The NHS is already suffering as a result of racist changes to the rules governing non-EU staff, even as desperate NHS bosses scour Africa and Asia in the quest for staff to fill growing numbers of vacancies.
From next April, non-EU nursing and other staff earning less than £35,000 (i.e. most non-EU nurses) will have to leave the country.
The government has persisted with this policy, despite warnings from NHS Employers. Indeed the Migration Advisory Committee specifically decided in February not to include nursing on the list of “shortage occupations” that were allowed to recruit beyond the EU.
The Health Service Journal’s Shaun Lintern reports one clinical director at a London hospital warning that staff are already leaving the NHS seeking to get jobs paying above £35,000. “In London we rely on nurses on work permits to keep our service running”.
The HSJ has previously reported that a staggering 83% of trusts have failed to meet their own planned nurse staffing levels.
But now staff are leaving, and expensively recruited new potential staff are unable to get work permits. That’s Tory policy for you – appeasing the racist right at the expense of public services.
The other reactionary Tory policy targeting non-EU migrants is also creating more problems for the NHS – the imposition of a £200-a-year “health surcharge” which migrants have to agree to pay as part of their visa application.
Straight after the election the Tory government announced plans to consult on extending these charges to emergency and primary care, which are currently free of any charges.
And to “incentivise” NHS Trusts to collect the money, short-term visitors from outside Europe – most of whom are working or studying here – will be charged 150% of the cost of treatment – again regardless of their ability to pay. Trusts that fail to collect these charges face possible fines.
And while ministers claim such charges could raise up to £500 million per year, they have not addressed the question of how much it would cost to collect the money, or the extra bureaucracy required to do so in each Trust.
Nether have ministers explained how such charges could be raised from refugees and migrants who, for whatever reason, do not have the means to pay.
In some fee-charging hospitals in West Africa, desperate hospital managers trying to secure payment for maternity services from destitute mothers have even resorted to keeping their babies hostage until the bills have been paid. It’s not clear if this is the model that appeals to Tory ministers.
Of course denying migrants access to primary care or emergency treatment on the basis of their ability to pay runs directly counter to the principles of the NHS, and obliges health professionals to breach their professional ethics and act as border guards.
Denying access to primary care could also result in the spread of infectious disease, and the worsening of conditions to create a much more expensive later emergency.
Nye Bevan, the founder of the NHS argued strongly against suggestions that the NHS should charge “foreigners” for using services:
“One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. …
“The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does any British citizen.
“However there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove they are not visitors?
“… The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.” (In Place of Fear, 1952)
Echoing several of Bevan’s arguments an academic analysis of the policy’s implementation argues that the charges are a false economy and could well cost the NHS more in the long run. They point out that access to health care is a quoted as a factor for migration by fewer than 3% of migrants surveyed by Doctors of the World. Evidence shows that undocumented migrants are healthier, cost less, and make less use of health services than nationals.
The crackdown on what has been ludicrously described as “health tourism” has already had an impact on pregnant migrant women and their babies according to Doctors of the World, who run a charitable clinic in London. They quote two examples of women faced with demands running into thousands of pounds – even after their babies died in hospital.
Aping the horrors of the American health care system, hospitals cannot turn away undocumented migrants in need of emergency or maternity care – but are obliged to pursue them for payment.
The whole policy on overseas staff and non-European migrants is based on the most flimsy research and assumptions, cynical exaggerations of how much “health tourists” actually cost the NHS.
While appeasing their right wing fringe Cameron’s government is eroding both the principles and the workforce that underpin the NHS. It’s time both lines of policy were challenged.