Plans to clamp down on “health tourism” by making people prove they are entitled to NHS care - and charging those who aren’t - could put all patients at risk, experts have warned.
From next week, anyone who seeks hospital treatment in England will have to take ID to show they are not from overseas. Those who cannot prove they are entitled to treatment can be refused it if doctors judge it is not urgent.
The move was announced by Health Secretary Jeremy Hunt earlier this year as part of an effort to save money supposedly lost to health tourism, where people come from abroad to get treatment for free.
But it would place a burden on already-overworked doctors to ensure their patients are not in need of immediate care, two experts argue in the British Medical Journal.
They also suggest there is no evidence it would save much money, adding the evidence was “consistently challenging the myth of widespread health tourism”.
This pressure “seems dangerous, especially when the performance of the NHS has been implicated as a possible reason for rising death rates”, Professor Martin McKee and Dr Lucinda Hiam write.
They warn doctors could only determine how urgent a person’s need for care would be by initial tests, which pose “considerable risks” if they are wrong.
To make this decision they can examine the patient and do some initial tests, but nothing further.
“Clearly, this requires considerable judgment, based on what will often be incomplete information... Yet, if [doctors] get this wrong, they face considerable risks,” the BMJ article says.
“If they breach the guidance by providing treatment to people lacking entitlement, they may reasonably fear potential disciplinary action, even if this threat is not explicitly stated.
“If they deny necessary treatment, they may be acting unlawfully under the Human Rights Act. Refusing care is unfamiliar to NHS clinicians and for many is an offensive prospect.
McKee, who is professor of European Public Health at the London School of Hygiene & Tropical Medicine, and Hiam, a GP and health adviser at the humanitarian aid charity Doctors of the World, call for the proposals to be withdrawn “until a thorough impact assessment on people in vulnerable situations has been carried out”.
“We’re adding a layer of work to people who really don’t need it. Adding something else they’ve got to do when they’re barely managing to cope,” Hiam told HuffPost UK.
The doctor added that, as waiting times across the NHS were worsening, the extra work was coming at “a very dangerous time”.
Although GPs’ services are not affected by the charges, Hiam said she did not know what they could do for patients if they are referred for hospital treatment that was then deemed non-urgent and for which they could not afford to pay.
“We won’t have anything else to do,” she said. “We only refer [patients elsewhere] if it’s something we can’t manages ourselves... That’s going to mean lots of appointments where we can’t provide any further solution.”
In their BMJ article, McKee and Hiam note the NHS trusts taking part in the pilot showed the checking process was complicated and easily misunderstood. Some hospitals were asking for a passport or utility bill, which would prove residence but not entitlement to care.
One trust initially screened those seeking HIV care, which is exempt from the charges.
In their article, Hiam and McKee also say people who are entitled to treatment could struggle to prove it, such as if they are homeless or have mental health problems.
One in six British nationals does not have a passport, they also note.
Hiam and McKee also suggest that, though contagious disease is uncommon among immigrants, the late detection of disease and the end of routine immunisation of children “could pose a direct threat” to the wider population’s health.
The system is due to be introduced on October 23.
Last week, former NHS England chief executive Sir David Nicholson was among more than 1,000 people who signed an open letter to Hunt, urging him not to introduce the policy.
The letter said: “We are concerned that these regulations have been laid without evaluation of their impact on health outcomes and health inequalities, without a full and robust assessment of the long-term costs to the NHS, and before the completion and evaluation of pilots on patient identity checks in hospitals.
“By denying healthcare to the most vulnerable in our society, these regulations will have negative consequences for us all.”
The Department for Health spokeswoman said: “The new regulations simply require NHS bodies to make enquiries about, and then charge those who aren’t entitled to free NHS care.
All the money raised goes back into funding and improving care for NHS patients.
“We are clear that some vulnerable groups such as asylum seekers are exempt from charging and the NHS will never withhold urgent and immediately necessary treatment.”