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.

Photo: Getty
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Why gay men love this photo of Prince George looking fabulous

It's not about sexuality, but resisting repressive ideas about what masculinity should be.

Last week’s royal tour by the Duke and Duchess of Cambridge provided the most intimate view of the young family to date. Throughout the five-day visit to Poland and Germany, it was the couple’s adorable children who stole the spotlight.

As George and Charlotte become better acquainted with a world in which everyone recognises them, this level of public scrutiny is something that will no doubt have to be carefully managed by the family.

But there is one particular image from the trip that has both captured people’s hearts and prompted debate. On the eve of his fourth birthday, Prince George was invited behind the driver’s seat of a helicopter in Germany. Immaculately dressed in a purple gingham shirt neatly tucked in to navy shorts, the future King is pictured staring out of the helicopter in awe.

As a man who was visibly gay from a young age, the distinctly feminine image of George smiling as he delicately places his hands on his face instantly struck a chord with me. In fact, an almost identical photograph of five-year-old me happily playing in the garden is hung on my parents' kitchen wall. Since the photos appeared online, thousands of other gay men have remarked that the innocence of this image reminds them of childhood. In one viral tweet, the picture is accompanied by the caption: “When mom said I could finally quit the soccer team.” Another user remarks: “Me walking past the Barbies at Toys ‘R’ Us as a child.”

Gay men connecting this photograph of Prince George with their childhood memories has been met with a predictable level of scorn. “Insinuating that Prince George is gay is just the kind of homophobia you’d be outraged by if it was you," tweets one user. “Gay men should know better than that. He is a CHILD," says another.

Growing up gay, I know how irritating it can be when everyone needs to “know” your sexual orientation before you do. There are few things more unhelpful than a straight person you barely know telling you, as they love to do, that they “always knew you were gay” years after you came out. This minimises the struggle it took to come to terms with your sexuality and makes you feel like everyone was laughing at you behind your back as you failed to fit in.

I also understand that speculating about a child's future sexual orientation, especially from one photograph, has potential to cause them distress. But to assume that gay men tweeting this photograph are labelling Prince George is a misunderstanding of what we take from the image.

The reaction to this photo isn’t really about sexuality; it’s about the innocence of childhood. When I look at the carefree image of George, it reminds me of those precious years in early childhood when I didn’t know I was supposed to be manly. The time before boys are told they should like “boy things”, before femininity becomes associated with weakness or frivolity. Thanks to a supportive environment created by my parents, I felt that I could play with whichever toys I wanted for those short years before the outside world pressured me to conform.

Effeminate gay men like me have very specific experiences that relate to growing up in a heteronormative world. It is incredibly rare to see anything that remotely represents my childhood reflected in popular culture. This image has prompted us to discuss our childhoods because we see something in it that we recognise. In a community where mental illness and internalised homophobia are rife, sharing memories that many of us have suppressed for years can only be a good thing.

People expressing outrage at any comparisons between this image and growing up gay should remember that projecting heterosexuality on to a child is also sexualising them. People have no problem assuming that boys are straight from a young age, and this can be equally damaging to those who don’t fit the mould. I remember feeling uncomfortable when asked if my female friends were my girlfriends while I was still in primary school. The way young boys are taught to behave based on prescribed heterosexuality causes countless problems. From alarmingly high suicide rates to violent behaviour, the expectation for men to be tough and manly hurts us all.

If you are outraged at the possibility that the future king could perhaps be gay, but you are happy to assume your son or nephew is heterosexual, you should probably examine why that is. This not only sends out the message that being gay is wrong, but also that it is somehow an embarrassment if we have a gay King one day. Prince William appeared on the cover of Attitude magazine last year to discuss LGBT bullying, so we can only hope he will be supportive of his son regardless of his future sexuality.

Whether Prince George grows up to be heterosexual or not is completely irrelevant to why this image resonates with people like me. It is in no way homophobic to joke about this photograph if you don't see a boy being feminine as the lesser, and the vast majority of posts that I’ve seen come from a place of warmth, nostalgia and solidarity. 

What really matters is that Prince George feels supported when tackling the many obstacles that his unique life in the spotlight will present. In the meantime, we should all focus on creating a world where every person is accepted regardless of their sexual orientation or gender identity, because clearly we’ve got some way to go.