Proposals by the UK government to charge non-EEA residents for access to the NHS fail to abide by the government's principles for the NHS, are ideologically driven and unlikely to result in substantial savings. These are the conclusions of an essay published today by the Journal of the Royal Society of Medicine, written by public health experts from the London School of Hygiene & Tropical Medicine.
The government's consultation document, entitled Making a Fair Contribution, proposes that while consultations with GPs and nurses in primary care remain free for non-EEA migrants, those using ambulances, or accessing emergency departments or inpatient services would be charged 150% of the tariff paid by NHS purchasers.
The essay's authors tested the proposals to assess if the changes are consistent with the four principles set out for the NHS by the government. These principles, say the authors, are subtly adapted from those on which the NHS is based, which were that it meets the needs of everyone, that it be free at the point of delivery and that it be based on clinical need, not ability to pay.
Dr Lucinda Hiam, of the London School of Hygiene & Tropical Medicine, said: "The imposition of charges sends an implicit message that migrants do not already contribute to the NHS. Yet between 2001 and 2011 non-EEA migrants contributed 2% more in taxes than they took out, amounting to a net fiscal contribution of £2.9 billion."
The authors believe that most NHS staff will find the proposals offensive and unworkable, creating further tension in an environment already suffering from low morale. The criteria for charging are confusing and assessment would be time-consuming, imposing a huge administrative burden. Furthermore, the authors anticipate that primary care is unlikely to be able to cope with the surge of attendances due to charging for A&E, eye care and dentistry.
Professor Martin McKee of the London School of Hygiene & Tropical Medicine, added: "The notion of a 'fair contribution' is ultimately flawed and against the founding principles of the NHS which strives to protect the most vulnerable." He pointed to the founder of the NHS, Aneurin Bevan, who noted, 'Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the costs of which should be shared by the community.'
Notes to editors
Making a fair contribution: is charging migrants for healthcare in line with NHS prinicples? (DOI: 10.1177/0141076816638657) by Lucinda Hiam and Martin Mckee will be published by the Journal of the Royal Society of Medicine at 00:05hrs (UK time) on Thursday 7 April 2016.
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