On Monday morning, Jeremy Hunt’s diary secretary rang me to arrange a time for me to speak to the Secretary of State over the telephone. I had already received an email from his special adviser the previous week, saying, ‘The two points which the independent research make clear are central to what you’ve been saying for a long time; namely that health tourism is a huge problem with a substantial cost to the NHS and the current system is an unfair burden on frontline staff.’
When Jeremy rang, he was charming, full of praise, and eager to tackle the issue of health tourism — the exploitation of the NHS by ineligible, non-tax contributing patients. Yet for all the Health Secretary’s good intentions, I fear his department is failing to grasp the nettle. The government has not recognised the extent of the problem, so its solutions are inadequate.
When I first raised this issue in The Spectator, I quoted from the Department of Health’s website section on ‘Eligibility for free hospital treatment under the NHS’, to show how open to abuse the rules and regulations governing free access to NHS care are. (Strangely enough, the page was removed and archived soon after my article was published.)
On the back of my article, the government employed a company called Creative Research to investigate the health tourism problem. It too found that the eligibility criteria for free NHS care were porous, ineffective and difficult to enforce, and that any determined non-resident can breach them. Nevertheless, Creative Research has grossly underestimated the extent of the problem.
Let’s first remind ourselves of the strict definition of a health tourist. It’s someone who arrives in the UK with a pre-existing illness whose purpose is to access free NHS care. (The term does not apply to visitors who suffer accidental or incidental illnesses during their stay, nor to asylum seekers or disadvantaged migrants who are entitled to ‘Good Samaritan’ NHS care.) The claim by Creative Research that this activity costs between £70 million and £300 million cannot possibly be correct. Where is the data to confirm that estimate? I still maintain that the cost of this component of the problem, as defined, is in billions, not millions. For example, the cost of treating expatriates who have lived abroad for decades and returned for treatment has not been included.
Creative Research is a market research company. It has little financial or commercial expertise. Its website states that it depends on freelance researchers to deal with commissions. It lists 32 examples of previous projects, only three of which are connected with health matters. The rest are client-based satisfaction surveys based on interviews and relating to museum attendance, water companies and the RSPB.
The Department of Health response to the Morecambe Bay scandal was to commission a report from Grant Thornton, a multi-national management consultancy with almost inexhaustible investigative potential. Is it too harsh to conclude from this enormous discrepancy in investigative skill that the Department of Health does not wish to investigate the true cost of health tourism?
In the next few weeks, in an attempt to reduce the cost of health tourism, the government will announce new rules about who can access NHS care. There is a proposal for an annual health levy or surcharge set at £150 for foreign students and at £200 for other temporary migrants. The levy will apparently generate £1.9 billion over a ten-year period, based on approximately 490,000 applicants who would be required to pay.
This amounts to the cheapest travel/health insurance on the planet! All that students and temporary migrants have to do is cough up £150 or £200 and they will be fully entitled to unlimited free health care. Besides, don’t the geniuses who thought up this plan realise that, apart from a few students who exploit the system, most health tourists come on a visitor’s visa, so would be exempt even from this minimal charge? Why shouldn’t students and temporary migrants be required to have health insurance, as is necessary for any British citizen studying or working abroad?
And how is the levy going to work? If the student is on a three-year course, would the outlay charge be £450 plus the cost of the visa? If the same student is bringing his/her spouse and three children, then would the outlay charge for three years be £2,250 plus the cost of five visas? Does this fit with the government’s idea of encouraging students to come to UK because they bring us so much revenue?
In any event, access to the NHS is based on residency, not contribution. The immigration minister Mark Harper has said that ‘Payment of the surcharge will ensure that most NHS services would then be free for migrant use.’ In a BBC interview, Jeremy Hunt said, ‘The levy could be set higher and might exclude certain treatments like IVF, cosmetic surgery, renal dialysis, transplantation and pre-existing pregnancies.’ That should definitely be the case — and let’s hope this idea will not become another coalition casualty.
Hunt’s other measure is to appoint a director of cost recovery. It has been assessed that £500 million per year could be saved through the health levy, by deterring health tourists, and finally by recovering costs from chargeable patients — meaning those who have received treatment but are deemed to have been ineligible for free NHS care. Invoices for this category of patient are already raised; but currently only 20 per cent are paid.
If proper entitlement controls were in place, though, surely this debt collector role would be unnecessary? Health tourists need to be identified and excluded from the NHS. But there is no method for enforcing payment. It’s fraud without penalty. Any charge made is at the NHS tariff, which is about 25 per cent of the equivalent cost in a private UK hospital. The only permanent solution is a method of personal identification to prove entitlement to free NHS care, as you can find in all other countries with health systems equivalent to our own. Health tourists come to the UK because we let them.