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Guest blog by Sophie Williams - NHS charges for non-EU students

Friday 14-11-2014 - 18:08

A campaign against unfair NHS charges for non-EU students and workers

The 2014 Immigration Act restricts access to the NHS for anyone from outside Europe, even if they are lawfully applying to work or study here.

This means that from May 2015, students and workers from outside the EU will have to pay a ‘NHS surcharge’ of up to £200 per year before they are given a visa. The charges apply to primary care (GPs) and A&E departments, as well as secondary care.

How will this be implemented?

To enforce these surcharges, NHS staff will have to check the immigration status of everyone who uses the NHS, whenever they register for a GP practice or go into A&E for emergency treatment.

As immigration checks are forced upon overburdened A&E, GP and hospital staff, we believe mistakes are inevitable and patients will suffer. The Act states that NHS Trusts will receive 'financial incentives' to recoup costs. This could mean pressuring staff to racially profile patients into those deemed eligible for free care, and those not. This discriminates patients, and goes against every NHS Trust policy on Equality and Diversity towards patients and staff.

The NHS surcharge forces international students and migrants to contribute more than the rest of society in order to access NHS services.  Migrants who come to the UK to work or study already pay into the system in many ways – through taxes, National Insurance, VAT and tuition fees. The Immigration Act also fails to recognise migrants’ work within the NHS itself, and these individuals will be required to pay a surcharge for the very services they provide. While international students contribute upwards of £14 billion to the UK economy, they are made the scapegoat of austerity.

Healthcare implications

The NHS has never been a contribution or insurance-based system, and this surcharge is a move away from the universal principles on which it was founded.  Although these changes seem small, it brings us closer to the American model where people are denied care because of their inability to pay.

Worst of all, when immigration enforcement enters the NHS many people will become scared and deterred from seeking care. This is already happening: many international students are not sure of the healthcare access they are entitled to. They may be afraid of having to pay or of having their movements reported to the Home Office. Health workers shouldn’t be responsible for policing patients’ immigration status. It breaks the trust between health workers and patients, and ultimately patient care suffers.

This will mean that health conditions will worsen and conditions that could have been more simply treated at an early stage will bring them to A&E at a much greater cost to the entire system (with an even smaller likelihood that they will be able to pay). While the Government has made assurances that treatments for infectious diseases (like HIV medications) will remain free, this doesn’t do much good if people are deterred from going to the doctor in the first place.

All people resident in the UK should be treated as humans, not wrongly categorized as vectors of infection for British citizens. All chronic conditions should be treated equally, regardless of a patient's national origin.

The reforms are based on misguided evidence

The Government claims these measures are necessary to combat the perceived problem of so-called ‘health tourism’, yet their own report acknowledges that their conclusions were drawn from ‘incomplete data, sometimes of varying quality, and a large number of assumptions.

The Government’s own estimates of the amount of money lost to ‘health tourism’ have varied widely, changing from £10 million to £2 billion in the space of three months last summer. Independent sources predict the cost to be somewhere between £70 million and £300 million, which amounts to, at most, about 0.3 per cent of the NHS’s total budget.

The computing requirement is also huge. Systems will have to relate Home Office and NHS data sets, and be consistent between Trusts. But the government has a poor track record of implementing large computing systems. In 2013, £10 billion was lost into a hole trying to create a universal computing system. If similar costs would be required for this new system, then that would wipe out any profit recouped from migrant health costs, even if the inflated figures where true.

The benefits of recouping such costs hardly seem worth the financial cost, let alone the risk these measures pose to public health, and the breach of basic medical ethics.

What’s next for the campaign?

While the Act passed last May, the Department of Health is currently writing the secondary legislation which will lay out how the law is put into effect. It will soon begin piloting the new registration database and will start implementing the visa surcharge and other charges within the next six months.

The DocsNotCops Coalition, along with prominent doctors organisations, advocacy groups and concerned citizens, is fighting to get the Department of Health to drop these misguided, discriminatory policies before they do too much damage.

As a start of this campaign, DocsNotCops, supported by NUS International Students’ Campaign, will be protesting at Home Office on Monday 17 November 2014 on the occasion of International Students Day. You can find more details on this Facebook event page.

Please be a part of our campaign for “Fair Care and No Levy” for non EU international students.

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