Heidi Alexander: Drop this fixation with ‘health tourism’ and tackle the real crisis in our NHS
The NHS must not be left picking up the pieces of an immigration enforcement system that is not fit for purpose, writes Labour's Heidi Alexander
In recent years, every six months or so, a government minister has talked about the need to “tackle health tourism”, “crack down on migrants using the NHS” or “charge overseas visitors for healthcare”. These statements may make the headlines, but they do nothing to address the deep-seated and worsening problems engulfing the NHS.
Today’s crisis hasn’t been caused by migrants, it’s been caused by ministers – their failure to adequately fund the NHS and social care, to properly plan and value the workforce and to reshape the provision of care so as to meet the needs of our ageing population. This has meant waiting times going up, patient satisfaction going down and the whole system left at breaking point.
I spent ten months visiting hospitals, GPs and care homes all over England. Not once did I see a queue of migrants at the door of A&E; instead, I met hundreds of immigrants staffing our services – as doctors, nurses, paramedics, porters and even volunteers.
So, what are the facts?
A study for the government in 2013 estimated that “normal use” of the NHS by foreign visitors who have ended up being treated whilst in England is £1.8bn a year.
“Health tourism” – those who come here specifically to receive free treatment – is estimated to cost £110m to £280m a year. Even at the upper end of this estimate, this amounts to circa 0.3% of the NHS budget.
Every effort should of course be made to reclaim the costs of treating those who aren’t eligible for free care. Jeremy Hunt was right when he said we haven’t done enough in the past to reclaim costs from other European countries for treating their citizens here.
But an NHS that is under such pressure to deal with the long line of frail, elderly people walking through the door, has little spare capacity to be chasing half way round the continent to get paid. The Department of Health’s Cost Recovery Support Team is a step forward but recovering costs from within Europe is probably simple (or at least it should have been) compared to the rest of the world.
The vast majority of the £1.8bn spent annually on providing NHS treatment to those people not eligible for free care relates to non EEA citizens. These costs are less about people who come here specifically for treatment and more about people who have overstayed their visas and end up needing care.
When the government has no reliable and routine mechanism for enforcing immigration decisions, and when the Home Office is increasingly granting visas of two to three years with limited leave to remain (which then expire and sometimes aren’t renewed), the number of people who end up living in limbo, and who aren’t eligible for free care, increases. These are people who aren’t allowed to work. They live in destitution and are simply unable to pay the bills which they are presented with.
If a post Brexit UK applies this system to EU migrants, and if we don’t find a way to routinely remove people from the country when they don’t have permission to be here, we should expect the numbers of erroneously named “health tourists” to increase. This won’t be because people are purposefully travelling here to give birth or have their hips replaced, but because their work permit expires, they fail to renew it (or an application is refused) and they subsequently fall ill, have an accident or become pregnant.
Doctors and nurses aren’t border guards – nor should we expect them to be. The NHS must not be left picking up the pieces of an immigration enforcement system that is not fit for purpose.
The government would do well to drop their fixation with “health tourism”, focus on the real issues which are causing such pressure within the NHS and find a timely, humane and professional way of enforcing immigration decisions.
If we continue with the current obsession, we won’t deal with the real NHS problems yet we will have bred more misinformation and ill feeling about migrants. And that we can well do without.
Heidi Alexander is Labour MP for Lewisham East and the former shadow health secretary