The NHS and migration: does the continent have the answer?

Elliot Bidgood, 2 July 2013

Health Secretary Jeremy Hunt is set to outline plans on Wednesday to curb ‘health tourism’ on the NHS, an issue which has crept onto the health agenda in recent months. Though Hunt hopes to work with GPs on the plans, the basic idea involves a tracking system related to a migrant’s NHS number. Estimates of the cost of migrants for the NHS vary considerably as you’d expect – the lower end has been £20 million over five years in the official figures, but this only accounts for known uncollected payments and not for free care granted to those who are legally ineligible, so it is likely an underestimate. Fullfact.org attempted to ballpark the real figure at £45 million a year, but also noted that the NHS’s collection agency, CCI Legal Services, placed the figure at between £50 million and £200 million in 2003.

Whatever the real figure, at a time when the NHS faces acute financial strain, ensuring that all intended payments are collected is important. Having a firm handle on the numbers is also perhaps a part of putting the contributory principle back at the heart of our welfare state – it is true that the money lost is likely well south of 1% of the NHS’s overall budget, but there is still symbolic value in ensuring that entitlement to the service is managed properly. GPs are however concerned by Hunt’s specific plans. Although Pulse magazine reports that 52% of GPs feel there is a problem and RCGP Chair Claire Gerada has stated that “the health system must not be abused and we must bring an end to health tourism”, Gerada has also warned that expecting GPs to actively regulate access and become, in her words, “a new border agency” could put GPs in a difficult position ethically. The BMA has raised similar concerns about workability.

Senior NHS surgeon J Merion Thomas perhaps proposed a better solution. Noting their use in the French, German, Dutch and Scandinavian health systems, he proposed the introduction of a personal identification card (‘NHS passport’) as a straightforward means of regulating eligibility. He is not wrong about this – in France the state-of-the-art electronic Carte Vitale system does avert such problems. Moreover, a card system could also yield other, more routine benefits for the NHS and its users – the French have also experimented with using the cards to store all of the personal health records of cardholders and thus ensure consistent, speedy access to them. This could of course raise concerns about data protection and privacy – Germany has grappled with this recently as it has sought to upgrade its electronic card system. But if we could learn from their experiences, it is possible that we could kill two birds, fraud and record-keeping, with one high-tech stone. Revolutionising the NHS with smart health cards is worthy of consideration.

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