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.

John Moore
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The man who created the fake Tube sign explains why he did it

"We need to consider the fact that fake news isn't always fake news at the source," says John Moore.

"I wrote that at 8 o'clock on the evening and before midday the next day it had been read out in the Houses of Parliament."

John Moore, a 44-year-old doctor from Windsor, is describing the whirlwind process by which his social media response to Wednesday's Westminster attack became national news.

Moore used a Tube-sign generator on the evening after the attack to create a sign on a TfL Service Announcement board that read: "All terrorists are politely reminded that THIS IS LONDON and whatever you do to us we will drink tea and jolly well carry on thank you." Within three hours, it had just fifty shares. By the morning, it had accumulated 200. Yet by the afternoon, over 30,000 people had shared Moore's post, which was then read aloud on BBC Radio 4 and called a "wonderful tribute" by prime minister Theresa May, who at the time believed it was a genuine Underground sign. 

"I think you have to be very mindful of how powerful the internet is," says Moore, whose viral post was quickly debunked by social media users and then national newspapers such as the Guardian and the Sun. On Thursday, the online world split into two camps: those spreading the word that the sign was "fake news" and urging people not to share it, and those who said that it didn't matter that it was fake - the sentiment was what was important. 

Moore agrees with the latter camp. "I never claimed it was a real tube sign, I never claimed that at all," he says. "In my opinion the only fake news about that sign is that it has been reported as fake news. It was literally just how I was feeling at the time."

Moore was motivated to create and post the sign when he was struck by the "very British response" to the Westminster attack. "There was no sort of knee-jerk Islamaphobia, there was no dramatisation, it was all pretty much, I thought, very calm reporting," he says. "So my initial thought at the time was just a bit of pride in how London had reacted really." Though he saw other, real Tube signs online, he wanted to create his own in order to create a tribute that specifically epitomised the "very London" response. 

Yet though Moore insists he never claimed the sign was real, his caption on the image - which now has 100,800 shares - is arguably misleading. "Quintessentially British..." Moore wrote on his Facebook post, and agrees now that this was ambiguous. "It was meant to relate to the reaction that I saw in London in that day which I just thought was very calm and measured. What the sign was trying to do was capture the spirit I'd seen, so that's what I was actually talking about."

Not only did Moore not mean to mislead, he is actually shocked that anyone thought the sign was real. 

"I'm reasonably digitally savvy and I was extremely shocked that anyone thought it was real," he says, explaining that he thought everyone would be able to spot a fake after a "You ain't no muslim bruv" sign went viral after the Leytonstone Tube attack in 2015. "I thought this is an internet meme that people know isn't true and it's fine to do because this is a digital thing in a digital world."

Yet despite his intentions, Moore's sign has become the centre of debate about whether "nice" fake news is as problematic as that which was notoriously spread during the 2016 United States Presidential elections. Though Moore can understand this perspective, he ultimately feels as though the sentiment behind the sign makes it acceptable. 

"I use the word fake in inverted commas because I think fake implies the intention to deceive and there wasn't [any]... I think if the sentiment is ok then I think it is ok. I think if you were trying to be divisive and you were trying to stir up controversy or influence people's behaviour then perhaps I wouldn't have chosen that forum but I think when you're only expressing your own emotion, I think it's ok.

"The fact that it became so-called fake news was down to other people's interpretation and not down to the actual intention... So in many interesting ways you can see that fake news doesn't even have to originate from the source of the news."

Though Moore was initially "extremely shocked" at the reponse to his post, he says that on reflection he is "pretty proud". 

"I'm glad that other people, even the powers that be, found it an appropriate phrase to use," he says. "I also think social media is often denigrated as a source of evil and bad things in the world, but on occasion I think it can be used for very positive things. I think the vast majority of people who shared my post and liked my post have actually found the phrase and the sentiment useful to them, so I think we have to give social media a fair judgement at times and respect the fact it can be a source for good."

Amelia Tait is a technology and digital culture writer at the New Statesman.