Abstract
In our paper, we noted explicitly that the Government’s proposals are politically motivated, rather than practically. Hence, it is unsurprising that there are some, such as Gee Yen Shin, who take a different view about the UK’s responsibilities to migrants who come to this country. There is a considerable mythology that has grown up around the costs of illegal immigrants and abuse of services, which has been refuted. 1 However, our article notably focused on the practical implications of this political decision, both for migrants and the public at large.
Is Shin really suggesting that patients should go untreated because they are no longer entitled to ‘free care’? In the context of tuberculosis, it is useful to recall the epidemic that occurred in New York in the 1980s and 1990s, which included multidrug-resistant outbreaks, and that eventually cost more than US$1 billion to address. 2 Such an epidemic in the UK would certainly be undesirable, both in terms of its human and economic costs. Indeed, while small amounts of savings for the NHS might appear justifiable in the short term, in the case of tuberculosis, and other communicable diseases like HIV, there is powerful evidence that it is far more cost-effective in the long term to provide free treatment to all. 3
Of course, as Shin suggests, money spent treating a migrant cannot be spent on a UK national. However, the opportunity costs of treating in terms of suffering, spread of disease, and long-term needs will be greater to the NHS, and to the UK, in reduced economic, social and political contributions. Also, the administrative costs of billing and recouping the costs of care under the Immigration Act 2014 will be considerable, as detailed in our initial paper.
Notably, the terms ‘migrant’ and ‘health tourist’ are complex because of the absence of standard definitions, with even different government departments themselves employing the terms in ways that result in different data depending on the selected definition. 4 Our statements employ definitions that are consistent to enable meaningful comparison, and the studies we drew upon also adopted consistent classifications. Troublingly, Shin himself collapses definitions, wrongly folding Trust policies on overseas patients (i.e. visitor, non-residents) into a discussion of amendments that affect broader populations that also includes all non-EEA temporary migrants, many of whom will have been in the UK for years, rather than days; a population who will be hit hard by the Immigration Act 2014.
We therefore encourage a focus not on entitlement, but on care and treatment on the basis of need; values that rightly sit at the heart of all medical practice and the NHS itself.