, for less than five years
• Have applied for asylum in the UK
The full details of the scheme will be announced in March, but it seems that the following groups of people will be required to pay for most treatment on the NHS
• Foreign workers in the UK, such as those with Tier 2 (General) and Tier 2 (Intra Company Transfer) visas
• Tourists
• Business visitors
• UK citizens who live and work abroad (It is not clear if this will apply to all such workers or whether some will be exempt from the requirement to pay)
Reactions to the proposals among medical professionals varied. Dr Laurence Buckman, a former chairman of the General Practitioners Committee, told the BBC that GPs were not opposed to charging foreign nationals for treatment but said that doctors needed clarity on who should be charged and when. He added that doctors did not want to act as border guards or tax collectors.
Dr Mark Porter, Chairman of the British Medical Association Council said that the proposals “could create unintended drawbacks for the NHS and patients.”
He continued: “They are likely to create a complex patchwork of charging and access entitlements where some services remain free, such as GP appointments, while others will be chargeable, including A&E visits and other services provided via many GP practices, such as physiotherapy”.
Dr Chaand Nagpaul, leader of the BMA’s GP committee, said: “We cannot have a situation where any patient with a serious health need is deterred from visiting a GP, especially if their condition raises a potential public health risk”.
Dr Helen Stokes-Lampard, a Birmingham GP and spokesperson for the Royal College of General Practitioners, said: “We are grateful that the government appears to have made some concessions to its original proposals and we are pleased that access to a GP will remain free at the point of need. However, we still need reassurances that GPs are not going to be pressed into acting as an arm of the Border Agency and we remain unconvinced that the proposals will work across the NHS.”
Writing in the Journal of Medical Ethics Blog on the British Medical Journal website, Iain Brassington wrote: “The planned NHS budget for the 2012/13 financial year is £108.897bn, in the context of which, £500m really isn’t that much”.
The Labour Party has accused the Coalition of attempting to gain headlines for being tough on immigration without addressing any underlying issues. Labour shadow health minister Lord Hunt said, “Labour is in favour of improving the recovery of costs from people with no entitlement to NHS treatment…Rather than more grand-standing, the government needs to deliver practical, thought-through changes to make that happen”.
Prime Minister David Cameron defended plans to charge migrants after treatment in accident and emergency departments, insisting the proposals were enforceable. Mt Cameron said it was right to charge foreign visitors for using the NHS and insisted that future migrants to Britain would face more stringent rules before being able to move here.
Speaking to the BBC’s Andrew Marr Show, he said the plans were workable: “Yes we can, we can (..) Our NHS is a national treasure and we can all be incredibly proud of it, and it is right that we all pay into it and everyone here has access to it for free.
“But people who come to our country, who don’t have the right to use it, should be charged for it and we’re putting that in place.”
The Government’s announcement comes amid fears among many Tory MPs that the expected influx of EU migrants from Bulgaria and Romania in the next few months now that restrictions have been lifted will put additional strain on the NHS and other public services.
The National Health Service was introduced in 1948 under Clement Atlee’s Labour administration. The then health minister, ‘Nye’ Bevan, famously proclaimed that: “the medical arts of science and of healing should be made available to people when they needed them, irrespective of whether they could pay for them or not (..) not at the expense of the poorer members of the community, but of the well to do” and “free at the point of delivery” should be its core principles.
