On 2 July, I found out that I could potentially lose my access to free NHS health care, due to proposals by Jeremy Hunt, the Secretary of State for Health, to restrict access to the NHS for non-EU migrants. This included plans for a minimum £200 levy (apparently some Conservative ministers wanted this to be significantly higher), and requirements for private health insurance. I read through the consultation document, and the ambiguity of the language was worrying: although ’the new system proposal is intended to operate from the first point of registration with the NHS, and so will impact only on people newly arriving from abroad’, ‘consideration will be given at a later date to identify those who are already registered but who should be chargeable’. It was unclear how this would actually be implemented: how would the levy be charged, e.g. when applying for or renewing a visa, or registering with a GP? The consultation document also suggests that even after paying the levy, you may also still be charged for services.
These plans have worrying implications. They involve outsourcing immigration controls on to medical professionals, similar to what has already taken place in education. Both the BMA and the RCGP have criticised these changes in terms of the consequences for the doctor-patient relationship and the duty of care. There are also public health consequences: if patients are unable to access primary care and wait until conditions are serious enough for the A&E, this will directly impact upon levels of morbidity and mortality and put pressure on already over-burdened A&E departments. What if people with communicable diseases do not access treatment for fear of being charged? And this comes at a time when there is a resurgence of TB and concerns over avian influenza.
About my own situation: I have now lived in the UK since 2007; four years was spent as a student, and a year and a half on the now-scrapped post-study work visa. I am now employed in a permanent job and will apply for a Tier 2 work visa later this year; I am only able to apply for this visa because I am fortunate enough to earn over £20,000/year (£23,000 in my area of work, according to the UKBA requirements). I worked part-time during my studies and full-time after my studies, and have paid tax and national insurance on all my earnings in the UK. Because I have no access to welfare benefits I must keep several thousand pounds in the bank in case of emergencies. I don’t understand how this in any way makes me a ‘health tourist’.
The time I have spent in the UK on a student visa and the Tier 1 visa do not count towards settlement. As such I will have to spend five years on the work visa before I can apply for indefinite leave to remain. This means that I am potentially facing five years where I will have to worry about getting sick. I have spent six years in the UK and have made my life here, making it difficult for me to simply “go back” (as some might suggest would be the “right” thing to do, implying my presence in this country is morally wrong) or to apply for private insurance from my home country. There are many of those in my situation, probably including a significant number of NHS staff (30% of NHS professionals were born outside the UK and 13% of NHS nurses are from abroad) raising the disturbing prospect of those providing healthcare services being unable to access them for free.
The worst thing about these proposals is that there is no real need for them; according to Mona Chalabi, Jeremy Hunt himself has been quoted as saying ‘health tourism’ (defined as unrecovered charges from those without NHS entitlement) only costs £12m out of £109bn; it is unclear whether implementing the new system may actually cost more than it will save. Migrants statistically tend to be younger (thus requiring less NHS care) and contribute more to public services than they use. The real reason for these proposals is to appeal to increasingly xenophobic perceived popular sentiment and to allay fears that disaffected traditional Conservative voters will defect to UKIP. It also fits in with the fight-for-the bottom rhetoric that has accompanied the implementation of austerity measures, where entitlement to public services is seen as ‘something for nothing’ – as charity doled out on behalf of the British taxpayer to a particular undeserving group – thus stoking resentment and creating moral justification for cuts. In my case, even working and paying tax is not enough; I am automatically a ‘scrounger’ simply because of holding a foreign passport.
There have been some important campaigns to defend the NHS by groups such as 38 Degrees and Keep Our NHS Public, including the vibrant – and partially successful- defence of A&E at Lewisham Hospital. However, at the moment (perhaps due to the limitations of single-issue campaigning), not enough links have been made between campaigns to defend public services and campaigns against restricting entitlement to these public services through immigration controls. In the absence of these links, it may be all too easy to convince voters that the best way to save the NHS is to drastically restrict access. This is a tactic that must be urgently resisted.
You can respond to the consultation here. Also, Migrants Rights Network is organising meetings about the issue, and also has briefings summarising the issues with both the NHS consultation and the private landlord consultation here.
About the Author: Originally from Canada, Kirsten Forkert first came to the UK as a student, and is now employed as a lecturer at Birmingham City University. Her current research explores the cultural politics of globalisation and austerity, with a focus on cultural work and education.