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6 February 2017

It’s not health tourism that’s thrown the NHS into crisis, it’s the cuts

The government's strategy of blaming foreigners for the mess will end in an ugly place. 

By Stephen Bush

The government will today announce new regulations, obligating hospitals to charge patients who are ineligible for NHS care before they are treated in a bid to cut costs caused by so-called “health tourism”.

How widespread is the problem? Well, at present, the NHS recovers 65 per cent of what it is entitled to from patients outside the European Economic Area (that is, the 27 other nations of the European Union plus Norway) and just 16 percent of the costs from inside it.  

The United Kingdom has always been something of an oddity in its approach to healthcare. Most countries with free-at-the-point-of-use systems check eligibility at admission. 

The government hopes to recover £500 millon a year through clamping down on unreclaimed costs, based, as far as I can tell, on assuming the savings secured in a pilot in Peterborough can be rolled out elsewhere.

But here’s the number that really matters: £116.4 billion, the NHS budget for 2015-16.

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Reducing the use of the NHS by ineligible patients might not shred the principles of free healthcare but as a funding mechanism, it’s about as effective as clamping down on stealing stationery.  Don’t forget, either, that that £116.4bn has proved inadequate to manage the growing pressures of our ageing population and the cuts to other parts of health spending. Here’s another number that actually matters: £4.6bn, the amount cut from social care since 2010. Anyone proposing that eliminating “health tourism” is selling snake oil. 

There are three things to watch out for here. The first is the extreme likelihood that the government won’t get close to £500m back, but will quickly find that those corners of the press cheerleading for today’s crackdown change their tune once a photogenic British citizen is turned away for not having the proper papers.

The second is what the new rules mean for the admissions process for British citizens who are originally from elsewhere. It’s striking that the NHS is so much better at recovering money from foreign patients from outside the EEA, suggesting that a degree of profiling is already at work in the Health Service. Our hospitals will continue to be busy and the likelihood is that for those of us with Anglo-Saxon accents and names, a visit to A&E won’t change all that much. But people with foreign accents and funny names  may well find hospitals an altogether less welcoming place.

The third is what happens when, even if the government can achieve its £500m target, that proves inadequate to the NHS’ financial need. The government is eschewing an honest conversation about funding the health service in favour of quick wins based on blaming the financial crisis on foreigners. It may not be the government that bears the blame when that crisis continues.