The reality behind the government’s attacks on ‘health tourism’


4:05 pm - July 10th 2013

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by Poorni Jaganathan

My ayya (grandmother) was diagnosed with terminal colorectal cancer in October 2003. She had been in the UK for one month to visit us. It was meant to be a trip for her to get to know her grandchildren better, to see the country they had been raised in, the opportunities it had opened up for them. I believe she experienced the best of this country, but in way that none of us at the time could have imagined.

My ayya experienced wonderful care from doctors in the NHS. At no point was her nationality a cause for suspicion or derision. She was an Indian national, yes, but first and foremost a human being whom was terminally ill and needed help.

She had surgery, followed by months of gruelling radiation and chemotherapy treatments. Even though she eventually succumbed to her illness I will be forever thankful that she was treated well and within a system that I fully believe highlights the compassion of the British people. Her acceptance into the healthcare system is something I know, she was incredibly grateful for.

Aneurin Bevin created the NHS in 1948. He wanted a health system with, according to NHS England, three principles at its core:-

1. That it meets the needs of everyone
2. That it be free at the point of delivery
3. That it is based on clinical need, not ability to pay.

Note that none of the above makes reference to the demographics of recipients of care within the NHS.

So then, what makes someone, ‘eligible,’ to use NHS services? Maybe those who contribute to it and pay their taxes should only use the NHS. That should mean that all those U.K. born nationals who are out of work and on benefits, not paying taxes, should also be made to pay out of pocket. Technically, children don’t pay any taxes and thus don’t contribute to the NHS in a productive manner. So then, should we start charging children too?

Jeremy Hunt has estimated that the cost of non-EU citizens using NHS services could be around £12 million.

Whilst Hunt no doubt used this figure as a means of scaring the British public, when contextualised, one begins to understand how much this issue has been pushed to further the Tory agenda. Mona Chalabi points out that health tourism costs, ‘equate to fulfilling 0.06% of the savings,’ that need to be made in the NHS. So why is this issue the Tories have decided to focus their attentions on?

harging non-EU citizens could be the beginning of a very slippery slope. The care a doctor provides to patients shouldn’t be restricted by nationality or bank balance. Care should be provided to patients because they are in need of the services and by the very virtue of their humanity.

Mario Cuomo once famously stated, ‘candidates campaign in poetry but govern in prose.’ Sitting on their thrones in Whitehall, what Tories fail to realise is that there are very real people who will be affected by their discriminatory policy.


Poorni Jaganathan is a final year medical student with an interest in topical health issues.

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Reader comments


‘So why is this issue the Tories have decided to focus attention?’

It’s an easy target for scapegoating which is unlikely to have any electoral cost to them and could gain votes from those who swallow the myth that health tourism is a significant factor for the reduction of services.

“Jeremy Hunt has estimated that the cost of non-EU citizens using NHS services could be around £12 million.”

…which makes a complete nonsense of the idea that there’s a serious financial problem here that needs addressing. We may as well start worrying that 1% of 1% of spending on road maintenance, or bin emptying, relates to non-EU citizens’ car journeys or kebab wrappers.

So, thank you Jeremy Hunt for reassuring me that this is a complete non-issue that’s best left alone, given the likely opportunity cost of tackling it. (It beggars belief that time and effort spent on this could not be better spent addressing other, bigger issues.)

Im in total agreement with you, as long as my family get treated well by the NSH im all for it.

So what’s your point here? Only current (?) taxpayers should have access to the NHS? People on JSA have their stamps paid, as do DLA recipients. Doesn’t that count? Stay-at-home mothers also have an equivalent stamp paid.

Alternatively, should we offer NHS services to anyone in the world who wants them? Would we offer free accomodation for their relatives too?

This is a prime example of the Tory “scrounger” narrative. A simple term, easily applied and angrily accepted by the people. Nobody likes a freeloader.

Labour’s “One nation” has to get some legs to beat it. Can nice & cuddly beat the contrived anger of the Tories?

Banker bashing and fairer taxation would gain more traction. Why are Labour ignoring the low-hanging fruit?

“So why is this issue the Tories have decided to focus their attentions on?”

It does seem to be a strategy the Tories have adopted: give credence to electorally useful myths by legislating against them. They want people being hurt by the cuts to get angry at recent immigrants rather than at them. They want people to think that the cuts are falling mostly on “foreigners”, not “people like us”.

“what Tories fail to realise is that there are very real people who will be affected by their discriminatory policy.”

Oh, I don’t think they “fail to realise” that, not at all.

re JC

The point I was trying to make is that based upon the prinicples the NHS was founded on, it is ludicrous to strart charging people to use health services that they need.

Irrespective of employment stauts or nationality, the NHS should continue to provide care that is free at the point of delivery, to indivuduals in need of the services.

8. the a&e charge nurse

‘The care a doctor provides to patients shouldn’t be restricted by nationality or bank balance’ – charging depends on which category a particular health problem falls into.

There are no charge for any emergency care provided by the NHS, but there ARE charges if follow up is required (via out patients, say) or when patients are admitted for investigations or a procedure.

‘Some people who are not ordinary residents in the UK are still entitled to at least some hospital treatment free of charge. These include those working for UK-based employers and students on courses of at least six months in duration. UK state pensioners living overseas, and those visiting from countries that have a reciprocal healthcare agreement with the UK, are also entitled to free hospital treatment, but not pre-planned treatment or treatment that can await their return home’.
http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx
The NHS has reciprocal agreements with countries like Australia, Russia and curiously the Isle of Man.

As far as I know these arrangements have not changed recently. Hunt’s tory-anguish may be related to the tendency of some hospitals to turn a blind eye, or bend the rules by not asking too many questions – unfortunately in the current financial climate I suspect such episodes of altruism may be happening less frequently nowadays?

Is it possible that the concerns that are being stirred up are not that people may come here just for treatment and go home again, but that free healthcare acts as an incentive to migrate here, which in its turn is, rightly or wrongly, a concern for some people.

The references to free healthcare for people from overseas are run in parallel to references to people coming here for benefits or people coming here to engage in criminal activity etc.

Therefore if you want to convince people that this is not an issue, you have to address other parallel issues that people are also concerned about otherwise they will think “ok, so it’s not a lot of people coming here just to get treatment, but what about all those who come here and claim benefits/take our jobs/push up the rents/make schools overcrowded/yada yada…and get free healthcare, and they wouldn’t come to live here if they didn’t get free stuff like healthcare”. You have to address the concerns as a package.

I’m glad, Poorni, truly, that your grandmother got wonderful care in the NHS and she got to see her family before she died. And I don’t much care that the money spent on her care could have gone to someone in this country, especially as the everyone can see, heatlth tourism is a very small part of the total cost of the NHS. But, the clue is in the name, National Health Service, we in Britain pay it for British citizens, whether they pay their tax, or other Britons cover their contributions. In the 70s the Arab nations were rich but had poor health care so they simply sent their citizens off to the west and paid for their treatment while they built up their own health services.
How easy would it be for a UK citizen to get free treatment from your grandmother’s home?

Sorry, just to had to previous post, Poori, it looks like your grandmother didn’t know she was ill till she got to UK, in which case I really don’t mind at all that she was treated to the best of the NHS’s ability and resources.

Still, the NHS is for the people of this country who are the ones who pay for it, so your grandmother’s goverment should have reimbursed our gov.

12. the a&e charge nurse

Perhaps Jabba the Hunt is keen to claw back a few bob from certain patients groups with serious health problems because far bigger sums are being ripped off (allegedly) by private firms brought in to ‘improve’ public services.
http://www.independent.co.uk/news/uk/politics/g4s-and-serco-face-50m-fraud-inquiry-8703245.html

Surely this can’t be the same SERCO who were awarded a three-year £140 million contract to ‘improve’ community health services for NHS Suffolk?
I assume not many overseas patients will be getting treatment they may not be entitled to in places like Ipswich?

That’s funny coming from the country that basically invented medical tourism sending the old and retired people to Spain for “major surgery + holidays in the sand”.

I am sorry about your grandmother, but would say from direct personal experience, that she new very well that she had serious health problems before she arrived in this country. Also from experience to be diagnosed within a month of arrival she would have had to contact a doctor almost on the day she arrived. I was diagnosed with the same problem last October so I do know of that which I write.

That being said I am glad our NATIONAL health service was helpful and of course you and the rest of your family have been paying into the system for some time, so questioning your Grandmother`s access to the NATIONAL health service would be a mute point.

That brings me to my main point you quote Aneurin Bevin who created the NHS in 1948. But omit to note that he did so in order to implement recommendations in the Beverage report 1942.

That report was not simply concerned with health but in what Beverage called The “Five Giant Evils” in society which were: Squalor, Ignorance, Want, Idleness, Disease.

Hence it was not simply a health service but a total NATIONAL welfare service which oddly included “Idleness” as one of the great evils.

Beverage therefore was not simply recommending answerers to the problems but also suggesting a method of payment, he envisaged full employment, hence the idea was not to create a welfare service open to anyone in the world but a national service open to those who had paid into the system and of course their families.

No NATIONAL health or any other service can survive if it treats very large amounts of people who have not paid into the system, that was never the intention of Beverage, Bevin or any of them. That might sound harsh, but is simple mathematics, the answer to your question is simple: those ‘eligible,’ to use NHS services are those who have paid into the system for some time, it should be seen as what it was always intended to be, an insurance policy and with such polices you are not eligible unless you have contributed.

The command paper that announced the NHS said in its introduction: “All the service, or any part of it, is to be available to everyone in England and Wales. The Bill imposes no limitation on availability – eg,. limitations on financial means, age, sex, employment or vocation, area of residence or insurance qualification.” The NHS was based on RESIDENCE not nationality.

Yes, someone has to pay for the care, but since the NHS is funded through general taxation it means that if you are resident here you are paying for the NHS through your VAT and duty payments (for example, when you buy petrol). If you are employed here you are paying for the NHS through National Insurance (which is simply a payroll tax, it is not hypothecated) and income tax.

It is worth pointing out that this government changed the existing regulations on foreigners getting NHS care for the period of the Olympics. Free treatment for people paying a lot of money to watch the Olympics? No. It was changed so that the already overpaid Olympic Committee officials could get free NHS treatment. It is beyond irony that this government would change the law to ensure that extremely wealthy foreigners could get NHS care for free while they are formulating xenophobic policies to prevent a “problem” of healthcare tourism that really does not exist.

All the people here being sort of sympathetic but asserting that the NHS is ‘theirs': one of the reasons the NHS could be built at all was the wealth in this country extracted during colonialism, and global financialisation carries on the process – and it is pushing both immigration to this country and the destruction of our hallowed NHS. The health tourism thing is just a distraction, but the reply should be to better distribute healthcare and other resources throughout the world, not shut the gates on people who have generally contributed to it for generations outside the UK.


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