Making foreigners unwelcome, charging for NHS care

By Savi Hensman
August 2, 2013

Tighter restrictions on free National Health Service care, supposedly aimed at ‘health tourists’, would hit many UK taxpayers who are foreign. The proposed changes might also open the door to making citizens pay at a later date, and could cause grave social and economic harm.

The government has brought in various measures aimed at winning support among voters concerned about immigration, despite criticism that this is stoking racism. These include vans warning illegal immigrants to “Go home” or face arrest. According to Sarah Teather, a former minister in the ruling Coalition, the Prime Minister set up a working group to create a hostile environment for unwanted immigrants.

Much NHS care is free at the point of delivery, though visitors are expected to pay for some services. The Home Office and Department of Health are consulting on proposed changes, which are part of an Immigration Bill. Proposals were publicised as a crackdown on ‘health tourists’ arriving in order to get free medical treatment.

“The NHS is one of our greatest assets but its resources are currently used to treat people who have made little or no contribution towards it – or who are not entitled to free care at all. This is unfair to UK taxpayers and impossible to defend in the current economic conditions,” claimed immigration minister Mark Harper.

But the planned changes would hit plenty of people working here and paying National Insurance and other taxes regularly. Overseas students, who collectively contribute huge sums to the economy as well as paying VAT (value-added tax) on many items, and partners of UK citizens who are awaiting recognition as permanent residents, would also be hit.

“The current qualifying test for free NHS treatment is whether a person is ordinarily resident (as defined by case law),” according to Department of Health document Sustaining services, ensuring fairness. “To tighten up on who is entitled to free NHS treatment, the Government propose to adopt a revised definition of qualifying residency that requires current residence with indefinite leave to remain for non-European Economic Area (EEA4) migrants.”

Others living here would have to pay a migrant health levy or the cost of their care. Even emergency GP care and treatment by hospital accident and emergency departments would no longer be free, except for treatment of infectious diseases and sexually transmitted infections, for public health reasons.

The rationale is that migrants are not “fully integrated” and workers “have made no prior contribution to the UK exchequer during their previous working life. Even while here, those who are not workers will make only a limited contribution through indirect taxes.” In reality the UK state will have been spared the cost of their education and healthcare while growing up. The proposals are exploitative and unjust.

Continually checking people’s entitlement to basic care would also result in friction with patients, and could pave the way for introducing charges at a later date even for UK citizens. Setting aide this possibility, the social and perhaps financial cost could be greater than any gains made, including administration.

Let us consider some possible scenarios under the proposed new system.

While on holiday, widower Jack falls in love and persuades the woman to marry him, return with him to the UK and help bring up his young children. Soon after, they conceive. They must pay the migrant health levy to access NHS maternity services, though the family lives here and the baby will be British.

Rosa has been recruited from abroad to work in a nursing home. On top of other taxes she cannot afford to pay the migrant health levy, and her employers do not additionally insure her – they already pay employer’s NI – but she is not too worried, being young and in excellent health. A resident has a persistent cough and Rosa starts coughing and feeling very ill but cannot afford to go to the doctor. She collapses and it turns out that she has caught tuberculosis. Her treatment is now free since it is an infectious disease, but her lungs are permanently damaged and she may have passed the disease on to others.

Fourth-year medical student Tony, whose family overseas are paying £30,000 in fees for that year alone, delays renewing his health insurance because he is so busy studying. On placement in a hospital, his nose is broken by a drunk patient. He warns that, if he is forced to pay to be patched up by the same hospital, he will sue. His parents and their friends decide not to send any of their other children to UK universities.

Emma was born in the UK and lived here all her life. She has dementia and recently moved to sheltered housing. She goes out on a cold night, gets lost and is brought into a nearby A&E, suffering from exposure. She cannot remember her new address or NHS number and the hospital is obliged to tell her that though they will treat her now, if she cannot prove that she is entitled to free care, she will later be billed. Anxious and confused, she leaves without being treated.

It is not just those who are, or appear, foreign who will be harmed if the system is changed. The proposals are unjust and harmful and should be scrapped.

Details of the consultations, which close on 28 August 2013, can be found on and


(c) Savitri Hensman is a regular Christian commentator on politics, social justice, welfare and religion. She was written extensively on the theological and religious issues involved in debates about sexuality and marriage equality. She works in the care and equalities sector and is an Ekklesia associate.

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