In 21st century Britain people are dying because they can’t get healthcare. That’s the disgraceful effect of existing restrictions on migrants using the NHS—and Theresa May wants to tighten them.
People not “ordinarily resident” in Britain can be charged thousands of pounds for some NHS services. This includes tourists, many migrant workers and their families, and destitute refugees.
Hospitals track down and bill overseas patients after treatment. This stretcher-chasing brought in £289 million last year—a tiny amount compared to the NHS budget (see below).
Now May and health secretary Jeremy Hunt want to start checking patients’ passports before they can be treated.
These controls on “health tourism” are a bogus response to a bogus problem. They distract from the real threats to the NHS, undermine its existence and are wrecking lives.
"She could have been alive today, but she was afraid to go to hospital. She was pregnant and died in her home.”
Her fears were well-founded.
Dianne went on, “A friend of mine was forced to give birth in hospital last year. Afterwards they presented her with a bill—but she has no income. She’s still paying, in little donations of £1 or £2.”
Those who can’t pay have their details handed to the Border Force.
One of Rapar’s refugee clients recently applied for leave to remain in Britain as the parent of a British-born child. His application was rejected due to outstanding medical bills.
Dianne said, “Several times I’ve been sick and I was afraid to go to a doctor because they would ask for my passport. I had severe flu, and that was very difficult.
“I even had a blackout. It was very scary, especially for my child. She was crying, ‘Mama, I don’t want to lose you’. It’s just the two of us in the country, and if I die she has no one.”
Asylum seekers can receive some care for free while their claim is processed, but anything deemed non-emergency is excluded. Those who are rejected lose even this.
Leda, a refugee support activist for We Are Wakefield in West Yorkshire, told Socialist Worker, “The whole situation is outrageous. Across the board I see people with conditions they can’t get treated.
“I’m currently working with a man who has an eye deformity. There are old people with arthritic-type conditions that would normally be treated with physiotherapy or a hip replacement. Instead they are in pain and difficulty.”
This cruel health apartheid harms everyone. Infectious diseases don’t check passports. If left untreated in some people they can easily spread.
And the attack undermines the idea of free, universal healthcare—something the Tories have dreamed of destroying for years.
Many migrant workers can’t access free NHS care due to immigration rules already. At present they are a minority.
But once the principle of charging for care has been established, and the machinery for immigration checks put in place, it could be extended at a stroke.
May’s refusal to guarantee the rights of European Union nationals adds to the fears that far more workers could be affected in the future. Yet migrant workers’ labour keeps the NHS going.
Jama “Haji” Mohamoud is the Unison union rep for cleaners employed by contractor ISS at Homerton hospital in Hackney, east London.
He told Socialist Worker, “Most people here have the right to work in Britain.
“But they don’t know what will happen to them down the line. If the government does this today, what will it do tomorrow?”
The Tories paint a picture of people conniving to milk the system. In reality it’s stacked against them claiming even what little they are entitled to.
Dianne was once turned away at a clinic. It was only when she went back the next day, armed with information about her rights, that she was added as a patient.
Not everyone can do this.
Leda said, “Whatever someone’s fled and however they’ve got here, it leaves them traumatised. Many never wanted to come to Britain, and don’t speak the language.
“People haven’t walked all the way from Sudan or Eritrea, or spent eight days in a car boot across the Sahara, for the sake of ‘health tourism’. They’ve done it because they had no choice.”
The government claims to be acting for the NHS.
They proposed checking women’s passports before giving maternity care last year. And they said one of the problems with the plan was workers’ reluctance.
The Royal College of Nurses, Royal College of Midwives, British Medical Association and Unison have slammed moves to turn their members into border guards.
Haji said, “They never consulted us, and if they did I would greatly oppose it. It’s vindictive and it’s about dividing the masses.
"Are we going to tell people you don’t have a right to your life being saved? You don’t have a right to give birth?”
Cuts and privatisation have plunged the NHS deep into crisis, making last month the worst ever for A&E waiting times.
The Tories’ racist attack on “health tourism” aims to provide a scapegoat and deflect the anger away from them.
As Dianne said, “It’s all lies.”
Those fighting to defend the NHS and the growing anti-racist movement must make common cause.
Stand Up To Racism is organising a block on the national demonstration for the NHS on Saturday 4 March.
Unison is backing the national demonstrations against racism in London, Glasgow and Cardiff on Saturday 18 March.
As Haji put it, “These changes are despicable, and it’s down to everyone to stand up against them.”
It’s official: health tourism is ‘not an issue’
The Tories claim that “health tourism” costs almost £2 billion a year and that new rules will claw £500 million of that back. None of this adds up.
The £2 billion figure comes from a government-commissioned study from 2013. It includes many people who are already being made to pay for treatment.
Some are from European countries whose governments reimburse the NHS. The government claimed £40 million back in 2015.
As well as paying tax, workers and students from outside Europe now face a £200 “health surcharge” on arrival. This raised £164 million last year.
People do fall ill while on holiday. But mostly they spend money. Foreign tourists spent £22 billion in Britain last year, swamping any cost associated with their care.
The government conjures images of people flocking into Britain to fleece the NHS. But its study noted that “empirical knowledge on the magnitude and effect of health tourism is lacking”.
Claims are based on “anecdotal evidence” because “there are no statistically valid samples to generate estimates”.
It did cite one piece of research carried out in a healthcare setting—which “suggests that it is not an issue”.
Its best guess of migrants “taking advantage” of the system was between £110 million and £280 million a year—just 0.3 percent of the NHS budget.
It estimated the cost of deliberate health tourism at between £20 million and £100 million.
And since this includes emergency care, which even under the new rules would remain free, the real figure is smaller still.
Neither the Department of Health nor the NHS Improvement agency running passport control pilot schemes could tell Socialist Worker how much is spent enforcing the fees.
But with dedicated teams in every hospital trust, this penny-pinching doesn’t come cheap.
It’s almost as if it was nothing to do with saving money.