How much does "health tourism" actually cost the NHS?

Jeremy Hunt promises to end the "costly abuse" of the health service by foreigners, but just £12m or 0.01 per cent of the NHS budget was lost in 2011-12.

Based on the attention the government is devoting to the issue, you could be forgiven for believing that "health tourism" is a significant problem. Ahead of his speech on the subject on Wednesday, Jeremy Hunt has vowed to end the "costly abuse" of the NHS by foreigners, declaring that "by looking at the scale of the problem and at where and how improvements can be made we will help ensure the NHS remains sustainable for many years to come". In the speech, Hunt will announce plans to introduce a new tracking system linking a patient's NHS number to their immigration status and GP charges for those not entitled to free care. But how "costly" is this "abuse"?

In 2011-12, the NHS officially spent £33m on treating foreign nationals, £21m of which was recovered. This means that just £12m, or 0.01 per cent of the health service's £109bn annual budget, was lost to "health tourists". In March, when David Cameron raised the issue in his speech on immigration, Hunt claimed the true figure was £200m but produced no evidence to support his claim. But even if we accept the Health Secretary's estimate, this figure accounts for just 0.18 per cent of the NHS budget and that's before we take into account the savings made from British nationals using foreign health services and the administrative cost of the new "crackdown".

As ever when immigration is discussed, it's also important to remember that migrants contribute far more in taxes than they receive in benefits and services. An OECD study earlier this month found that they make a net contribution of 1.02 per cent of GDP or £16.3bn to the UK, largely because they are younger and more economically active than the population in general. As I've noted before, if David Cameron wants to reduce the national debt (and he hasn't had much luck so far), he needs more immigrants, not fewer. While zero net migration would cause the national debt to rise to more than 160 per cent of GDP by 2060-61, an open-door approach would see it fall to around 40 per cent from its current level of 75.2 per cent.

Health Secretary Jeremy Hunt speaks at the Conservative Party's annual Spring Forum on March 16, 2012 in London. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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The UK is dangerously close to breaking apart - there's one way to fix it

We must rethink our whole constitutional settlement. 

When the then-Labour leader John Smith set up a report on social justice for what would be the incoming government in 1997, he said we must stop wasting our most precious resource – "the extraordinary skills and talents of ordinary people".

It is one of our party’s greatest tragedies that he never had the chance to see that vision put into practice. 

At the time, it was clear that while our values of equality, solidarity and tolerance endured, the solutions we needed were not the same as those when Labour was last in power in the 1970s, and neither were they to be found in the policies of opposition from the 1980s. 

The Commission on Social Justice described a UK transformed by three revolutions:

  • an economic revolution brought about by increasing globalisation, innovation and a changing labour market
  • a social revolution that had seen the role of women in society transformed, the traditional family model change, inequality ingrained and relationships between people in our communities strained
  • a political revolution that challenged the centralisation of power, demanded more individual control and accepted a different role for government in society.

Two decades on, these three revolutions could equally be applied to the UK, and Scotland, today. 

Our economy, society and our politics have been transformed even further, but there is absolutely no consensus – no agreement – about the direction our country should take. 

What that has led to, in my view, is a society more dangerously divided than at any point in our recent history. 

The public reject the status quo but there is no settled will about the direction we should take. 

And instead of grappling with the complex messages that people are sending us, and trying to find the solutions in the shades of grey, politicians of all parties are attached to solutions that are black or white, dividing us further. 

Anyone in Labour, or any party, who claims that we can sit on the margins and wait for politics to “settle down” will rightly be consigned to history. 

The future shape of the UK, how we govern ourselves and how our economy and society should develop, is now the single biggest political question we face. 

Politics driven by nationalism and identity, which were for so long mostly confined to Scotland, have now taken their place firmly in the mainstream of all UK politics. 

Continuing to pull our country in these directions risks breaking the United Kingdom once and for all. 

I believe we need to reaffirm our belief in the UK for the 21st century. 

Over time, political power has become concentrated in too few hands. Power and wealth hoarded in one corner of our United Kingdom has not worked for the vast majority of people. 

That is why the time has come for the rest of the UK to follow where Scotland led in the 1980s and 1990s and establish a People’s Constitutional Convention to re-establish the UK for a new age. 

The convention should bring together groups to deliberate on the future of our country and propose a way forward that strengthens the UK and establishes a new political settlement for the whole of our country. 

After more than 300 years, it is time for a new Act of Union to safeguard our family of nations for generations to come.

This would mean a radical reshaping of our country along federal lines where every component part of the United Kingdom – Scotland, Wales, Northern Ireland and the English regions – take more responsibility for what happens in their own communities, but where we still maintain the protection of being part of a greater whole as the UK. 

The United Kingdom provides the redistribution of wealth that defines our entire Labour movement, and it provides the protection for public finance in Scotland that comes from being part of something larger, something good, and something worth fighting for. 

Kezia Dugdale is the leader of the Scottish Labour party.