A fellow doctor had the nerve to tell me on national radio yesterday that health tourism is an insignificant problem for the NHS.
Listeners to the Today programme on Radio 4 heard her claim that ineligible patients from overseas account for just 0.3 per cent of the health service’s budget.
That’s what many doctors like to believe. And even if this were the case, 0.3 per cent would amount to some £360 million, enough to pay for thousands more doctors and nurses in our overstretched health service.
But the truth is actually far worse: health tourism costs the NHS in the region of £2 billion. And it is contributing hugely to a crisis in our capacity to provide care as patients are turned away because beds are full and operating theatres are not available.
Hospitals under the most pressure from health tourists are ones close to major airports in London, Birmingham and Manchester
Changes were introduced yesterday by Health Secretary Jeremy Hunt to tackle the problem of health tourism, obliging hospitals to identify and charge up front any foreign patient not eligible for free treatment.
But as I will show, these measures go nowhere near far enough to protect the NHS against health tourists — people who fly to Britain from all over the world to take advantage of our health care system, with no intention of paying for it.
Let me be clear that I am not talking about emergency treatment. This should always be free on the NHS, to whoever needs it and wherever they come from, as well as treatment for genuine asylum seekers and certain disadvantaged groups.
I am talking about people from abroad who target the NHS because they will often get better treatment than at home — and for free.
The abuse is particularly bad in maternity and cancer wards. At St George’s hospital in Tooting, South London, deliveries by mothers from outside the European Union totalled a fifth of all births, according to figures released by the NHS board last year.
Measures do not go far enough to protect the NHS from people who fly from all over the world to take advantage of the health care system, the former consultant writes
Around 900 women were treated, costing the hospital £4 million in unpaid bills. It beggars belief that so many patients were seen — nearly three a day for an entire year — yet no one appeared to care whether they were eligible for NHS treatment.
But in my experience this is not unusual. Many young NHS doctors take the attitude that it’s our responsibility to provide care for everyone, regardless of where they come from or whether they meet the criteria for free treatment — as if any other attitude was tantamount to racism.
Despite daily experience of staff shortages, bed shortages, overcrowding and endless waiting lists, they behave as if it is Britain’s responsibility to extend free health care to the whole world. As with so many utopian ideals, the reality of this approach causes actual hardship and suffering.
To give a stark example: the BBC documentary Hospital, which aired last February, featured a Nigerian mother Priscilla who had fertility treatment in her home country. She arranged to have her quadruplets delivered by Caesarean section in Britain, although she didn’t qualify for NHS care. One baby was stillborn. Two died after months of intensive care in a neonatal unit. The fourth required care for much longer.
At the lowest estimate, the cost to the taxpayer in Priscilla’s unpaid medical bills was nearly £500,000, but that to me is not the real issue. What really matters is capacity: in this case, the three cots with numerous specialist staff and vital equipment that were not available for other babies.
To be fair, the policy introduced yesterday is an attempt to tackle such abuse. It means that, for the first time, NHS staff including doctors will have a responsibility to report patients they think may not be entitled to free care.
The latest policy designed to clamp down on abuse of the NHS by health tourists doesn’t go far enough, says J. Meirion Thomas
The guidance also makes it clear that NHS staff facilitating health tourism may be committing fraud. Yet in most ways, the new policy will do next to nothing to solve the problem. When they register, patients will now be asked if they have lived in the UK for more than six months.
If they answer ‘no’, they will be sent to an overseas visitor manager (OVM) who will ask to see their passport or proof of address.
If they answer ‘yes’, they will receive treatment with no further questions asked.
To say this is open to abuse is an understatement of almost comic proportions.
In fact, what was designed as a deterrent will become an incentive to health tourists, as news spreads that it is this easy to take advantage of Britain’s hospitality.
It is incredible to me that simple proofs of identity will not be required. A utility bill to prove residency and a passport to exclude identity fraud do not seem excessive requirements: they are necessary to open a bank account, after all. Without them, the policy is as good as useless.
A doctor told Radio 4 that health tourism is not a significant problem for the NHS, but J. Meirion Thomas says otherwise
Nor will the new rules do anything to prevent widespread identity fraud already taking place across the NHS, as health tourists from abroad turn up at hospitals with false names and addresses, often of a relative who is entitled to free NHS care.
The hospitals under most pressure from health tourists are the ones close to major airports, in London, Birmingham and Manchester.
Frustratingly, these are the very hospitals least likely to be following the guidelines.
Six weeks ago, I sent Freedom of Information requests (FOIs) to 17 health trusts in these three cities, asking how many overseas visitor managers (OVMs) were employed by each to check on health care entitlement, and how many new patients were seen weekly.
The answers were shocking. I learned that Bolton NHS trust, for instance, sees 3,966 new patients weekly, and employs just one OVM. There is also just a single OVM at University Hospitals trust in Birmingham, where 4,124 new patients are seen each week.
The Christie Hospital, one of the largest cancer centres in the country, which serves Greater Manchester and Cheshire, also employs one OVM . . . and treats 44,000 patients annually. One can only feel sorry for the beleaguered individuals trying to do their impossible jobs, all alone in these immense hospitals.
‘The Health Secretary expects a tiny bandage to cover a gaping wound in the health service.’
Perhaps that is why three Manchester health trusts (Wythenshawe, Stockport and Tameside and Glossop) confess they do not employ any OVMs, though all admit more than 2,000 new patients a week — and why the Pennine NHS Trust, with its weekly rush of 6,046 new patients, employs one part-timer, two-and-a-half days a week.
Yet the Government’s guidance on Jeremy Hunt’s latest policy places so much responsibility directly on the OVMs. They are expected to undergo additional training, and then teach other staff about the new strategies. How is this possible, when the OVMs themselves do not exist?
The Health Secretary expects a tiny bandage to cover a gaping wound in the health service. He must be aware none of the basic NHS targets are being met nationwide: emergency patients should be seen within four hours, cancer patients should start treatment within 60 days and patients who undergo elective surgery should start treatment within 18 weeks.
These are not mere statistics. They are the promises made to British healthcare users, who pay for the NHS in the first place, and they are all being broken. The cost in human lives is inestimable.
Fixing the National Health Service is a gargantuan task. But the introduction of simple ID checks would be a major step towards combating health tourism.
Doctors must stop dismissing it as an insignificant problem. It isn’t: it costs countless lives and it is undermining the whole of the NHS.
- J. Meirion Thomas is a private consultant surgeon