Leading article

To defend the NHS, stop health tourism

We don't have the capacity to fund a worldwide health service – pretending otherwise just imposes a needless burden on both the NHS and the taxpayer

15 August 2015

9:00 AM

15 August 2015

9:00 AM

Speaking after the Stafford hospital scandal in 2010, the then newly appointed Health Secretary, Andrew Lansley, grandly announced plans for a charter to support whistleblowers. The government, he said, would ‘create an expectation that NHS staff will raise concerns about safety, malpractice and wrongdoing as early as possible’.

We now know just how that fine pledge worked out. In 2013 this magazine ran a piece by J. Meirion Thomas, then a cancer specialist at the Royal Marsden hospital in London, about his concerns at how the NHS was being exploited by health tourists. He had tried, he said, to expose an ineligible foreign patient but had as a result been accused of unethical behaviour.

Meanwhile, the scale of health tourism in the NHS is becoming clearer by the day. Junior NHS managers have spoken of being ignored or being branded ‘racist’ by senior staff for daring to raise the issue. Hospitals, knowing that they are treating health tourists, refuse to admit them as such because they know they will then not be fully compensated by the NHS for the treatment they have given. Foreign patients have been given dialysis treatment — at a cost of £40,000 a year — with no questions asked and no attempt made to recoup the costs from their home health service. A Nigerian mother has been revealed to have had five babies on NHS wards before being rumbled.

Then there is the scandal of European Health Insurance Cards (EHICs) which citizens across the EU can apply for in order to obtain emergency treatment in other countries. The idea of the cards is that the cost of the treatment is then recouped from the patient’s home health service, thereby ensuring that the burden falls where he pays his taxes. However, in handing out the cards Britain has been far too carefree — with the result, it has emerged this week, that a Hungarian journalist was able to obtain a British EHIC after spending just one day in Britain. She then returned to Hungary and received treatment in a Hungarian hospital, the cost of which was billed to the NHS.

It is galling to discover that the government knew about this loophole in 2013 but has failed to do anything about it. That year, the government put the cost of health tourism at around £2 billion. But that is almost certainly a huge underestimate, given the refusal of many parts of the National Health Service even to check for eligibility.

It is not just hospitals which are guilty of this. When in 2013 the government announced limited measures to alleviate the problem, Clare Gerada, then chairman of the council of the Royal College of General Practitioners, accused ministers of ‘xenophobia’ and said that GPs would not act as a ‘new border agency’. It was a fatuous remark. No business would survive for long if it didn’t check the eligibility of people demanding access to its services. An insurance company would go bust in a day if it paid out all claims without bothering to check whether the claimant had a policy. The NHS is forever asking pointless questions about our ethnic origin, so why should it be beyond a general practice surgery to check a patient’s eligibility for treatment?

The NHS is struggling to meet the demands of the taxpayers who fund it. It has no capacity to act as a worldwide health service offering treatment to anyone, funded by British taxpayers. The NHS has left itself open to abuse for two reasons.

First, the qualification for eligibility is too loose. Anyone can qualify for free treatment if they are ‘ordinarily resident in Britain’. This is a definition that does not require a patient to be a legal resident of the UK.

Secondly, while the NHS does issue cards, they do not carry photographs or biometric data to prove that they were actually issued to the people who present them. Nor, following the failure of the NHS computer system, is there even a central database which can be used to check a patient’s eligibility for publicly funded treatment.

Of course, there are circumstances when doctors should not be expected to do this. Where someone has suffered an accident or requires emergency surgery, they should be treated regardless of who they are. But there is a big difference between an emergency and, say, five years of dialysis treatment. The health problems of the wider world should be a matter for the aid budget, not the NHS. Over a quarter of the £12 billion aid budget already goes on medical projects.

Those who shout ‘racist’ at anyone who raises the issue of health tourism claim to be on the side of humanity. But they are really just people without any sense of financial responsibility. They are, ultimately, enemies of the NHS — because they are trying to impose on it a burden which it cannot possibly sustain indefinitely.

It is high time that the government was prepared to stand up and make this point — and defend those brave individuals within the NHS who have put up with the disapproval of colleagues for daring to speak of the abuses which have been taking place.

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Show comments
  • Reluctant Mlungu

    I just cannot understand why one of the most advanced societies on Earth cannot have a ‘national’ ID card, or health services card, or whatever, for every legal resident and citizen. Soft-touch, liberal, do-goody Canada has it – why not the UK?

    • Gilbert White

      We already have lots of id. cards, passport, drivers etc but we do not have a universal national correlation for these as documents.

      • Brian Metters

        In a way, we do. It’s our NI number! All we need is an NI card.

        • Aberrant_Apostrophe

          And to get an NI number all you need is a mate to pretend to employ you. Not exactly the most foolproof system, is it?

      • Paul Montgomery

        A UK passport is a de facto ID card.

    • PM

      One Card = Less Jobs

    • licjjs

      Someone suggested yesterday that a British Passport should act as ID for all these services. Why can’t this be the case? Most people have passports and those that have not yet could be issued with them now.

  • Rik

    When my nephew emigrated to New Zealand,as well as requiring a firm job offer he had to provide proof of health insurance and certification to show he was AIDS and TB free.Why should we settle for less??

    • licjjs

      Why indeed…

  • Wilky1

    Couldn’t agree with this piece more if I’d written it myself.

    I note with interest you avoided the attacks heaped on Farage by avoiding mentioning AIDS health tourists & the cost to the taxpayer for their treatment. Perhaps wise judging by the uproar on the left & right of politics at mentioning them…

  • CharleyFarleyFive

    Words fail me.

  • greggf

    It’s an attitude problem that has developed with all aspects of welfare in Britain. That the “NHS meets the needs of everyone; that it be free at the point of delivery” is stereotypical of this attitude, and a millstone for any sense of financial responsibility.
    It’s the same with the idea of allowing access to welfare to anybody and everybody who presents with a “need”. Failure to measure such need with entitlement is a governance en route to Carey Street.

  • Tamerlane

    All true, it is up to the NHS to police its own behaviour. Like all giant state monoliths it has no concept of living within a budget or protecting its income as there’s always plenty more where that came from, and in a state entity there normally is, it’s not their job anyhow they argue. When the politicians who control the purse strings know no other mode than fawn and shudder and have never had the courage to ‘get tough’ with the NHS or its reckless spend thrift behaviour, costs can only escalate and opportunists can only benefit.
    The problem is as much cultural as structural and that takes years to fix, if not at least a generation. Meanwhile I would like to have my money back please and I will top it up out of my own pocket and go private thank you very much.

    • Kennybhoy

      “The problem is as much cultural as structural and that takes years to fix, if not at least a generation.”

      Insightful. Although it bears saying that the cultural problem is one of British society at large not just this or that institution. For this reason I personally believe that the problem is unfixable this side of some sort of societal collapse…

      • Brian Metters

        Or civil war.

        • Kennybhoy

          Hate to nitpick man but civil war is a species, or “some sort” even, of societal collapse… 🙂

    • Paul Montgomery

      Dead easy to fix.At least in theory.

      Adopt an insurance style system like the rest of W Europe (NOT like the USA!).

      You pay cash to the hospital & those eligible reclaim all or most of the cost.
      I suspect that if this is the only income hospitals receive, they will be meticulous is charging everybody.

  • Sinceyouask

    Not the first or last stupid remark by Gerada.

  • Guest

    Back when I was a lad you would have been called a far right racist,nazi,satanist or some other such tosh for using common sense. Abuse will ruin it for everybody,simple as that. Either have some or none but you can’t have both,it’s unfair and unsustainable.

  • mmac1968

    The NHS should not be refunded for treatment it can not prove was given to a legitimate recipient. They would soon stop treating people for free. Ps i am sitting in a surgery and so far as i can tell i am the only Brit born here.

    • mohdanga

      And I bet you feel ‘enriched’ by all the ‘diversity’ in this ‘vibrant’ environment, right? We are doomed.

    • Bonkim

      appearances can be deceptive.

  • alphonsus44

    Listening to the BBC today and the strain under which the NHS is put has nothing at at all do do with health tourism nor the number of immigrants swarming to our shores.

    It is simply down to an ageing population. Even the common purpose bird they wheeled out from NHS England told us, so it must be true.

    Our national broadcaster becomes louder mouthpiece for Left with each passing day.

  • Gilbert White

    The sad aspect of this is that most responsible British people do not put one leg out of the country without expensive private insurance.

  • ohforheavensake

    The only figure you quote here is the 2013 estimate of £2 billion.

    This was fact checked at the time-


    Here’s the full text-

    This morning, the Department of Health released a report which led to a rash of headlines on the massive costs of “health tourism”.

    Creative Research, a research firm, was commissioned by the Department of Health to examine how much is spent on health for visitors to the UK and migrants.

    They came up with a figure of £2bn.

    Shortly afterwards, the government said it wanted to collect an extra £500m a year from overseas visitors and migrants. Jeremy Hunt, the health secretary, proposed a £200 health levy on foreigners coming to the UK.

    But the figure of £2bn seemed quite a jump from previous estimates. In July, in the House of Commons, Steve McCabe MP saidthat David Cameron had suggested “health tourism” cost £10m. Jeremy Hunt, the health secretary, had claimed it was £200m and the then health minister, Anna Soubry, had suggested it was £33m.

    Does it stand up? We put it to the FactCheck test.

    The analysis

    ‘Health tourists’

    According to the government’s own report, “health tourists” cost us nothing like £2bn a year. The £2bn figure refers to total numbers of visitors and migrants using the NHS.

    The Department of Health said that “health tourists” – defined as people who have travelled here to get free healthcare they’re not entitled to – cost £70m to £300m a year.

    But it goes on to point out that “these estimates for the costs of health tourists are very rough and far from certain”.

    ‘British expats’

    The report says that migrants or visitors from the European economic area (EEA) cost us £261m last year, and those from outside this area cost us £1,075m, or around £1.1bn in 2012-13. It lists another category – “irregular migrants”. This group includes failed asylum seekers, overstayers and illegal migrants. They cost £330m last year.

    While the figures are large, they’re not surprising, and actually consume a tiny proportion of overall NHS spending. In their report, they say that NHS expenditure on services was £91.5bn – about 2 per cent.

    What did come as a surprise, however, was another group of NHS users who should be paying for treatment, and that’s British expats.

    While small in number – the figures the Department of Health uses assumes there may be 65,000 present in England on an average day – they cost health services more per head than anyone else.

    Expats, this report suggests, cost £1,449 per head. Visitors here from outside the EEA who’ve been here for less than three months cost £1,000 less, at £449 per head.

    Students from outside the EEA cost £713 per head, and migrants who’ve been here more than a year who have come from outside Europe cost £822 per head.

    The expat cost is highest because their age tends to be greatest, and they therefore tend to require more complicated and lengthy healthcare.

    So do they all owe us £2bn?

    No. All of this only looks at how much they actually cost – many of these people are entitled to use the NHS because they’ve been here for long enough, because of European regulations, or because of exemptions.

    It’s also the case that A&E and primary care are supposed to be free at the point of delivery – regardless of where you’re from.

    The more telling figure is how much the above users could potentially owe the NHS – and that’s far, far lower than £2bn.

    The report suggests that for healthcare used by such users, the NHS could charge for just £190m of it.

    How much does the NHS get back?

    In terms of how much of that the department has managed to collect – they don’t say. What they do say is that a previous Department of Health study has “shown that only about £23m is collected of the £57m that is invoiced” – about 40 per cent.

    In terms of what the NHS has lost, that wasn’t in this report either. But a parliamentary question in November 2011 did go some way towards answering that. It said there was £6.8m of bad debts and abandoned claims for overseas patients in 2010-11. In other words, foreign patients (and British expats) who came and used the NHS and should have paid for it but didn’t accounted for just under £7m.

    Is this the final word?

    However, there are some serious caveats to all of this, and that’s not from us, it’s from the Department of Health.

    Here is a “note of caution” contained in the report: “All of the estimates presented are subject to varying degrees of uncertainty… the estimates for the number of irregular migrants are very uncertain and based on out of date population estimates.

    “The estimates for health tourism, as for any unlawful activity, are impossible to estimate with confidence and are a structured judgement… The estimates are presented as the best that can be made at present, recognising that they are based on incomplete data, sometimes of varying quality, and a large number of assumptions.”

    The report was also based on 30 out of 161 acute NHS trusts. An earlier edition of the report, which looked at qualitative data, suggested that staff were not collecting data in a systematic way. So for all we know, patients who are visitors could cost more.

    The verdict

    While much of the rhetoric around ‘health tourism’ uses this single phrase, it’s clear the group themselves don’t cost the NHS £2bn.

    Even if we accept the heavily caveated report, they cost £300m at most. Mr Hunt’s proposed levy to raise £500m wouldn’t even come close to addressing the simple category of “health tourism”.

    It’s also worth pointing out that some of the people included in the report are British themselves.

    In terms of how much visitors, foreign, British, legal or illegal, cost the NHS – this report’s headline figure is on expenditure, not on losses. Based on the free care that many visitors are entitled to, it’s only about £190m they owe, under current guidelines. It doesn’t say how much has been lost, but previous figures from the Department of Health suggest it was about £7m in 2010-11.

    There is also the problem of how reliable these figures actually are – the Department of Health concedes their uncertainty.

    Nevertheless, it is seen as being one of the most comprehensive estimates to date. There haven’t been many detailed analyses of how much migrants and visitors cost the NHS.

    Perhaps now the health secretary has made it his mission to claw back money from visitors and migrants using the NHS, there will be more.

    – Do you actually have any evidence that this fact check- which is based on the department’s own figures- is wrong?

    • mohdanga

      Only 300 million to fund these deadbeats? Well, everything is OK then.

    • Paul Montgomery

      Please google the word “brevity”.

    • Gilbert White

      Oh, Brevity mischievous is thy name. We need to know how many like you exist here. Would you conflate elder British expats sneaking in for a bit and evil young Somali parasites doing the same. Your measure of equality is so literal?

  • logdon

    We. Are. Paying. For. This.

    Free at the point of delivery doesn’t mean free unless you are a foreigner.

    • ohforheavensake

      No. We. Are. Not.

      • logdon

        That’s it?

        We can all do that, in fact I just did.

        Still they say that plagiarism is the highest form of compliment.

      • Paul Montgomery

        Pray tell us who is paying?

  • fundamentallyflawed

    “She then returned to Hungary and received treatment in a Hungarian hospital, the cost of which was billed to the NHS.”
    There are numerous reports of British holiday makers being refused treatment on an EHIC card until they also cough up private insurance details… the wonderful EU in action

    • Suzy61

      My husband suffered a stroke whilst in Spain – he was hospitalised for one week – I spent 24 hrs beside him everyday (as relatives in Spain are required to feed, wash and dress and toilet the patient). Every day a woman from the hospital administration came to us demanding to see our private health insurance papers – even though I had provided the EHIC.

      It was an English doctor, working in Spain, who advised us to tell her to p*ss off. As you say, the wonderful EU in action.

    • Aberrant_Apostrophe

      It would have been useful to know exactly what treatment she received. When I first read about this, I got the impression that the hospital in Hungary was colluding with the patient in providing non-emergency treatment. I could be wrong of course. Even so, it is a blatant misuse, even fraudulent use, of the EHIC system.

  • ohforheavensake

    Just to draw out a point from my post below: this editorial states-

    That year, the government put the cost of health tourism at around £2 billion.

    However, as the C4 factcheck points out, this is at best misleading-

    According to the government’s own report, “health tourists” cost us nothing like £2bn a year. The £2bn figure refers to total numbers of visitors and migrants using the NHS.

    The Department of Health said that “health tourists” – defined as people who have travelled here to get free healthcare they’re not entitled to – cost £70m to £300m a year.

    – so you’ve quoted the figure incorrectly. Will you rewrite this in accordance with the facts?

    • MrMulder

      Only £300 million a year, oh that’s alright then! And are we supposed to to trust any ‘facts’ that come from channel 4’s stable.

  • ohforheavensake

    And, as the fact check points out, even if we accept the upper limits of health tourism costs, the cost of treatment for expats is far more of a drain on the NHS’ resources.

    Would you advocate stopping their treatment?

    • Suzy61

      British ex-pats, for the most part, only move abroad in retirement which means they have spent a lifetime paying NI contributions.

      Politics of envy dictate that we should all begrudge those lucky enough to be able to do this – however, anyone with a sense of fair play would see that they have more entitlement than someone who arrived three months ago and has paid precisely….nowt.

    • Paul Montgomery

      I think that your dogma has blinded you to the truth.

      “Expats from outside Europe who return to the UK to use NHS hospitals will be billed for 150 per cent of the cost of treatment…..”

  • Lady Magdalene

    Let’s remind ourselves who cried “racist” at Mr Farage when he pointed this fact out during the General Election campaign.
    Oh yes …… it was the Mainstream Media, including The Spectator. And the legacy parties, including the Conservative Party.
    And you wonder why we support UKIP. Mr Farage is the only mainstream politician who isn’t afraid to tell the electorate the truth.

    • Kennybhoy

      Well said.

    • victor67

      Health Tourism counts for a fraction of the NHS budget compared to the monopoly of the multi national drug companies over charging the NHS.
      Perhaps redirect your rage or is it about foreigners?

      • Paul Montgomery

        And the source of your figures is?

        • victor67

          After staffing costs. The bill for medicines is the next biggest expense.
          The drugs companies fix their trials and extend patents to maximise their profits so it goes without saying.
          But if you want to indulge your grievancezs against the foreign other go on believing the bull

          • Aberrant_Apostrophe

            How do they ‘extend patents’? The reason they charge so much is that drug patents are only awarded for a short time – and that includes the development, testing and trials periods – so they only have a few years to recoup their costs and make a profit. If the patent was able to be extended then they would charge less – at least, in theory.

          • Tom M

            Having a high medication bill isn’t proof of over charging though is it. Let’s have some figures.
            The part I don’t think people like you making loose comments like that appreciate is just what it takes to provide a new drug these days. When you think of the research needed, the trials to go through and when you finally get it to market you find the Koreans are copying it and selling it for peanuts.
            Whilst I’m sure drug companies will take full advantage of state employed NHS buyers, with all that implies, I do think there is another side to the argument.

          • Paul Montgomery

            Your argument here is effectively: “This is what I believe & you must believe it too!”

            Please, most of us have left the nursery.

      • licjjs

        I don’t care how small or large the financial cost is, it should not happen; it insults the British people and should stop now.

        • victor67

          That’s not my point. Health tourism is wrong I just don’t see the Barclay’s or Murdoch’s letting their journalists expose corporate theft of a tax payer funded public service.
          Much easier to direct the middle classes wrath against the foreign brown people.

    • Scradje

      The line he takes on health scammers and asylum scammers is commendable. But on certain other issues he falls well short of the mark.

      • Aberrant_Apostrophe

        Which issues?

        • Scradje

          His frequent appearances on RT, in which he has become the Kremlin’s favourite British politician. No wonder; he shares its objectives. He praises the murderous thug Putin and excoriates the EU and Cameron on the hate, lies and propaganda channel of an expansionist foreign power that refuses to respect the sovereignty of independent nations and uses brute force against them. This type of behaviour is no different from what might be expected of Corbyn should he become Labour leader. it is dangerous, unpatriotic and anti-British. The strategic objective of Putin’s Russia is the destruction of the EU and the creation of a new Eurasian superstate with himself at the helm. Russia already has Greece, Hungary, Le Pen’s FN which they sponsor, as well as all the other eurotrash fascist parties. How much money has it given directly or indirectly, to Ukip?
          If Farage admits that he has made a terrible mistake, disconnects his party completely from Yedinaya Rossiya and bans apologists for Putin’s fascist rule from his party, then he can once again claim to be a patriot.

  • DennisMcScumbag

    An article repeating exactly what UKIP has been saying for years, this must be an Isabel Hardman piece.

  • Nigel Farrage

    The NHS is a red herring. This article is about 2 issues.

    (a) Non British citizens taking advantage of our very expensive welfare state.
    (b) Anyone who criticizes Non British citizens taking advantage is by default a racist.

    The left are complaining that Labour has moved to the right. Rubbish. Britain has moved over to the left and is in total denial. The Tory party like barking, but the last 5 years have shown they have no stomach, or intention, of cracking down on immigration, illegal immigration, and fraudulent tourists. Who needs Cooper & Burnham with David Cameron running the country.

    • Nigel Farrage

      I had a good rant there but didn’t suggest any solutions….Here is one…Any doctor (etc) who has a track record of ignoring fraud, should be reported to the police and prosecuted.

      • Terry Field

        Or suffer FGM and MGM?!? (Not Metro Goldwyn Meyer)

  • davidofkent

    I’m afraid this is the consequence of requiring other people’s money to pay for public services. Both the staff and those who pay no tax see no reason why treatment should not be provided on demand to all who demand it. We have to establish some measure of contribution to save the NHS. Unfortunately, in Britain there is such a thing as ‘a free lunch’ for millions.

    • Nigel Farrage

      We are regularly told that our NHS would not function without overseas workers. Maybe they have sympathy towards their countrymen.

      • Aberrant_Apostrophe

        Maybe they have sympathy towards their countrymen

        Is that because those countries don’t have any decent health workers left because they’ve all scarpered off to the UK?

        • Terry Field

          Fog in Channel, Continent cut off!!!

      • licjjs

        I am willing to risk it.

      • Terry Field

        I had a touch painful procedure in Normandie the other day. As the surgeon grinned behind the bloody scalpel (local anesthetic!) he said in halting English
        ‘That gets you back for the Thirty Years War’.
        Entente Cordiale or what!

        • Hamburger

          I am not sure why he mention the Thirty Years War. It was one of the few where your involvement was minimal.

  • Chris

    In years to come, people will look back shaking their heads in disbelief asking themselves why the generation before them allowed such things to happen and at the same time wreck what was once such a fine country. It also beggars belief that so many of us have allowed ourselves to be conned into believing that “diversity” and mass immigration could possibly end in anything but disaster. Anybody, who votes for any party other than UKIP deserves all they get.

    • CO Jones

      The people who will be looking back in a few years time will probably be busy writing to their relatives back in Ethiopia and Eritrea and many other such places, telling them how barmy the previous population of the UK must have been, to allow it to be taken over so easily.

  • Nutzlos Mund.

    Time for Britain to define itself. Free healthcare for those born here as British citizens. Free for those who have been naturalised as British citizens (and time to tighten up the rules governing who qualifies for this privilege-because it is a privilege-keep those who have a trade or profession, refuse everyone else). Make those who fall sick here, or who give birth here, pay. And if they can’t pay, make them work until they have paid their debt.

  • gerronwithit

    As a member of a privileged and advanced society any entitlement to its services should be earned and not just doled out on demand. In order that our society is not cleaned out by the dross of the earth manipulating its way to our shores, we must ensure that the occupants of the British Isles are who they say they are and have a proven right to all our hard earned resources.

    If that means more enhanced and exacting identity cards then so be it. Unfortunately our whole way of life is under attack and our politicians do not seem to be terribly interested in preserving either our borders or national identity.

  • AverageGuyInTheStreet

    And to stop health tourism we need to be able to control our borders, and to do that we need to get out of the EU as soon as.

    • Nigel Farrage

      I want out of the EU as well…But leaving the EU will not sort Calais…Unfortunately.

      • Oddsbods

        It will help to sort it out, because outside of the EU no other parliament can stop Britain making laws which may allow British citizens better conditions than foreign citizens. Whether British politicians want to do that is another question.

        • Nigel Farrage

          ..”Whether British politicians want to do that is another question”..Very true

      • Terry Field

        Hello Nigel, hope you are well.

  • Bonkim

    It is not that difficult for GPs to verify bona fide UK resident status of new registrants – ether via verifying the applicant’s NI or citizenship/visa details if temporarily resident before accepting on the register. The lady having five children on the NHS – is she also claiming child and other benefits?

    Health service registration should be taken out of GP and Hospital administration altogether and centralised and GPs and hospitals should only provide treatment followin central registration.

    • Mary Ann

      It does of course mean applying the same checks to us British. In French hospitals they employ staff whose main job is the check everyone is entitled, I wonder how much it costs, compared to the cost of health tourism.

      • Bonkim

        What is the problem? With the system computerised individual’s entitlement can easily be included with all NHS registrations and accessed at point where the person wants treatment, doctor surgeries, consultants, etc. Alternatively National insurance number a must for NHS and GP registrations. Simple.

      • Aberrant_Apostrophe

        With slightly more than one administrator per bed on average, I expect the NHS has more than enough pen pushers to do the checks.

        • Terry Field

          Have you seen the pace at which NHS admin staff work!

      • Terry Field

        Please! The admin in French hospitals has a fully costed procedure database, which allows the seamless integration of the massive private capacity with the state capacity. Its called the modern world, as per every advanced nation, but not in permanently-1948 Ernie Bevan’s Britain.

  • Aberrant_Apostrophe

    Surely the solution would be to take any Health Tourism costs out of the Foreign Aid budget, and if the EHIC system is being abused, take the losses out of our EU contributions? That should satisfy even the most fervent hand-wringing moralists.

    • Mary Ann

      Why should innocent children dying of measles in a third world country have to suffer for the laxity of the NHS, Sounds like a reverse Robin Hood. I do wonder with a lot of cases whether it is cheaper not to follow up, such as needing a few stitches or a ring cut off.

      • Aberrant_Apostrophe

        Why should British cancer patients be denied life prolonging drugs just because of Cameron’s vanity? See, I can play the victim card too.

  • WTF

    As a former resident of Spain I had state provided health cover there under EU reciprocal agreements BUT before having surgery in February this year, I had to produce my SIP card which allows me free health care in Spain and my passport as proof of ID. If Spain can do it why not the UK !

    • Mary Ann

      Because British people don’t want identity cards. In France your Carte Vitale has your picture on it.

      • Aberrant_Apostrophe

        The tide will eventually turn. When it does, the former lack of ID cards will be one less attraction to illegal immigrants.

      • WTF

        Perhaps when they get fed up paying for third world illegals they might realize that ID is required for legal entitlement and other than micro chipping everyone like you would a pet dog I can’t see any alternative !

        Its beyond belief the amount of ID crap that I’ve had to provide recently just for changing address’s with financial institutions & government departments as well as moving proceeds of a house sale from Spain but the NHS doesn’t even do the basic stuff. Everyone who is legally in the UK has some form of ID that could be used and the admin staff could easily demand to see it.

        • Terry Field

          How would they charge anyone? They are unique in the world in having no clue about costs, and an idealogical desire to remain bloody ignorant.

    • Terry Field

      Because Britain is utterly irrational when it comes to the delivery of health care.

  • Scradje

    In all cases except road accident or assault, force all non-UK passport holders to pay cash or be refused for treatment. If their case has any merit, they can reclaim the payment after treatment. Stop heavily pregnant women and the obviously ill from boarding flights to Britain in the first place.

    • Mary Ann

      So what about all those people born and bred in Britain who do not have passports, my grandson doesn’t have one, should he be denied.

      • Scradje

        No, he just needs to prove that he is a citizen. Passport is the obvious way. But there are plenty of other methods.

  • Terry Field

    Were the NHS run on rational lines, as is found in the advanced countries of Europe, ‘health tourism’ would be impossible. Without digital card access, everything is charged.
    But then, the NHS has absolutely no idea of how much any given procedure should cost, so it would fall at the first hurdle!!!

  • Peter Bensley

    To defend the NHS, stop listening to conservatives.