Socialist Worker

The intensive scare around ‘health tourism’ is helping the Tories kill the NHS

by Dave Sewell
Issue No. 2541

Border guard Theresa May and her henchman Jeremy Hunt want to keep migrants out of hospitals

Border guard Theresa May and her henchman Jeremy Hunt want to keep migrants out of hospitals


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.

Posters like these are now a common sight in NHS hospitals

Posters like these are now a common sight in NHS hospitals (Pic: Socialist Worker)


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.

Dianne Ngoza is an asylum seeker from Zambia and an activist for Manchester refugee charity Rapar. She told Socialist Worker, “I went to a funeral last month, for a young woman from South Africa.

Alive

"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.

Hospital cleaners at Homerton in east London, many from migrant backgrounds, fighting cuts by their privatised employer ISS

Hospital cleaners at Homerton in east London, many from migrant backgrounds, fighting cuts by their privatised employer ISS (Pic: Guy Smallman)


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.

Machinery

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.”

Bevan’s warning still holds  Labour health secretary Aneurin Bevan launched the NHS in 1948. Bevan famously vowed that it “will last as long as there are folk left with the faith to fight for it.”  For all Bevan’s limitations, he also warned about health tourism scares. In 1952 he described “criticism, most of it ill-informed and some of it deliberately mischievous” of “the free treatment of foreign visitors”.  Bevan pointed out that visitors to Britain contribute to government income through taxes, and caring for them costs a “negligible fraction” of the total.  It would be “unwise as well as mean to withhold the free service from the visitor to Britain”. British citizens would have to carry documents to prove their nationality, “For if the sheep are to be separated from the goats both must be classified.”  Bevan remarked, “The whole agitation has a nasty taste”. He accused the Tories of seeking “to exploit the most disreputable emotions” in order “to discredit socialised medicine.”

Bevan’s warning still holds

Labour health secretary Aneurin Bevan launched the NHS in 1948. Bevan famously vowed that it “will last as long as there are folk left with the faith to fight for it.”

For all Bevan’s limitations, he also warned about health tourism scares.

In 1952 he described “criticism, most of it ill-informed and some of it deliberately mischievous” of “the free treatment of foreign visitors”.

Bevan pointed out that visitors to Britain contribute to government income through taxes, and caring for them costs a “negligible fraction” of the total.

It would be “unwise as well as mean to withhold the free service from the visitor to Britain”.

British citizens would have to carry documents to prove their nationality, “For if the sheep are to be separated from the goats both must be classified.”

Bevan remarked, “The whole agitation has a nasty taste”.

He accused the Tories of seeking “to exploit the most disreputable emotions” in order “to discredit socialised medicine.”


The government claims to be acting for the NHS.

But most NHS workers are horrified at the idea of denying care to those who need it—as bosses at St George’s hospital in south London found.

Passports

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’

Figure it out

Figure it out

The NHS is haemorrhaging money—but not to migrants. The tiny slice of this pie chart shaded yellow represents the whole £2 billion estimated cost of care for non-residents, who can be charged for under migration rules. The £70 million of this attributed to deliberate health tourism is too small to even see

Why not get tough on these health spongers instead?

  1. Profiteers
    £8.7 billion
    of last year’s NHS budget went to private contractors. They cream off cash for their profits, bonuses, share dividends, advertising—and to lobby for yet more contracts
  2. Understaffing chaos
    £3.7 billion
    was wasted last year on drafting in expensive “locum” staff to work on wards whose regular workforce has been cut to the bone
  3. Loan sharks
    £2 billion
    a year goes to service PFI loans to private banks and construction firms
  4. Tory cuts
    £22 billion
     is to be snatched away in “efficiency savings” by 2020 in England alone. These take the form of 44 regional Sustainability and Transformation plans (STPs) of closures and cutbacks
  5. Big Pharma
    Billions
    of the NHS prescription budget goes straight to giant drug firms. One 2014 study found that over £2 billion went on expensive branded drugs even when cheaper “generics” were available—often at a tenth of the price
  6. Fat cats
    Billions
    go into giving those at the top of NHS bodies pay packages to rival corporate executives. University Hospitals of Leicester trust chief executive John Adler took the biscuit with a total pay package of £490,000 last year

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.


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