Govt’s figures say tourists cost NHS only £7m a year


by Sunny Hundal    
1:30 pm - March 27th 2013

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In his immigration speech earlier this week, David Cameron said he wanted to “stop the expectation” the NHS is “free to the entire world” and would take steps to ensure the NHS can claim back money owed by those not entitled to it.

How much did they cost then? Cameron put the figure at £20m, and Jeremy Hunt then randomly upped it to £200m.

But the true figure may be less than £7 million – and this is the Coalition government’s own figure.

In March 2011, the Tory MP Priti Patel asked the health minister Anne Milton:

…. how many residents of each (a) EU member state and (b) non-EU country were treated by the NHS in each of the last five years; and what the cost to the public purse was of such treatment in each such year.

The response: For 2009-10 the figure was put at £6,967,780.

This figure doesn’t not include the benefits from those health tourists coming here and spending money.

Update: And just to be clear, that £7m figure includes the costs to the NHS of EU and non-EU citizens treated in the UK. So where did Cameron get his £20m figure from, and where did Jeremy Hunt get his £200m figure from?


This article’s headline was changed from ‘immigrants’ to ‘health tourists’ to offer more clarity.

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Reader comments


I wonder how many “immigrants” work in the NHS.

I was surprised to learn from friends and acquaintances of around my age with extensive healthcare experience, NHS and private, of a strong consensus as to which ethnicity makes for the best nurses: Filipinos

There is also a strong consensus about who make the worst but I dare not mention that.

2. Dave Menochethy

Important point. But I’d feel better about tweeting this / bigging it up if you would do a spellcheck on your articles. The lack of proofreading on this site kind of suggests that you’re sloppy with your facts too… which I’m sure is not true.

3. ex-Labour voter

A few years ago, the Labour government was up to a similar disgusting game. John Reid’s claims were seen to be very false and seriously misleading too.

So this government doesn’t check it’s facts. What’s new? We all know how incompetent they are. There seems to be a new gaff every week.

Same place he got his 20p can of Lager from , his bigotted Fascist head .

1) The official figure is 20 million approx, however,
2) If a hospital patient is recorded as a UK resident the NHS pays for the treatment received, but if recorded as non-resident, then the hospital has to attempt to retrieve the cost. This produces an incentive to record non-residents as residents.
3) The true cost is not known, but 200 million has been suggested. It may be more, or very much less.

7. Shatterface

This article’s headline was changed from ‘immigrants’ to ‘health tourists’ to offer more clarity.

Or reality

The response: For 2009-10 the figure was put at £6,967,780.

I’m sure that figure is correct but I’d like to know how it was arrived at.

You see I’ve been to hospital casualty department a few times over the past years and only once, and that quite recently, have I been asked “have you got a British passport?”. I should add that having seen my raised eyebrows, the nurse asking the question quickly added “we ask that of everyone coming to register”. I wasn’t asked to produce my passport neither did I ask what would have happened had I said “no”. At the time I was in too much pain to bother about pursuing human rights issues. So I suspect that the £7 million figure refers to those who have volunteered the information that they are not entitled to free NHS care but have been treated anyway, or about whom it has subsequently been discovered that they are not eligible.

“have you got a British passport?”.

Why would they ask that anyway? Surely the logical question is if you’ve paid stamp?

7

It is highly unlikely that anyone would be treated in an NHS hospital without knowing details of previous medicines/treatments/doctor except in an emergency and when the person is not conscious. In any case, this information would be pursued after treatment and the person’s national health number would be sought. It would then come to light that the person is not registered in this country, which would give a good indication about the person’s residency status.

A problem exists as follows:

1) The official figure is 20 million approx, however,
2) If a hospital patient is recorded as a UK resident the NHS pays for the treatment received, but if recorded as non-resident, then the hospital has to attempt to retrieve the cost. This produces an incentive to record non-residents as residents.
3) The true cost is not known, but 200 million has been suggested. It may be more, or very much less.

The Answer to the NHS

I hope to explain my theory and the possible answer to NHS which has always in my opinion been a complete shambles from day one. If my system works we will have the best free health care in the world with a huge amount of financial relief on the tax budget.

? First put a value on every hospital in the UK property/land etc
? Yes they are all going to be sold but do not dismiss this letter please read on.
? Once a hospital becomes private owned they will be run in the manner they should be run
? All properties have a lease on them from the government and can never be changed with the planning departments into any other type of business.
? This has now taken the stress off the government other than visits to grade the hospitals as we do hotels
? Once the hospital is private owned we do not have to worry about running costs and management taking back hander’s which we know does happen from drug companies.
So now what happens? The simple answer is that the government takes an insurance policy out on every NI numbered UK resident.
? What this does is stops all non UK residents getting free treatment in our hospitals
? Everyone gets treated to a high standard because if you owned one of the hospitals you want the payments from the insurance companies.
? The patient now has a choice where to be treated.
? The patient can upgrade their insurance policy if they choose.
? The patient can have options on the policy to include travel.
? Once insured and hospitals are private owned there will be NO false claims on the dhss
?
Quick breakdown
? It is cheaper to insure our people than run the NHS
? We do not have the trouble with false claims and use of our hospitals
? The hospitals will be better run, just think if Sir Richard Branson owned a few they would be run better than most hotels
? No illegal immigrants using our free service.
? No slackers in their hospital jobs as now they answer to share holders etc
? Insurance companies will be falling over themselves for the contract but there must be a set percentage set for future policy’s
? If the hospital does not reach the standards they will loose it and be resold, set out in the lease.
? We do not have problems with unions and all the other pen pushers that seem to get a free ride.
If you are insured by the government regardless if you are in employment, you have free health care !!!
Yes this system need fine tuning but I did not want to write a ten page essay just give you the core of the idea.
Best Regards
Keith Pearce (keith@opimusinvestments.com)

13. Man on Clapham Omnibus

There is surely a bigger picture here? Its not only the cost of the healthcare system that is the issue is it?

14. Man on Clapham Omnibus

11. keith pearce

‘Once the hospital is private owned we do not have to worry about running costs and management taking back hander’s which we know does happen from drug companies’

That’s a relief! I was starting to worry!

Oh by the way, Branson is involved in the NHS and the patients arent happy as I recall.

Nice work.

That really is one silver bullet’s worth of research.

I suppose that how best to fire it is now the question.

16. The Maelstrom of My Memory

This article demonstrates that the £7 million figure is incorrect.

http://www.bbc.co.uk/news/uk-england-london-16711783

I’ve just discovered from an enquiry related to another matter that on the UKBA General Visitor Visa form (the one for tourists) are the questions:

9.2 have you ever received medical treatment in the UK?
Put a cross (x) in the relevant box

9.3 did you have to pay for the treatment?
Put a cross (x) in the relevant box

9.4 Where did you receive the treatment?

Keith Pearce @ 11:

Charming idea but it has a fatal flaw. Private insurance costs more. There have been quite a few studies that have looked at the NHS and come to the conclusion that it is best value for the money.

I know that for Tories labouring under the myth that private is more efficient, this comes as a shock, so let me admit there is one way in which private is much more efficient, and that is lining the pockets of its CEOs and shareholders.

So we’re going to get a system a bit like the one you specify (except we’re going to have to take out the insurance ourselves), not because it’ll be any better at looking after us. It won’t be. We’ll get it because it will be much better at stuffing yet more filthy lucre into the already overstuffed pockets of the rich.

19. Charlieman

@16. Bitethehand: “I’ve just discovered from an enquiry related to another matter that on the UKBA General Visitor Visa form (the one for tourists) are the questions…”

I filled in an exit form (not leaving the UK) a couple of weeks ago. I provided sufficient information to keep the officials happy, to appear unexceptional, to keep the queue flowing. I presume that others act in the same way.

For entry forms, I fill them in diligently, because they are the ones that immigration officials read.

20. Derek Hattons Tailor

@ 11

Why do you believe that backhander don’t happen in the private sector ? Backhanders are far more common there than in the public sector, when was the last time a public servant was prosecuted for fraud ?

Where is the evidence that the private sector run public services better ?

If I get hit by a bus how do I exercise my “choice” of hospital ?

What do the patients/local population do if a hospital closes for not being profitable ?

How does being “insured by the government” differ from the current system of National Insurance ?

How does a universal system work with the private sector imperative to price risk for individual patients – something all private health provider do routinely ?

hi guys,
Lots of questions,
I’m insured for any hospital in the world for 246.00 per year, the NHS breaks down to 1700.00 per head. If you get hit by a bus you go to the nearest hospital. where back handers are a concern that would be the owners problem not ours. If they do not keep the standard up they LOOSE the hospital and of course their money so not wise. Not the governments problem for any other issue. which ever way you look at it, its a massive cost to the government. I wonder how many slip in for treatment who do not even belong in this country? you must be an English resident to get treatment hence you must have insurance or PAY. There again if the gov does not own the hospitals not our problem its the new owners problem of false treatments, how much do we pay out for bad decisions or mistakes by our doctors? 200million has been mentioned which would not be our problem. By the way tesco’s insure for 0.16p per day?

22. Charlieman

@OP, Sunny: “How much did they cost then? Cameron put the figure at £20m, and Jeremy Hunt then randomly upped it to £200m.”

I think you’re being over defensive. It is quite clear that UK government, NHS administrators and political speech writers have absolutely no idea how much is spent to treat UK visitors.

The BBC has a page where some treatment costs are listed:
http://news.bbc.co.uk/1/hi/programmes/breakfast/4898158.stm

A GP consultation cost c. £24 in 2006, which was less than the cost of raising an invoice to claim back the money.

The £7 million quoted would have paid for about 2,500 broken legs or 220 heart transplants. It doesn’t buy a lot of health care, so we should assume that the figure is wrong. Even £200 million doesn’t buy a lot.

Then we should look at the other number: how many people visit the UK. It’s 29.2 million visitors for 2011 according to Wikipedia which does not cite the source; but assume that the figure is about right. It is not a useful number because we don’t know about duration of visit or motivation. All it can provide is scale, that the number of visitors is a bit freaky when you look at the size of our islands.

UK visitors may get ill when they are here and require NHS treatment. The vast majority of visitors come from (EU/EEA) countries where we have reciprocal agreements for healthcare treatment. The UK may lose out on this marginally if more people visit the UK than UK citizens travel abroad. Then there are citizens from the USA, for example, who have no right (beyond medical ethics) for treatment anywhere; they may be winging it at home, trusting on youth and a healthy lifestyle, or they are insured.

It is thus likely that the sick visitors who upset right wingers, visitors from a country without reciprocal agreement with the UK or from a country where health insurance is not a necessity, come from a poor part of the world and are probably non-white. Who would have ever thought?

Is the NHS doing a good job at classifying whether patients are automatically eligible for treatment? For some treatments (GP consultation, A&E for minor injury), no purpose is served by asking questions; get them in and out of the door quickly and safely, and bugger the invoice. For long term treatment, eligibility questions may be pertinent but ethics will always overrule. If the patient requires treatment, NHS doctors and nurses deliver it.

The cluelessness about how much it costs to treat UK visitors demonstrates the cost of knowing. Why count pounds that you cannot collect unless to accommodate a managerialist freak?

23. Charlieman

@19. Derek Hattons Tailor: “Backhanders are far more common there than in the public sector, when was the last time a public servant was prosecuted for fraud ?”

There was an arrest a couple of days ago when a prison officer was accused of providing information to a newspaper. Plus a thousand other Leveson-related arrests, questionings and prosecutions of police, prison officers and other public officials.

“How does a universal system work with the private sector imperative to price risk for individual patients – something all private health provider do routinely ?”

I think that is a great question. The thing is that the private sector imperative is correct; it may be a shitty idea, but doctors should treat the patient rather than the symptoms.

24. the a&e charge nurse

[22] ‘The thing is that the private sector imperative is correct; it may be a shitty idea, but doctors should treat the patient rather than the symptoms’ – which symptoms, those that the private sector imperative deems OK to treat?

As a matter of interest which health system best epitomises this principle?

25. Derek Hattons Tailor

@ 20 Even if I believe that £240, what does that actually cover you for ? When I briefly had private insurance (it was free with an ex partners job ) it excluded any serious or chronic conditions – in other words the very conditions most of us will suffer from at some point and which cost the NHS the most. £240 might be the premium (with lots of exclusions) for a youngish healthy non smoker etc, but what about everyone else ?

If I get hit by a bus and go to the nearest hospital how is that a choice ? It’s exactly what I’d get now

If the hospital operators are taking backhanders, I as a patient would suffer through poor quality/no care. There have already been drops in standards in the NHS, local government and the Police as outsourcers take over public services and cut corners. So it isn’t just a matter for the firm. In a genuine free market I can go elsewhere if I’m unhappy with quality, I can’t do that with a private healthcare monopoly

I understand they would LOOSE the hospital and the revenue, but as a patient I don’t care about that, I care about replacing that lost capacity ?

Again, Tesco insure what exactly for 0.16 per day

What about development of new drugs/treatments. All drug research is funded by government would the private sector take this on, if yes, how would they fund it cheaper than government can ?

And finally, what about training, no private providers train doctors or nurses, so where would they come from, would we import them, or would the private sector fund training ?

The problem with private medical insurance has always been that it’s cheaper – until you actually get ill.

26. Charlieman

@23. the a&e charge nurse: “…which symptoms, those that the private sector imperative deems OK to treat?”

I said treat “the patient”. Look after the person.

But you raise a question that doctors working in the private sector might judge symptoms differently. Are you suggesting that private sector ethics are different?

27. Charlieman

@24. Derek Hattons Tailor: “What about development of new drugs/treatments. All drug research is funded by government would the private sector take this on, if yes, how would they fund it cheaper than government can ?”

Drug manufacturers create new drugs. Government bodies are consumers.

“And finally, what about training, no private providers train doctors or nurses, so where would they come from, would we import them, or would the private sector fund training ?”

UK imports nurses.

Private UK companies train nurses.

If the NHS ceased training of doctors, private companies would train doctors. Think about it for 20 seconds: why would anyone wish to train as a doctor in the UK if the teachers weren’t so damned good at it.

27 Charlieman

‘Drug manufacturers create new drugs. Government bodies are consumers’.

True, but this hides a major benefit for the cost of new drugs to the private sector – the NHS buys in such large quantaties that the cost of development and initial production is quickly recouperated and prices fall. This wouldn’t happen so quickly if smaller private healthcare providers were the only purchasers.

Private UK companies train nurses.

This is also correct, however, the NHS are still paying for the student’s training and also for the private company to do the training. This does work-out more expensive than the NHS.

UK imports nurses.

Also correct but this doesn’t work so well in the Mental Health Services where talking therapies are carried-out by nurses, unless those nurses are fluent in English.

26

‘Are you suggesting that the private sector ethics are different,.

In the USA, where health care is purchased either by the rich or via insurance premiums, it has been found that drugs and therapies are given on demand when in fact they are useless other than as a placebo effect. Medical and nursing staff have to adhere to NICE guidelines.

29. the a&e charge nurse

[26] “Are you suggesting that private sector ethics are different?” – yes, of course they are, Steve B @28 beat me to the punch as to why.

I really have no idea what you mean when you say treat the person rather than the symptoms.

The OP is about the cost of health care for those from overseas what concrete examples did you have in mind when trying to differentiate between treating the person, rather than the symptoms?

I took the OP to allude to the pros/cons of providing ‘free’ health care for people who may not have contributed via taxes.

Please keep it simple, no tax id number or nia number no treatment unless you pay or your insurance pays,
For our choice is it cheaper to pay out for insurance or spend billions running it ourselves?
I have many friends who are doctors and it would be nice to see staff get the correct pay for the job they do. So many health staff work extra time without pay because they Care!
I have lived outside the UK for the last 10 years and now come back for business reasons and I’m heart broken what has happened to this wonderful country. Get out of the EU get rid of people who should not be here and the rest I give a warning FIT IN OR F/OFF!!


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