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To defend the NHS, stop health tourism

We don't have the capacity to fund a worldwide health service – pretending otherwise just imposes a needless burden on both the NHS and the taxpayer

15 August 2015

9:00 AM

15 August 2015

9:00 AM

Speaking after the Stafford hospital scandal in 2010, the then newly appointed Health Secretary, Andrew Lansley, grandly announced plans for a charter to support whistleblowers. The government, he said, would ‘create an expectation that NHS staff will raise concerns about safety, malpractice and wrongdoing as early as possible’.

We now know just how that fine pledge worked out. In 2013 this magazine ran a piece by J. Meirion Thomas, then a cancer specialist at the Royal Marsden hospital in London, about his concerns at how the NHS was being exploited by health tourists. He had tried, he said, to expose an ineligible foreign patient but had as a result been accused of unethical behaviour.

Meanwhile, the scale of health tourism in the NHS is becoming clearer by the day. Junior NHS managers have spoken of being ignored or being branded ‘racist’ by senior staff for daring to raise the issue. Hospitals, knowing that they are treating health tourists, refuse to admit them as such because they know they will then not be fully compensated by the NHS for the treatment they have given. Foreign patients have been given dialysis treatment — at a cost of £40,000 a year — with no questions asked and no attempt made to recoup the costs from their home health service. A Nigerian mother has been revealed to have had five babies on NHS wards before being rumbled.

Then there is the scandal of European Health Insurance Cards (EHICs) which citizens across the EU can apply for in order to obtain emergency treatment in other countries. The idea of the cards is that the cost of the treatment is then recouped from the patient’s home health service, thereby ensuring that the burden falls where he pays his taxes. However, in handing out the cards Britain has been far too carefree — with the result, it has emerged this week, that a Hungarian journalist was able to obtain a British EHIC after spending just one day in Britain. She then returned to Hungary and received treatment in a Hungarian hospital, the cost of which was billed to the NHS.


It is galling to discover that the government knew about this loophole in 2013 but has failed to do anything about it. That year, the government put the cost of health tourism at around £2 billion. But that is almost certainly a huge underestimate, given the refusal of many parts of the National Health Service even to check for eligibility.

It is not just hospitals which are guilty of this. When in 2013 the government announced limited measures to alleviate the problem, Clare Gerada, then chairman of the council of the Royal College of General Practitioners, accused ministers of ‘xenophobia’ and said that GPs would not act as a ‘new border agency’. It was a fatuous remark. No business would survive for long if it didn’t check the eligibility of people demanding access to its services. An insurance company would go bust in a day if it paid out all claims without bothering to check whether the claimant had a policy. The NHS is forever asking pointless questions about our ethnic origin, so why should it be beyond a general practice surgery to check a patient’s eligibility for treatment?

The NHS is struggling to meet the demands of the taxpayers who fund it. It has no capacity to act as a worldwide health service offering treatment to anyone, funded by British taxpayers. The NHS has left itself open to abuse for two reasons.

First, the qualification for eligibility is too loose. Anyone can qualify for free treatment if they are ‘ordinarily resident in Britain’. This is a definition that does not require a patient to be a legal resident of the UK.

Secondly, while the NHS does issue cards, they do not carry photographs or biometric data to prove that they were actually issued to the people who present them. Nor, following the failure of the NHS computer system, is there even a central database which can be used to check a patient’s eligibility for publicly funded treatment.

Of course, there are circumstances when doctors should not be expected to do this. Where someone has suffered an accident or requires emergency surgery, they should be treated regardless of who they are. But there is a big difference between an emergency and, say, five years of dialysis treatment. The health problems of the wider world should be a matter for the aid budget, not the NHS. Over a quarter of the £12 billion aid budget already goes on medical projects.

Those who shout ‘racist’ at anyone who raises the issue of health tourism claim to be on the side of humanity. But they are really just people without any sense of financial responsibility. They are, ultimately, enemies of the NHS — because they are trying to impose on it a burden which it cannot possibly sustain indefinitely.

It is high time that the government was prepared to stand up and make this point — and defend those brave individuals within the NHS who have put up with the disapproval of colleagues for daring to speak of the abuses which have been taking place.

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