Panorama’s latest undercover investigation took as its theme
the abuse of the NHS by “health tourists” and illegal immigrants, setting three
undercover reporters the task of seeing if they could gain access to treatment
via using assumed identities. Although it helped to highlight significant flaws
in the existing system and unearthed a murky underworld where access to the NHS
is illegally purchased from unscrupulous middlemen, it left a number of questions
untouched, but given the limited length of the programme and the depth of the
investigation, it can perhaps be forgiven for not having addressed still more
facets of this problem.
It is only natural that anyone in long-term pain or
suffering from illness should go in search of a cure or treatment should the
opportunity to do so afford itself. In a world in which global transport and
communications have revolutionised the ability of people to travel between
countries and continents, and border controls in the UK have been scaled back,
there exists a natural temptation for citizens of other states where there is
inadequate healthcare to come to the UK to take advantage of the NHS. These are
“health tourists” in the strict sense of the term, but there is also the issue
of the large number of illegal immigrants resident in the country who also use
the NHS.
Guidance relating to who is and who is not eligible to NHS
treatment is opaque and complex, and whereas the instinctual reaction of those
working in the medical profession is to offer treatment to those in need, the
reality is that we are already denying our own citizens medical care and
treatment because we do not possess the necessary funds to offer this, so how
in effect can we justify providing treatment to “health tourists” and others
who are not eligible to receive these services? It is manifestly unjust that
our citizens, who have contributed via National Insurance and taxation to the
NHS, should effectively be denied treatment because those who have contributed
nothing are abusing the system. Such abuse is in fact helping to erode public
support for this aspect of the welfare state, as well as reducing the ability
of the NHS to deliver the services that we deserve.
However, it should be noted that hard statistics relating to
the costs incurred are hard to come by, and although they are significant, they
are thought to be relatively small in terms of the overall annual NHS budget.
In 2012 for example, the NHS budget is estimated to be some £104 billion, yet
one estimate provided in the Daily Mail in a story on “health tourism” that it
ran in June this year, suggested that the treatment of “those from outside the
EU who have lived in the country for less than a year” amounted to £200
million, or approximately 0.2% of the total budget. Still, this is a useful sum
of money that could pay for a lot of treatments, and time spent treating
somebody who is not entitled to treatment, is more time spent on a waiting list
for someone who is.
One of the reasons why this phenomenon has grown to be such
a problem was alluded to in a comment made by Panorama presenter Declan Lawn in
the introduction to the programme when he described Britain as “one of the most
multicultural societies on Earth.” Presumably, many personnel within the NHS
must be justly concerned that they may be accused of ‘racism’ if they demand
proof of identity from certain patients. Moreover, the programme made clear how
confusing NHS guidance on who was entitled to register with a GP, although the
situation with respect to who should receive treatment in hospitals was rather
clearer; that said, use of the qualifying term “ordinarily resident” combined
with government guidance of over 100 pages in length make the process of who
meets the criteria difficult.
One undercover reporter pretended to be a Nigerian health
tourist with “restless leg syndrome” and managed to gain initial registration
with a GP for a fee of £300 charged by a fixer (also of African origin),
whereas another undercover reporter took on the assumed identity of an illegal
immigrant from Kosovo with a bad back, who managed to obtain an NHS card for a
fee of £200, and so it went on. The documentary made it clear that for those
with the money and the right contacts it is perfectly possible to obtain an NHS
card and thereby gain access to free treatment. Quite how widespread this is,
we cannot know, but evidently some unscrupulous people are profiting from this
situation and the system is open to abuse.
A Migration Watch spokesman made the point that Attlee and
Bevan had intended to set up a National Health Service, not an International
Health Service. Some campaigners however, think that the NHS should treat
everyone. As mentioned earlier though, we simply do not possess the resources
to treat our own people, let alone “health tourists” and others who are not
eligible.
Clearly, there are some illegal immigrants who are in a
desperate situation through no fault of their own, i.e. those who have been
brought into the country in conditions of near slavery such as those who have
been trafficked for sexual exploitation. It would be callous indeed to deny
them emergency treatment, and ultimately the solution to the abuse of the NHS
lies with a robust approach to immigration that will enable us to continue to
provide the universal healthcare to all of our citizens that they deserve.
Without gaining effective control of our borders, how can we hope to provide
meaningful healthcare for our citizens? The standards and scope of treatment
within the NHS ought to be improving year upon year, not getting worse, but we
can only ensure the former if we possess the funds with which to achieve this.
Tackling illegal “health tourism” and putting in place effective border
controls can help us to ensure that the scarce funds available are allocated to
the best effect. In the interim, until such controls are put in place (assuming
that a party willing to institute such changes to our border regime is ever
elected), targeting those who facilitate the abuse of the NHS ought to be
looked at more seriously with a view to reducing its prevalence.
