As a nurse, I was left feeling remarkably unsurprised on Monday when HuffPost UK revealed that the Department of Health and Social Care had overstated the extent of NHS fraud committed by migrants.
It adds to a growing body of evidence that undermines the Government’s economic justification for expanding Hostile Environment policies in the NHS, and puts yet more pressure on the home secretary, Sajid Javid, to scrap the broader policy in its entirety, not just in name.
The Hostile Environment has seen unprecedented restrictions imposed on people’s access to essential public services, from schools to housing, from healthcare to banking. Since October 2017 NHS Trusts have been forced to check people’s immigration status and to charge those found to be ineligible for free NHS care before they receive any treatment. The introduction of upfront charging, which involves billing migrants at 150% of the cost for a range of NHS services, and the introduction and then doubling of the NHS surcharge on visa applications, fundamentally undermines the founding principle of the NHS – that care should be provided on the basis of need, not ability to pay. Charging systems in the NHS have been justified as a means to address so-called ‘health tourism’. This framing helps facilitate the creation of an infrastructure of payments within the health system that continues to build barriers to care and support.
By the Government’s own estimate deliberate ‘health tourism’ accounts for only 0.3% of the NHS budget, a figure that pales in comparison to the £2billion a year spent servicing PFI debt. It speaks volumes that the DHSC still refuses to publish the results of their upfront charging pilot study. We do know, however, that independent research found that of 8,900 patients asked to show ID only 50 were found to be chargeable. There are also costs these estimates can never capture. People don’t stop getting ill when they cant access care, they just access care later, often with much worse outcomes and usually at much higher cost to the NHS, study after study shows that providing free preventive care to all is cheaper in the long run. Of course there is no economic justification for the harm this policy causes.
What I and many other health professionals fear is that this policy deters people from seeking care when they need, forcing them to choose between destitution and good health. We also see the devastating impact on our colleagues as health workers are forced to choose between being able to work and being able to live with their family. Since the introduction of the policy I’ve heard so many stories of people denied access to the care they need. From the Windrush scandal and Sylvester Marshal being billed £54,000 for cancer care, to Elfreda Spencer ding a year after diagnosis from a cancer that in many cases responds well to treatment.
For every story that becomes public there are many that never get told, people suffer in silence for fear of deportation, healthcare workers remain unable to speak out for fear of being isolated in their workplace. Working in A&E I’ve witnessed treatment for critically ill sepsis patients delayed while their family are asked to fill in forms proving their eligibility, I’ve seen patients who need dialysis turned away because their potassium levels were not life threatening enough. All this despite the fact A&E is a primary care service where some of the most vulnerable people seek care, and doesn’t fall under the charging system.
Across the country healthcare workers are pushing back against this misleading rhetoric and fighting to preserve the universal principles of the NHS they chose to work for. They are calling on NHS Trusts to stand up for the people they serve and to tell the Government the policy is unworkable because it fundamentally undermines our duty to put the needs of our patients first. We have been doing this by holding demonstrations, blocking the Department of Health and Social Care, returning awards in protest, and joining with patients and community groups to hold NHS Trusts to account.
It is imperative that we push back against these harmful narratives and hold the Government to account for the NHS’s staff and funding crisis. The NHS belongs to us all, we need to fight to keep it free for all, with care provided on the basis of need, not ability to pay. If you want to help keep it this way, join Medact and Docs Not Cops.