THE BLOG

I'm A Doctor - Not A Proxy Border Guard

23/10/2017 10:51 BST | Updated 23/10/2017 12:20 BST
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Jeremy Hunt's actions today are more callous than ever.

Today, new regulations come into force in the NHS. Anybody accessing an NHS service outside of hospital will be required to prove their eligibility for free care. This includes mental health and antenatal care. Foreign visitors who are deemed ineligible will be required to pay up-front, before accessing the care. Since there is no easy way to check eligibility for care without racially profiling patients, pilot programs have asked all patients to bring proof of identity and address.

The argument for it is purely financial. The Department of Health says these new regulations are necessary to deter freeloading 'healthcare tourists' and to recoup costs from those availing of NHS care. It claims that up to £500m can be recovered annually.

The argument against - part one

The new regulations will not save the NHS money. I repeat, MONEY WILL NOT BE SAVED.

The DoH declined to publish its full costings, so it is unclear how they arrived at the £500m figure quoted. The training of the staff required to implement these regulations, as well as their salaries and overheads, would amount to a substantial figure that appears not to have been taken into account.

Not to mention the compensation that may have to be paid to those mistakenly denied care. GPs and hospitals already erroneously decline care to people, often the most vulnerable in society, such as the homeless and those seeking asylum. Pilots of the new regulations have continued to make such mistakes, e.g. by denying HIV care, which is supposed to be exempt from charges.

As well, we know from the experience of Grenfell that putting up any kind of identity check or barrier to accessing care deters not just undocumented migrants, but also documented migrants who actually are eligible for free care. NHS doctors already see this happening regularly. Vulnerable people who do not know their rights may not present at all, but more often, they present later, when their condition has advanced further. By then, it is likely that it will cost more to care for them.

Of course, apart from the financial cost, there is a human cost to denying people care that they need, which brings us to part two.

The argument against - part two

The primary duty of healthcare professionals is to provide care for those who present themselves to us. We do not want to be proxy border guards.

More to the point, patients do not want their health services to be reporting on them to the UK Border Agency. Patients want to know that confidential information entrusted to a medical professional will not be shared and used against them. This is one of the cornerstones of the doctor-patient relationship.

We are trained to provide care, not to check passports. In a survey that we have conducted in Manchester only 21% of healthcare professionals felt confident even defining words like refugee and asylum seeker. Only 26% correctly identified eligibility criteria for primary care, and a worrying 32% failed to correctly identify eligibility criteria for emergency care.

In summary, it goes against our ethical principles to decline care to those who need it. And we are not trained to determine eligibility for care.

Why is Jeremy Hunt doing this?

We have established that the regulations being brought in today are:

• Inadequately costed

• Inadequately evidence-based

• Counter-intuitive

• Cruel

They will not save money. They will disproportionately affect the health of the most vulnerable in society.

The only explanation for these illogical, unethical measures is that Hunt is blaming and scapegoating 'healthcare tourists' to distract attention from the largest ever sustained reduction in overall NHS funding as a share of GDP, over which he has presided.

What you can do:

• Educate yourself. Follow the links in the text to assess the evidence and come to your own conclusions.

• Write to your own MP and/or Jeremy Hunt.

• Join one of the organisations campaigning against these measures: DocsNotCops, Medact, Doctors of the World, Asylum Matters.

Piyush Pushkar is an NHS psychiatry doctor, Wellcome Trust fellow, and co-chair of Manchester Medact. He is currently conducting research for a PhD at the University of Manchester. This blog expresses his own personal views, not those of any of the organisations listed above.