Health Secretary Jeremy Hunt (Photo: Isabel Infantes EMPICS Entertainment)
Doctors in the UK are describing wards that are like war zones. And if you believe the recent headlines, it's all the fault of those goddamn foreign "health tourists". Monday's front pages screamed that foreign patients on the NHS will be "made to pay", and that patients could have to show passports before getting non-urgent treatment.
According to some estimates, "health tourism" costs a massive 0.3 percent of the entire NHS budget. Cracking down on it is taking up a huge percentage of Health Secretary Jeremy Hunt's attention span. Apparently we could save a whopping £500 million this way – take that, £22 billion NHS deficit!
(Or could we? The "apparently" there is important. The National Audit Office's report says it's "difficult to know" how much money could be saved. They say that even if you did "claw back £500 million", to use the government's ugly term, you wouldn't necessarily have an extra £500 million to spend: "The net gain for the NHS is not clear.")
Several health professionals I spoke to this week told me the many reasons that this is a bad idea, using words like "bollocks", "propaganda", "nonsense", "smokescreen" and "dead cat on the table".
I called Doctor Ben White – who took the government to court over the junior doctors contracts – to ask if he spends his days running around treating tourists undergoing elective treatments. Is "health tourism" actually a big deal?
"I've worked in a lot of hospitals all over London and in Essex, which have huge populations of migrants, and I would say, 'No, it's not.' It's being massively overblown. It's much easier to create a narrative about [health tourism] than it is to discuss honestly with the public that over the last six years – and going forward – the NHS has been systematically de-funded."
Not only is it a smoke-screen, it could be dangerous. "If you're not treating somebody who might have tuberculosis, who might have early meningitis, who might have a type of pneumonia which is contagious, you're creating public health crises. You're harming the public at large. They're not going to be deported when they leave your A&E."
I spoke to a nurse working in central London and he agreed: "Ignoring the moral aspect of indirectly trying to stop people seeking medical help, the knock on effects can be grave. Do you want your neighbours, co workers, people on your bus, to have untreated tuberculous and other dangerous communicable diseases?"
Are British citizens going to be happy to become ill, satisfied in the knowledge that at least those bloody immigrants aren't scrounging off the NHS?
As GP Dr Youssef El-Gingihy put it: "There are pretty strong public health reasons for treating everyone the same. Something like meningitis, TB, a new diagnosis of HIV or a sexually transmitted disease – all are examples of a disease where you want to treat people, because if you don't treat them as soon as possible, they're likely to affect other people."
When I asked them about this, the Department of Health gave me a response so matter-of-fact I was initially embarrassed at the stupidity of my question: "Exemptions from charging will remain in place for the diagnosis and treatment of specified infectious diseases in order to protect the public."
I checked the consultation document. The PR person was right. It says: "The Government is clear that, for the wider public benefit, diagnostic services to detect specified infectious diseases and the treatment of those diseases will remain free to all."
Panic over? Maybe. But if several doctors weren't clear on that point, how is an undocumented migrant with English as a second language and a slightly worrying cough going to know whether or not they'll be eligible for free care without being hassled for their passport?
"Right, yep", said Dr Pete Campbell, co-chair of the British Medical Association (BMA) junior doctors committee, "that's the whole thing about this, from my point of view, is that it's a policy based on fear. The policy itself won't do what the papers say it will. Effectively it's a piece of rhetoric from the government. It certainly won't save them the £22 billion that is being cut from the NHS budget – the amount of money potentially saved is negligible. So what you're left with is news stories. Those news stories will be remembered by migrants and be remembered by people who have travelled here, and they will know, 'Well, they don't want me to go to hospital, do they?'"
Before this latest round of baiting, Doctors of the World – a charity that provides medical services to people who can't otherwise access it – were already reporting instances of discrimination at GPs. "How do we know they're not terrorists?" one receptionist reportedly said, when a volunteer tried to register a migrant at a clinic.
"We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS."
Leigh Daynes, executive director of Doctors of the World UK, has said, "At our clinics we see heavily pregnant women, cancer sufferers and people with ill children who are already too scared to see a doctor. Hospitals should be reducing the barriers these people face, not putting up more." The BMA, meanwhile, have warned, "We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS."
Dr Pete Campbell again: "When I was a medical student I was talking with refugees who were living in Newcastle at the time, who were basically saying, 'In the country I come from, if you're a troublemaker you don't go to the hospital because it's too closely aligned to the state.' You feel that they are going to make an example of you. Their understanding of that difference between emergency and non emergency – it's not going to matter for this or that [type of illness]; they just don't get, and why would they?"
And it's not just undocumented migrants. What about vulnerable Brits?
In November, Meg Hillier, MP to the Public Accounts Committee, said, "I have constituents who have no photo IDs. Because they have never travelled they have no passport. They have no driver's licence because they have never driven. They still live at home because they can't afford to move out, so they've never had a utility bill in their name. [They are] perfectly entitled to health care – British born, British resident. How are you going to make sure that people have access easily to the National Health Service without having to go through a very humiliating and impossible to meet set of demands?"
Monday's press release says the Department of Health is "determined to ensure there is minimal burden on British citizens". Meanwhile, in the consultation document, Jeremy Hunt elaborates: "We are setting out… to ensure that information on a person's eligibility for free healthcare is captured at their first point of contact with the NHS, regularly verified and available to other NHS organisations where necessary." Sounds totally unobtrusive to me.
Ultimately, with a lot of these questions, we just don't know the answers. There is no real plan, and very little evidence. The National Audit Office report responds to NHS workers' concerns about a public health risk: "There is insufficient evidence to assess whether, or to what extent, these concerns are justified." Maybe it'll harm public health, maybe it won't.
With this lack of clarity, sick people who are worried about state intrusion are likely to stay away. The rest of us are left to paranoid speculation about what comes next.
Doctor White was worried about the kind of precedent militantly charging people could set. "Why are we introducing credit card readers to the wards? I'm very cautious about any sort of slippery slope argument, but in this case, it doesn't seem like a slippery slope. When you've got the staff and the card readers on the wards, there's nothing to stop the government bringing in charging for everyone."
If that sounds like a bit of a reach, it's barely been noticed that the consultation document summary talks about the government's "intention to make sure that only people living here and contributing financially to this country will get access to free NHS care".
Contributing financially? With a government that demonises "scroungers" and a health service already part privatised, am I reading way too much into this government document that implies you shouldn't get medical treatment unless you're economically productive? Excluding foreigners is just a cough away from talking about excluding all those feckless, work-shy slobs we hear so much about.
It's also worth pointing out that this is supposed totally reasonable because it's about "non-urgent, planned care". With our finances in a dire state, what reasonable government could happily accommodate a flood of, idk, Polish grandmas popping over for a free hip operation before heading back to Kraków? But they might not stop here. Terrifyingly, the consultation makes clear that asking people for their passport in an ambulance or in A&E is still on the table. They've just parked this suggestion and are "considering the points raised" by health professionals about why they definitely shouldn't do that. They'll make an announcement later in the year. Those Tories aren't keen on red tape until you're bleeding from the head and asking for help.
All of this is sold to us on the idea of "fairness to the British taxpayer". I'll sure be glad when I've saved some money to keep some foreigners ill, who might then make me ill.
All of this seems pretty spiteful, but it's not merely a bad attempt to save a few pennies by denying foreigners health care. Last week, Kingsley Manning, the former head of NHS Digital, revealed how the Home Office "put him under immense pressure" to hand over data to help trace "immigration offenders".
The NHS is supposed to be a "safe haven" for data, but according to Manning, "We said to the Home Office: 'We need to understand what the legal basis of this is.' The Home Office response was: 'How dare you even question our right to this information…' The Home Office view was that tracing illegal immigrants was a manifesto commitment."
Since Theresa May was Home Secretary, Britain has been a "hostile environment" for migrants, and now that extends even to hospital wards. It doesn't matter that this is unethical and dangerous. Britain's bedside manner is to be that of a racist guard at a migrant detention centre.
For a while now, campaigners and politicians worried about the crisis have been talking about "Our NHS" – owned by everyone, not a cash cow for corporations taking fat cheques for running outsourced services. For the government, it wasn't that much of a leap to imply that "our NHS" is "ours", because it is not theirs. Our National Health Service with an emphasis on the National.