The extent of deliberate health tourism has been “hugely overstated” and is in fact a “very small part of NHS expenditure. The NHS is wasting billions of pounds a year through inefficient use of staff, paying over the odds for supplies, “bed blocking”, missed appointments, marketization, and undue reliance on agency workers. The cost of hospital litigation and defensive medical practice is high and now runs at £5bn per year….writes Dr Kailash Chand, the former deputy chair of BMA Council
A Public Accounts Committee (PAC) report says the system for recouping costs from overseas patients is “chaotic”. Chairwoman Meg Hillier attacked the government’s “failure to get a grip” as “simply unacceptable. The report calls on the Department of Health to publish an action plan by June, “setting out specific actions, milestones and performance measures for increasing the amount recovered from overseas visitors.
The NHS has been obliged to collect money from foreign patients since 1982 when charging regulations were first introduced. These state that only patients who are ‘ordinarily resident’ in the UK – and have lived here for at least six months – are eligible for free treatment, operations and scans. This excludes GP and A&E services which are currently free for all.
I agree, that those accessing NHS service are eligible to do so and that we recover the costs for treating overseas visitors. There is a legal requirement for hospital trusts to verify the eligibility of accessing the health care. The systems to do this need to be practical, economic and efficient and must not jeopardise access to healthcare for those who need it.
In my view any charging systems should not prevent sick and vulnerable patients receiving necessary care, otherwise there may be serious consequences for their health and that of the public in general.
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 often used assertion are simply not there. A Department of health study== reliant on a fair bit of guesswork – suggested that health tourists accounted for only £60m to £80m, with £50m to £200m more if you added people who were “taking advantage” of the NHS but had come to the UK for other reasons.
This is a lot of money, but it is a drop in the ocean of the English NHS’s budget of more than £100bn a year. Even if we can find a way to identify and charge these people – and this wouldn’t be easy – it would make no real difference to the strains on your local hospital or GP surgery.Permanent migrants account for far more use of the NHS but they also make a contribution through tax, national insurance and, in quite a few cases, actually working for the service itself.
The Institute of Economic Research has said, the extent of deliberate health tourism has been “hugely overstated” and is in fact a “very small part of NHS expenditure. The NHS is wasting billions of pounds a year through inefficient use of staff, paying over the odds for supplies, “bed blocking”, missed appointments, marketization, and undue reliance on agency workers. The cost of hospital litigation and defensive medical practice is high and now runs at £5bn per year.
Raising health tourism costs to the NHS, is about deflecting the blame for the NHS crisis away from real challenges of resolving the junior doctor’s general practice, A&E crisis and pressures on the NHS due to massive funding cuts to social care and public health. The health secretary would be wise to concentrate on these challenges, rather than being distracted by imposing an unworkable system of charging for health tourism. If this plan comes to fruition it will at best reduce the role of doctors to debt collectors. At worst it will deter them from registering migrants and asylum seekers. Tampering with the core principle of the NHS, that it is free at the point of delivery, runs the risk of loading scarce resources on a minority issue, while the more meaty challenges remain unresolved.
(Dr Kailash Chand OBE is Chair of Healthwatch Tameside, and the former deputy chair of BMA Council)