Reforms to 'Health Tourism' - a one way ticket to a sustainable NHS?

Following a disclosure by the Public Accounts Committee to the Department of Health warning of millions of pounds of unrecovered health tourism costs, Jeremy Hunt has pledged to reform current laws to enable the government to recover £500m of these costs in 2017-18 to be reinvested into patient care. The new laws are set to be in place from April 2017 and will require NHS Hospital Trusts to check identification of overseas patients to confirm their eligibility for free care on the NHS. This announcement comes at a time when the NHS is under severe pressures of costs, demand and overall sustainability. Yet, despite the necessity, many have argued that the responsibility of those on the frontline is to treat all patients they come in contact with, instead of becoming a gatekeeper for overseas visitors.

Health tourism, a term that has come to apply to overseas visitors who ‘seek registration in the hope of being referred for hospital treatment without being correctly identified as chargeable’, or those seeking to evade payment of such charges, is not a new phenomenon. Back in 2013, Theresa May, then Home Secretary, issued a consultation paper on behalf of the government outlining the issues with health tourism and its impact on the NHS from those seeking expensive treatment in the UK or concealing a prior intention to use the NHS to obtain free prescription medicines. However, such awareness has not amounted to a solution, with the National Audit Office issuing a report stating that in 2015, of the £500m recoverable in health tourism costs, health services attempted to recover just £289m and were successful in recovering only £255m.

The current procedure for dealing with overseas health visitors is set out in the National Health Service (Charges to Overseas Visitors) Regulations 2015. Part 2 covers the ‘provision for making and recovery of charges’ requiring NHS Trusts, Foundation Trusts and some local authorities to make enquiries and be satisfied that they recover charges for the relevant services provided through calculating charges set out in the regulations (the usual tariff plus 150% for those not a resident of another European Economic Area state or Switzerland). Specified services such as emergency treatment remain free, providing the person did not travel to the UK specifically to receive such treatment.

The new reforms will place further pressure on NHS bodies to check the identification of overseas patients prior to their non-urgent treatment. However, the Department of Health has issued a clear message that overseas visitors can continue to access UK healthcare and insists these reforms are required to enable the NHS to pursue the necessary charges. For some, the reforms come as a welcome step in contemporary health policy. Notably, a pilot scheme undertaken by Peterborough and Stamford Hospitals NHS Foundation Trust, which requires patients to show two forms of ID for non-urgent treatment, has led to recouped costs of £350,000 a year. As Jeremy Hunt insists, the recovered costs would be reinvested to improve patient care and mitigate against the growing pressures, acting as the much needed ticket towards a safe and sustainable NHS. However, the reforms do not come without criticisms.

Sceptics to these reforms, such as former non-EU citizen Dr Thom Brooks, Reader in Law at Durham University, suggest that the government has failed to capture the true issue:

“Non-EU migrants are required to pay national insurance which contributes financial support to the NHS not unlike all British citizens. The claim that non-EU migrants have a free ride lacks evidence and credibility.”

The feasibility of the reforms is questioned further when examining the true impact on overseas visitors. As reported in the Telegraph, one mother from Nigeria, Priscilla, gave birth to quadruplets in the UK, two of whom died, leaving her in debt to the NHS of nearly £500,000. Moreover, the success of the reforms is not only dependent on those using the NHS, but those checking and recovering charges, requiring buy-in from those treating patients. Crucially, the chairwoman of the Royal College of GPs, Professor Clare Gerada, stated that:

"My first duty is to my patient - I don't ask where they're from or whether they've got a credit card or whether they can pay".

Further to this, the reforms may deter those who are unwell from using the NHS services. An issue such as this could eventually have a detrimental impact on the health of the wider community, as the risk of disease would increase.

It is clear that the viability of the reforms to health tourism, aiming to achieve a sustainable NHS, is not without scepticism, particularly given the increased burden on those who are there to treat patients. However, in a time of severe pressure on the NHS, not least financially, perhaps the new reforms will spark a welcome debate on the payment of the NHS as a whole.