Exposing the true costs of the Immigration Act in the NHS

Sophie Williams
  sw6613@imperial.ac.uk
  
Ruth Atkinson
  ruthemilyatkinson@gmail.com
  Queen Mary University of London

Abstract

The 2014 Immigration Act mandates charges for non-EEA migrants without temporary visas to access NHS hospital care . Current proposals look to extend chargeable services into emergency and primary care . These so-called “efficiency” savings contradict the NHS’s founding principles, creating major public health issues and promoting racist scapegoating. Furthermore, they are not as profitable as the government has suggested, indicating that recouping costs is not the primary motivation.

The Department of Health state that they hope to save £500 million by 2018 with these charges . They recommend that, where possible, hospitals create overseas management teams to fulfil their statutory requirement to identify and charge certain migrants . Our research sought to answer two main questions: Has this resulted in a uniform procedure for charging? How does the amount of money recouped under these charges compare to associated administration costs?

Freedom of information requests were sent to 156 hospital trusts across the UK. Information was requested regarding finances in the 2015 calendar year: i) the total amount invoiced in accordance with the Immigration Act, ii) the amount recouped and iii) the amount spent on overseas charging teams. Of the trusts approached, 6 declined to give information (for reasons relating to lack of data collection, 3, internal review, 2, or no response, 1). Of the responding trusts, 70% stated they had no operational charging team, and 70% made charges relating to the Immigration Act. Of the trusts that invoiced patients, 34% spent more on the team than they recouped in that calendar year.

These findings suggest that charging under the Immigration Act is being conducted on an ad-hoc basis as most trusts do not employ a designated team. This exploits employees’ uncertainty – leaving individuals to self-police using their own interpretation of the law. Furthermore, DoH’s projected savings are clearly vast overestimates, and additional charging infrastructure represents an economic burden for a large proportion of trusts, as it undoubtedly would for primary care facilities. Extension of charges will be expensive and burdensome, as well as posing a significant public health threat.

In the NHS, the is a tension between defending universal healthcare and providing a nationalised service. Charging some to access services challenges the belief that the NHS should be universally accessible, but also that it should be free. Activists need to continue to expose the attacks on free healthcare, in the many forms they take.
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1. Lea W. Guidance on implementing the overseas visitor hospital charging regulations 2015 [Internet]. Department of Health; 2016 [cited 2016 May 31]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf

2. Visitor and Migrant NHS Cost Recovery Programme. Making a fair contribution: A consultation on the extension of charging overseas visitors and migrants using the NHS in England [Internet]. Department of Health; 2015 December [cited 2016 May 31]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/483870/NHS_charging_acc.pdf

3. Department of Health. New rules to improve overseas visitors’ contributions to NHS care [Internet]. UK Government; 16 February 2015 [cited 2016 May 31]. Available from: https://www.gov.uk/government/news/new-rules-to-improve-overseas-visitors-contributions-to-nhs-care

4. Lea W. Guidance on implementing the overseas visitor hospital charging regulations 2015 [Internet]. Department of Health; 2016 [cited 2016 May 31]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf

migration - NHS - racism