I'm a junior doctor—this is why the new NHS immigration checks are bad for everyone

Quite aside from the obvious moral case, the new policy will impact the economic sustainability of the NHS and the health of the population for decades to come

October 23, 2017
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As a doctor in the NHS, I’ve seen Jeremy Hunt’s Department of Health initiate a number of controversial reforms, including the widely unpopular junior doctors contract, mostly without proper consultation. However, none have had the destructive potential of the department’s latest intervention.

From today, it becomes mandatory for all patients seeking NHS care in England to undergo immigration checks, with those deemed ineligible to pay 150 per cent of the cost of care up front.The stated aim is to recover costs from so called ‘health tourists’ but there will be wide ranging and severely negative impacts on both the economic sustainability of the NHS and the health of the population in coming decades as a result.

The NHS is one of the most cost effective healthcare systems in the world. By being resident-based, it avoids the bureaucracy of insurance eligibility and by treating everyone, it maximises public health benefit. Both advantages of our pooled system are under threat from this policy.

The Government’s own research shows that overseas visitors not entitled to care cost the NHS at most £300 million per year, less than 0.3 per cent of its budget.

This broad and blunt attempt by the Department of Health at recouping this cost is complicated by a number of practical issues. Firstly,

17 per cent of the UK population doesn’t have a UK passport with which to prove their eligibility. Secondly, a majority of migrants are entitled to NHS care either through annual tariffs they pay as part of their visa or exemption status as refugees or asylum seekers. The proportion of ineligible patients able to pay the fee is likely to be insubstantial.

Since the 2014 Immigration Act, an ever more hostile NHS environment has developed. Patients’ stories are a sign of things to come. I saw one woman in recent months who told me she hadn’t come to her previous appointment for fear her asylum request would be rejected if she used her name. Sadly, this fear is justified. An agreement between the NHS and Home Office to share patient information shows a hidden motive behind this reform.

Another patient was threatened by a Trust with a rejected asylum claim if they didn’t pay the NHS bill they had received in the post. Many patients have reported being racially profiled in order to determine eligibility checks. One in-patient I was caring for was approached by an overseas officer—not clinically trained—who demanded they leave the ward due to ineligibility and failure to pay. How on earth are we to build a space of care and trust if there are the equivalent of loan sharks going around the NHS threatening and intimidating our patients?

Many patients become fearful of sharing information even with their nurse or doctor. Those directly impacted by this policy are more likely to be ill, poor and people of colour. Most are legally entitled to healthcare; and, regardless, I have a duty to treat them all.

At the hospital where I trained in A&E, infectious diseases accounted for at least one third of patient admissions. Failure to treat these cases in a timely fashion leads to more severe illness, more expensive emergency treatment, and also increased risk of transmission to others in the community. Treating migrants benefits everyone, in the same way that immunisation benefits the whole community.

Proponents of the reform may point to charging exemptions for the most contagious infectious diseases, such as TB and HIV, but how a non-clinical team administering up-front charging is able to guess at the cause of a cough is beyond me. It is also worth asking who will be deterred from ever stepping foot inside a hospital. If the NHS gets borders, who will we be trapping on the outside?

There are caveats to the new system that will make sure those requiring “urgent” or “immediately necessary” treatment are not prevented from receiving it. However, unpicking this distinction reveals another flaw—dialysis being a good case in point.

Using a dialysis machine is a common treatment for those with severely failing kidneys, the usual regimen being three four-hour sessions per week to remove sufficient toxins from the blood. If an individual is unable to access this ‘non-urgent’ treatment, the toxins build up and within a week the individual will inevitably require emergency care and likely hospital admission to an intensive care unit.

Unfortunately this is a scenario that I, and many emergency clinicians, have seen in recent years. The cost of this admission easily outweighs the cost of ‘non-urgent’ dialysis and will not be recouped if the individual is unable to pay. Furthermore, a previously available bed becomes occupied unnecessarily. Heading towards another winter crisis, this doesn’t bode well.

Whether motivated by a xenophobic rhetoric in parts of the mainstream media, an unrelenting austerity agenda, or a step towards upfront charging for all NHS patients, if followed through this reform will add further pressure to a system struggling to cope, and cause serious harm to the health of the population. I have no doubt that an independent cost-benefit analysis will demonstrate a failure to recuperate costs.

If, as I fear, such an analysis does not happen, it is up to health care workers to refuse to comply with this latest assault on the NHS, up to patients to stand together in refusing to prove their eligibility in their moment of need, and up to NHS Trusts themselves to break their silence and stand up to the Government’s illogical and harmful policies.

Learn more about the Docs not Cops campaign.