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A �200 bill won't stop foreigners abusing our NHS. But I know what will...

By Professor J Meirion Thomas

PUBLISHED: 23:55, 3 July 2013 | UPDATED: 07:46, 4 July 2013

In a bid to tackle health tourism, Jeremy Hunt has proposed that non-EU nationals coming to England for more than six months should be charged �200 a year to access NHS treatment

In a bid to tackle health tourism, Jeremy Hunt has proposed that non-EU nationals coming to England for more than six months should be charged �200 a year to access NHS treatment

The Health Secretary, I�m afraid, is trying to use a tiny sticking plaster to treat a patient who is suffering from life-threatening injuries.

In a bid to tackle health tourism, Jeremy Hunt has proposed that non-EU nationals coming to England for more than six months should be charged �200 a year to access NHS treatment.

He has also suggested charging tourists for GP access, and improving the way in which hospitals reclaim costs from EU patients.

While these proposals are a step in the right direction, they are woefully inadequate, given the scale of the problem.

Health tourists are people who visit the UK with pre-existing illnesses, with the sole purpose of accessing free NHS care.

I don�t mean patients who have accidents or suffer from unforeseen illnesses while visiting the UK. I am talking about people who arrive here suffering from cancer, for example, or who are HIV-positive. Also, people who come to Britain seeking renal dialysis or medical help with a complex pregnancy.

In other words, they�re looking for specialist and expensive treatment and they travel to the UK to receive it without having to pay for it.

They are able to go to a GP and are given a unique and permanent NHS number, which they are then usually able to use to get free hospital care.

Of course, that care is not actually free � it�s paid for by you and me, the UK�s taxpayers.

No one knows exactly what health tourists cost the NHS annually. The Prime Minister has suggested the sum is �20 million a year. Mr Hunt has previously bandied around a figure of �200 million.

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But as a senior consultant in the NHS who has researched this issue thoroughly, I believe the cost to the taxpayer to be billions of pounds annually.

Even when health tourists do end up paying for their treatment � a relatively rare occurrence � they are getting bargain-basement, sale-of-the-century prices compared with the cost they would have to pay in the private sector.

Thus, the proposed new health care levy of �200 a year for foreigners will rank as the cheapest travel insurance ever devised, especially if it covers family and dependants.
Guessing game: No one knows exactly what health tourists cost the NHS annually. The Prime Minister has suggested the sum is �20 million a year. Mr Hunt has previously bandied around a figure of �200 million

Guessing game: No one knows exactly what health tourists cost the NHS annually. The Prime Minister has suggested the sum is �20 million a year. Mr Hunt has previously bandied around a figure of �200 million

The charge will inevitably be regarded as granting health tourists entitlement to as much NHS care as they need.

One of Mr Hunt�s proposals is to end free access to GPs for visitors who spend less than six months in the UK. But how would that work? Who is going to check the immigration status of each and every visitor? It would necessitate close co-operation between GP surgeries and the UK Border Agency.

The British Medical Association and the Royal College of Practitioners have already said that they will refuse to work as a border force.

Mr Hunt�s proposal is a good idea, but it�s probably unworkable.

He has also suggested a new registration and tracking system for chargeable patients. Again, there is no explanation of how this will work. Currently, only 30 per cent of invoices raised are honoured by patients who are ineligible for free NHS care.
On Radio 4's Today programme yesterday, Dr Clare Gerada, chair of the Royal College of GPs, dismissed the notion that health tourism could be costing taxpayers billions of pounds

On Radio 4's Today programme yesterday, Dr Clare Gerada, chair of the Royal College of GPs, dismissed the notion that health tourism could be costing taxpayers billions of pounds

I know of one hospital in London where that figure is down to nine per cent. What magic remedy will ensure payment?

However, at least Mr Hunt acknowledges that there is a problem.

Interviewed on Radio 4�s Today programme yesterday, Dr Clare Gerada, chair of the Royal College of GPs, dismissed the notion that health tourism could be costing taxpayers billions of pounds. But she also admitted that she didn�t know the true cost.

However, she was sure that the figure was just a tiny proportion of total NHS costs.

How can anyone be so flippant? Even if the cost was no more than �20 million, that sum would pay for 7,000 hip replacements or 2,000 heart operations.

The truth is that the cost of health tourism should be seen in terms of ways that the money could be better spent on deserving British taxpayers.

Dr Gerada�s main worry seemed to be that the Government�s response to health tourism must be �proportionate�. She was also very concerned that if health tourists were discouraged from seeing GPs, that could lead to the spread of infectious diseases such as TB.

Her argument seemed to be that trying to crack down on health tourism could actually end up costing us more than health tourism itself.

It was a line picked up by the BBC�s health correspondent Nick Triggle. Writing on the Corporation�s website, he said: �GPs have already made it clear they will not be �border guards�, and without a simple system to check eligibility there is a risk the crackdown will cost more than it saves.�

He also claimed: �Those working in the NHS are much less exercised about the health tourism �problem� than politicians.� Note those quotation marks around the word �problem�, and the implication that it is far from established that there is any such thing as health tourism.

When BBC presenter Sarah Montague interviewed Jeremy Hunt, she gave the word �problem� particular emphasis, employing the spoken equivalent of quotation marks.
Regardless of how much the actual figure is, the truth is that the cost of health tourism should be seen in terms of ways that the money could be better spent on deserving British taxpayers

Regardless of how much the actual figure is, the truth is that the cost of health tourism should be seen in terms of ways that the money could be better spent on deserving British taxpayers

On Twitter, naturally, shadow public health minister Diane Abbott weighed in with her contribution: �What price xenophobia? Stigmatising foreigners accessing NHS creates a public health risk.�

Yet whatever the BBC and tweeting shadow ministers might think, I can assure them that there most certainly is a problem, and to say so has nothing to do with xenophobia or stigmatising foreigners.

I have worked for the NHS for 43 years � 31 as a consultant surgeon. I see the NHS being targeted by foreign patients who are ineligible for free care, but who usually get it anyway.

I have also spoken to many �overseas visitor officers� in numerous hospitals, whose job it is to try to identify and charge patients ineligible for free care.

Mr Hunt should be aiming to reduce the number of chargeable patients to a minimum.

It must be emphasised that it is a principle of the NHS that it is free at the point of service � but only for eligible patients. That is the message given by other countries with a health service comparable with ours.
Mr Hunt should be aiming to reduce the number of chargeable patients to a minimum

Mr Hunt should be aiming to reduce the number of chargeable patients to a minimum

France, Germany, Holland and Scandinavian countries have a rigid system to prevent health tourism. Why is the NHS managed so differently?

I find it deeply disappointing that regardless of the new proposed measures, foreign patients suffering from all kinds of infectious diseases will continue to be treated free on the NHS because of �public health concerns�. Thus, visitors arriving in the UK with HIV are immediately entitled to free treatment so that they do not spread the virus.

The unintended consequence of this altruism is that the NHS is targeted by visitors with HIV specifically because treatment is free.

Of course, this issue involves moral and ethical arguments, but the bottom line is that in London hospitals we spend almost twice as much on anti-HIV treatment as we do on anti-cancer drug treatment.

There is no financial restriction on the former.

Yet doctors regularly have to apply for special funding for novel anti-cancer drugs for the latter.

Is that fair?

The tragic consequence of all these ineligible patients is that British taxpayers are kept on waiting lists and drugs are denied them, while the emergency treatment of overseas visitors takes precedence.

Then there�s the erosion of motivation and goodwill among NHS staff as junior doctors, trainee midwives, nurses and others are regularly exposed to this exploitation of the health service.

Ultimately, this argument is about the finite resources of the NHS.

I believe that the only solution is an �NHS passport� which defines entitlement on the basis of permanent residency. This would be of similar design to the plastic driving licence. It should contain biometric identification and a unique identification number.

I can see no other way forward. If you are serious about tackling health tourism, Mr Hunt, you need to perform radical surgery, not a minor cosmetic procedure.

Professor J Meirion Thomas is a consultant surgeon in the NHS

Why can we not make travel insurance compulsory on all visa applications? Newspapers often carry articles about British tourists who have not bought travel insurance and consequently needed expensive treatment abroad. They are usually asking / hoping that family, friends etc will help raise cash to pay for their treatment because its not free in that country.
They wont do it because there is nothing in it for them, no money, no gong, so let the PLEBS pay for it and everything else as well, they know the people will not rise up because all the brain washing they have done through our schools and the BBC has worked.

OK SO NOW I JUST HAVE TO PAY �200 A YEAR INSTEAD OF MY NATIONAL INSURANCE? YOU CANNOT HAVE ONE SYSTEM FOR THE PLEBS AND ANOTHER FOR THE FOREIGNERS TO LIVE OFF YOUR BACK CAN YOU.
NO TOURISTS ETC WITHOUT TRAVEL INSURANCE, SIMPLES.