Why Hunt's crackdown on "health tourism" could cost more than it saves

"Health tourism" currently costs £12m, just 0.01 per cent of the NHS budget. The new crackdown could cost far more.

Jeremy Hunt is spending this morning discussing the government's plan to charge non-EU migrants a fee of at least £200 a year to access the NHS. He said: "We need to ensure that those residing or visiting the UK are contributing to the system in the same way as British taxpayers, and ensure we do as much as possible to target illegal migration. We have been clear that we are a national health service - not an international health service - and I am determined to wipe out abuse in the system. The NHS is a national treasure and we need to work with the entire health system to develop plans and make sure it is sustainable for years to come." The government is also planning to end free access to GPs for those from outside the EU who stay for less than six months. 

For entirely political reasons (the rise of a certain europhobic party may have something to do with it), the problem of "health tourism" has been much exaggerated. 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. In March, when David Cameron raised the issue in his speech on immigration, Hunt claimed that 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".

On the Today programme this morning, Hunt chose not to use the £200m figure, instead conceding: "the truth is we don't know the number". He added: "if you take the lowest number, which is the £12m that we don't collect, that alone is around 2,000 hip operations". But could Hunt's plans end up costing more than they save? The chair of the Royal College of GPs, Clare Gerada, estimates that staff costs alone will amount to £500m, more than 40 times the £12m currently lost to "health tourism". Gerada also warned that immigrants with infectious conditions, such as TB, could end up "wandering around for fear of being charged" or going to more expensive emergency units, which could cost more. "We need to make sure that what comes out the other end is sensible, proportionate and fair and doesn't cost us all much more money and put us at much more risk than the current situation which is one that, even at the worst estimates, is a tiny proportion of NHS costs," she said.

Hunt insisted that the government's consultation would take all of these issues into account, but his clear inclination to impose new curbs on foreigners won't assuage fears that the Tories are once again putting politics before policy. 

Health Secretary Jeremy Hunt speaks at the Conservative conference in Manchester last year. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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Scotland's vast deficit remains an obstacle to independence

Though the country's financial position has improved, independence would still risk severe austerity. 

For the SNP, the annual Scottish public spending figures bring good and bad news. The good news, such as it is, is that Scotland's deficit fell by £1.3bn in 2016/17. The bad news is that it remains £13.3bn or 8.3 per cent of GDP – three times the UK figure of 2.4 per cent (£46.2bn) and vastly higher than the white paper's worst case scenario of £5.5bn. 

These figures, it's important to note, include Scotland's geographic share of North Sea oil and gas revenue. The "oil bonus" that the SNP once boasted of has withered since the collapse in commodity prices. Though revenue rose from £56m the previous year to £208m, this remains a fraction of the £8bn recorded in 2011/12. Total public sector revenue was £312 per person below the UK average, while expenditure was £1,437 higher. Though the SNP is playing down the figures as "a snapshot", the white paper unambiguously stated: "GERS [Government Expenditure and Revenue Scotland] is the authoritative publication on Scotland’s public finances". 

As before, Nicola Sturgeon has warned of the threat posed by Brexit to the Scottish economy. But the country's black hole means the risks of independence remain immense. As a new state, Scotland would be forced to pay a premium on its debt, resulting in an even greater fiscal gap. Were it to use the pound without permission, with no independent central bank and no lender of last resort, borrowing costs would rise still further. To offset a Greek-style crisis, Scotland would be forced to impose dramatic austerity. 

Sturgeon is undoubtedly right to warn of the risks of Brexit (particularly of the "hard" variety). But for a large number of Scots, this is merely cause to avoid the added turmoil of independence. Though eventual EU membership would benefit Scotland, its UK trade is worth four times as much as that with Europe. 

Of course, for a true nationalist, economics is irrelevant. Independence is a good in itself and sovereignty always trumps prosperity (a point on which Scottish nationalists align with English Brexiteers). But if Scotland is to ever depart the UK, the SNP will need to win over pragmatists, too. In that quest, Scotland's deficit remains a vast obstacle. 

George Eaton is political editor of the New Statesman.