Big changes are under way affecting access to the NHS. On 30 December, the UK Department of Health published a response to a consultation on changing the charging regulations for migrants accessing the NHS. Did you hear about it? Given the date, probably not - it didn't get much media coverage, and there has been very little public debate. What coverage there has been has tended to focus on 'health tourists', people coming to the UK for the exclusive purpose of abusing the NHS. This deliberately misses the point. These changes will affect far more people than this small, very hard to quantify group. In fact, they will affect everyone who uses NHS services.
The African Health Policy Network, a charity campaigning to improve the health of African people in the UK, has been working with National Voices, the national coalition of health and social care charities in England, to raise our concerns about these changes.
The changes the government want to implement will involve everyone accessing the NHS going through a new registration process that will check their immigration status. This would mean linking NHS and Home Office systems and sharing data. This could put people off seeking healthcare and would be a big change to the way our information we share with the NHS is used. It will also involve new IT and data sharing systems, which will be expensive and complicated to achieve.
There are also practical problems. People's immigration status changes, for example, when an asylum claim is turned down, or a visa runs out. So the registration could not be a one-off but would have to be re-checked. There's no fixed formula for how often that would need to be.
Also, it may be difficult for some people to provide the documents needed to prove their status - for example people without a permanent address. The issue of proof of identity is also complex - not all British citizens have a passport or photo ID - how will everyone be expected to prove their identity when they present for health services? And how will people feel about doing this?
The proposals will also change who has to pay to access the NHS, and which services they have to pay for. Charging will be introduced to A&E for some care - what impact will this have on people getting the care they need when we already see massive delays and understaffing in A&E?
Linked to the Immigration Bill currently going through parliament, the definition of 'ordinary residence' is also being changed, to include a much wider group of people. Currently most people who have lived in the UK for 12 months have this status. But the new proposals will link 'ordinary residence' to 'indefinite leave to remain'. This takes at least five years, and sometimes far longer, to get. So people who have been in the UK for years, often working and certainly paying taxes (e.g. VAT as well as income tax and National Insurance) will now be classed as 'visitors' and will have to pay. So people with limited leave to remain in the UK, but who are in the country legally, have their only home here, work and pay taxes, will be charged extra for accessing the NHS.
These are big changes, and currently there is no clear picture of how much they will cost to implement. For the changes to be worthwhile, there should be an evidenced, cost-effectiveness case. But there is no robust evidence for how much could be recovered or saved with the new charging regulations. It would continue to be really difficult to recover these costs. People such as irregular migrants still won't be able to pay. The cost of setting up and running the system could far outweigh the amount saved or recovered.
We could all find it much harder to access NHS services, vulnerable people could be put off or prevented from accessing health care that they need, NHS staff will have an additional administrative burden to implement the system. And we don't know if it will really save any money.
We should all be worried about what this means for the NHS.