GHT Homepage News Health Tourist Myth - Migrants Pay the Penalty

Health Tourist Myth - Migrants Pay the Penalty
14th May 2008

A report out today rejects the claim that the NHS is being exploited by people coming to the UK just to get free health treatment. But some parts of the NHS claim tough restrictions are necessary.

Two years ago, the international medical aid charity Médecins du Monde, best known for its humanitarian work in war zones or areas of famine, sparked controversy when it set up a clinic in London to provide marginalised people - homeless people, illegal migrants and those in the limbo of the asylum system - with care and health advice.

The clinic's arrival, and its explicit intention of helping this group of patients to access NHS treatment to which they are entitled, ignited a debate on "health tourism". Critics argue that the NHS is being ripped off by foreigners who are visiting the UK solely to get healthcare at the UK taxpayers' expense.

The heat of that debate will increase this summer when a government consultation will propose even tighter restrictions on NHS access for foreign nationals, including denying access to basic GP services.

free treatment saves money
Médecins du Monde today launches a report on the first two years of the work of Project London. The findings, it says, give a lie to the notion that allowing universal access to basic healthcare for anyone, regardless of nationality, would cripple the NHS financially.

Instead, it argues that timely treatment keeps people out of hospital, stops the spread of infectious diseases such as TB, saves lives, and saves the health service money.

Single consultation
The drop-in clinic in Bethnal Green, East London, staffed by volunteer doctors and nurses, carried out 1,074 consultations on 893 patients between January 2006 and December last year. The vast majority, 78%, came only once, and for many their problems were solved as a result of that single consultation.

The clinic saw people from China (131), Democratic Republic of Congo (68), India (45), Brazil (30) and Bangladesh (29).

They wanted help with depression, headaches, anxiety and stress, back pains, sleep disorders, dental problems, abdominal problems - problems that, the report says, are "broadly reflective of the conditions seen among the general population in general practice".

It adds: "Of the service users who had medical consultations, less than a third even required prescriptions. The majority needed help to access primary care or antenatal services, rather than expensive specialist treatment."

In contradiction of the clichéd image of health tourists landing at Dover and demanding an NHS kidney transplant, it also found that patients had been in the UK an average of three years before seeking medical help.

People with a right to a GP refused
Worryingly, 29% of patients who were legally entitled to an NHS GP had been turned down because of confusion about eligibility rules. GPs currently have the discretion to treat anyone as an NHS patient. But in 2004 the government proposed this option be removed. This would effectively bar some 310,000 to 530,000 people - described by the Home Office as "irregular migrants" - from access to primary care. It has not yet barred NHS doctors from treating everyone they take on.

At the same time, the government actually changed the overseas visitors treatment regulations so that the same people were barred from accessing hospital care in all but specific circumstances.

Médecins du Monde says the timing led to confusion. Although GPs usually knew they could still take on any patient, the administrative staff who register patients were often uncertain; some thought the proposed bans were already in place.

The only exceptions to the hospital ban are treatment in A&E departments, treatment for infectious diseases such as TB and polio, sexually transmitted infections (but not for HIV), and any treatment that is "immediately necessary", such as antenatal care.

“Immediately necessary” care must be provided but the NHS nonetheless charges anyone needing it who is caught by the regulations. The bill for treating a pregnant woman with HIV during pregnancy and for a caesarean delivery to avoid onward transmission to the baby is typically over £6000.

But the report found that of the 118 pregnant women who came to the clinic, just 10% were registered with a GP. It discovered that 98 women came to the clinic in order to get help accessing antenatal care, and fewer than a third of the women had received any antenatal care before coming to the clinic.

Susan Wright, director of Project London, concludes: "There is absolutely nothing in the Project London data to support the idea of large numbers of overseas visitors coming to the UK specifically to seek out free treatment."

Letter to Trusts after High Court decision
The report is timely. Last week, the Department of Health (DH) wrote to NHS chief executives saying they must reconsider decisions to refuse treatment to some 11,000 failed asylum seekers who are unable to return home. The department was responding to a High Court ruling in which a judge said regulations banning a failed Palestinian asylum seeker from treatment for chronic liver disease were unlawful.
[see http://www.ght.org.uk/news_and_views_news_article/1686 for report and Department of Health letter]

The medical charity Medact is coordinating opposition to further restrictions on NHS care. Spokeswoman Moyra Rushby says: "Denying healthcare to people who need it - including pregnant women, torture survivors and people with communicable diseases - is both inhumane and unpragmatic. It also contravenes our professional codes of conduct."

tough charging at some hospitals
West Middlesex university hospital trust is close to Heathrow airport, which means it treats a large number of foreign nationals as emergency cases. It has become a key player in shaping future policy around treating overseas patients.

Normally, non-NHS patients are treated and then billed for the care they received, but some patients give false addresses or simply return home and ignore requests for payment. There are no reliable figures on the total cost to the NHS.
The trust has pioneered "stabilise and discharge", a proactive approach it claims has "all but eradicated health tourism". Those not entitled to NHS care either pay, using a bedside credit-card reader, or are asked to go, usually within 48 hours.

Overseas visitors are identified when they are treated in A&E, and if they need treatment that goes beyond A&E, they are stabilised as quickly as possible and then told how much it will cost for full treatment. For those who can't or won't pay, it is left up to three senior doctors to decide if they are stable enough to go - and that includes people who have had heart attacks. Some patients have been escorted off the premises. The trust is estimated to recoup up to £700,000 a year in this way - far higher than other hospitals with similar levels of overseas patients.

tough charging pilot for rest of the NHS
The trust was selected for a DH/UK Border Agency pilot that started last year with two other trusts and is looking at how hospitals operate the charging regulations. The DH says the next stage of the pilot could see the three trusts become a test bed for proposals that could see tighter restrictions on access to the NHS.

Stabilise and discharge is the brainchild of trust income generation manager Andy Finlay, who says he has witnessed systematic abuse by health tourists every week and faced death threats and verbal abuse. Finlay believes that adopting the policy across the NHS "has the ability to virtually eradicate health tourism as it would make the UK an unwelcome destination".

He adds that the policy "is not a tool for xenophobes, racists and the hang 'em and flog 'em brigade. It's a concept that not only promotes fairness and equity in a service that serves 59 million people, but it creates capacity in an already creaking system, thereby increasing NHS income as empty beds are occupied by eligible patients."

time to reconsider policy
This pilot and plan to test proposals that tighten further the restrictions on access to free NHS treatment needs to be reconsidered following the High Court’s recent judgement. The effect of the judgment is that many migrants have an existing right to free NHS healthcare because they are “ordinarily resident.” NHS trusts were wrongly denying that legal right under pressure from the Department of Health and its dodgy dossier of guidance.

It is hard to see much point in pressing on with ever harsher rules and NHS policing unless the Department wins its appeal at the House of Lords, or changes the NHS law itself.

In the interests of improving public health and in the spirit of the International Covenant on Economic, Social and Cultural Rights which the UK endorsed in 1976 with its promise to all living in the UK that we have the “right to the highest attainable standard of health”, it is surely time for a change of heart.

Rather than saving money, the proposed government changes on health regulations would only result in greater costs because:
* Lack of GP access means no chance of preventing diseases
* Lack of GP access means no chance of early and affordable treatment of diseases – including those which are contagious
* Lack of GP access is likely to lead to increased pressure on already burdened A&E departments.

Further information
Project London report
http://www.medecinsdumonde.org.uk/doclib/104524-report2007light.pdf

edited and expanded from source
http://www.guardian.co.uk/society/2008/may/14/nhs.society