Introductory comments and information from Greg Dropkin
I’ll make some general points about the charges imposed on certain migrants for using the NHS. This stands at the border between two very big issues: immigration control and the hostile environment created deliberately by the government, and the attack on the underlying principles of the National Health Service. The idea of the NHS was to offer comprehensive healthcare for everyone in Britain, that is to say universal and comprehensive healthcare, publicly provided, publicly accountable, publicly funded through general taxation, and free at the point of use. Each principle is under assault, and the migrant charges are part of the attack.
Healthcare is no longer universal if certain people can no longer access it in reality, and it is no longer free if certain people are forced to pay for it. Listen carefully to what the last Health Secretary, Jeremy Hunt, had to say in 2017 in introducing the Govt response to the consultation on extending charges still further.
“Our NHS is the envy of the world and we have no problem with overseas visitors using it – as long as they make a fair contribution, just as the British taxpayer does.” And then, in the Overarching Principles, the gov’t stated “Whilst overseas visitors can access its services, in order for the NHS to be financially sustainable it is vital they make a fair contribution towards the cost of those services. It is therefore our intention to make sure that only people living here and contributing financially to this country will get access to free NHS care.”
That might sound reasonable, until you think about it. If only people living here and contributing financially to this country will get access to free NHS care, what about the 12 million people in Britain under 16 years old, none of whom are contributing financially? What about the chronically ill, or the Long Term Unemployed?
Of course, children will become part of the future workforce and if they manage to get a job, they will pay income tax. But so will migrants, who already pay taxes every time they go to a shop, who want to work and who are, on average, healthier than the rest of the population.
Why is the NHS in financial difficulties? Is it health tourism – i.e. people who come here just to use the NHS and then go home? No, that costs £70m per year, around 0.06% of the NHS budget. Could it be PFI, which costs £2bn per year? Staff shortages £3.7bn. Private contactors £8.7bn. Or government cuts to the NHS budget, £22bn per year? Blaming migrants diverts attention from the real causes of the funding crisis in the NHS. But there is more to the agenda.
In order to try to recover costs from certain people, hospitals and community services have to set up a complex system to check everyone’s entitlement to free NHS care, train staff to use it, allocate computers etc. In future that system can be aimed at anyone the government wishes to charge for any aspect of their health care. It is the thin end of the wedge to destroy the principle of free NHS care.
Then there is privatisation. Currently, care of the dying is exempt from charging migrants, but only if it is provided by a Community Interest Company or charity. In other words, this specific care need is being moved out of the NHS for certain people. In 2011, the govt floated the idea of requiring health insurance in order to get a visa. As we know, the long term aim of the various NHS reorganisations is to move to a health insurance system.
Attacking migrants access to the NHS puts clinical staff in a conflicting position. They are trained to deliver care on the basis of clinical need, not immigration status. Except for urgent and immediately necessary treatment, certain migrants must now pay upfront charges at 150% of the NHS tariff, before they are treated. Urgent treatment is billed afterwards. Migrants from outside Europe will be reported to the Home Office after two months if they owe the NHS over £500. When patient data is passed to the Home Office, it undermines the trust between patient and doctor.
People who are frightened of being charged or reported to the Home Office may delay or avoid seeking treatment. They are then at risk of getting more ill and ending up in A&E. Even with an infectious disease like TB, whose treatment is free for everyone, the stresses faced by migrants in the hostile environment including poor housing, mean they are at greater risk of developing the disease, and then at greater risk of delaying treatment, which is then a public health risk for the whole community. The NHS needs to trace people with infectious diseases to know who they’ve been in contact with, but fear of being charged or reported makes that even harder. In other words, in public health terms the policy is crazy.
There is an excellent overview in a recent article by Ed Jones, which I urge you to read along with a national leaflet from KONP, explaining the charges and busting the myths about migrants and the NHS. For example, about 20% of NHS workers were born outside the UK – so much for the myth that the NHS is a national, not an international service.
To sum it up, migrants are not causing the crisis in the NHS. The charging regime is inherently racist, no matter what Equality Impact Assessments the gov’t issues. We should oppose charging anyone in Britain for using the NHS, and we should defend all of its fundamental principles.
Rayah Feldman is here now. She is a social researcher in London who has studied both HIV and maternity, including several reports for Maternity Action, including the very recent “What Price Safe Motherhood?” She will explain in detail the real situation facing undocumented migrant women during and after pregnancy, as a result of the charges.