Theresa May refuses to "quantify" cost of "health tourism" as she panders to immigration fears

The Home Secretary glossed over the fact that "health tourism" costs just 0.01% of the NHS budget.

Among the measures included in the government's new immigration bill, which is published today, is the introduction of a £200 charge on all temporary migrants, such as overseas students, to use the NHS and a requirement for GPs to check the migration status of new patients. 

Both policies are aimed at solving the alleged problem of "health tourism", whereby migrants travel to the UK to seek free healthcare, 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". The cost of administrating the new system could well outweigh the savings (the chair of the Royal College of GPs, Clare Gerada, estimates that staff costs alone will amount to £500m), while also increasing public health problems such as TB by deterring temporary migrants from seeking treatment when they first fall ill. 

Challenged on this point on the Today programme this morning, Theresa May repeatedly refused to "quantify the problem", instead describing it as "a point of principle" and noting that the public believe "there is an issue out there". In other words, the government is making policy based on fears, rather than facts. 

A dose of sanity was provided by east London GP Paquita de Zulueta, who warned that the bill would make it "considerably harder for vulnerable migrants in considerable need to access healthcare" ("if they can't access primary care or they're too frightened to they'll wait until they're really ill," she said) and pointed out that "we're net exporters of patients". 

But to May, the woman who once warned that the Conservatives were seen as "the nasty party", all of this is irrelevant as where UKIP leads, the Tories follow. 

Theresa May speaks at the Conservative conference in Manchester earlier this month. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty Images
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Autumn Statement 2015: a test of competence as well as compassion

George Osborne's chickens may be coming home to roost.

The debate will be political and polarized, as you’d expect, when the Chancellor sets out the results of the Spending Review tomorrow and how his £20bn of savings will be realised. However my suspicion is that while many followers of the Westminster's circus are debating what it all means for compassionate or compassionless conservatism, the public will be more interested in a more straightforward question: one of competence. 

Strip away the hyperbole and the election in May was won on an assessment of which party was the more competent to govern. A huge part of the public’s judgment in this regard was to trust the track record of the Conservatives in balancing the books and that the £20bn in departmental savings earmarked was a reasonable and responsible ambition. 

This is the question in point because what the public did not endorse explicitly was significant change in the size and role of the state. The argument was made and won for a budget surplus, not necessarily for its consequences. As Paul Johnson of the IFS has been at pains to say after every recent budget.

We should acknowledge that one of the reasons the Chancellor does have the public’s confidence is that the cuts to public services so far have not been as damaging as many opponents predicted. The NHS is under-strain, but has not broken. Hard pushed local government leaders have managed to shield social care from the worst of the changes, and the majority of police officers lost were in the back-office not on the beat. So when pollsters ask the public whether they have noticed the effects of austerity, most say they haven't. 

Understanding what the implications are of further large reductions in areas in the firing line such as police forces or local government is hard to do. So the government has told the public "trust us". Now we are going to find out how well that trust was placed. The point is this though - if the public haven't yet felt the full affects of a smaller state they may not be so tolerant it if they do. That brings us to the Chancellor’s real test. The easy cuts have surely been made, after the long years of spending increases prior to 2010 you would expect the system to be able to tighten its belt. But with five years of austerity under that belt there is a risk that the additional cuts could push services too far. 

The public were told that £20bn of saving could be achieved without the kind of pain that will be felt if social care for the elderly really starts to fall over, if police officers become significantly more scarce, or if the NHS does need much more than the promised £8bn (as many believe it will). On this point they have trusted the Chancellor to understand the implications of what he is promising. So if the policy choices in the Spending Review turn out to show that he did not, it will be the Government's competence as much as its compassion that will concern the public.


Steve O'Neill was deputy head of policy for the Liberal Democrats until the election.