Coffee House

Britain can’t afford an International Health Service

21 February 2013

3:14 PM

21 February 2013

3:14 PM

Health tourism is raised every now again by politicians, but never has it been raised so forcefully by such a senior doctor. In this week’s Spectator, Professor J.Meirion Thomas, a consultant surgeon with the NHS and one of Britain’s leading cancer experts, speaks out about health tourism. He writes:

I am frustrated at seeing the NHS targeted by patients who are ineligible for free care, but who usually get through the net. Specialist units may be especially vulnerable. Reluctantly, I have decided to share my concerns. The final trigger to write this article was a potentially ineligible patient who accused me of unethical behaviour because I would not promote his application with my Trust for immediate and free NHS care. In any event, it is not the doctor’s job to decide on eligibility, but often it is only at the time of the initial or even subsequent consultations that the breach is first recognised.

The consultant explains how patients who are not British citizens are still able to claim free NHS care:

The Department of Health has abrogated its duties by delegating responsibility to individual hospitals. But the ‘Eligibility Officers’ at each hospital have a near impossible task, because the guidelines they have to follow are vague and open to interpretation. Moreover, ineligible patients are often familiar with the guidelines and can exploit their ambiguities.

The Department of Health states that NHS treatment is free to those who are ‘ordinarily resident’ in the UK, meaning that they live here ‘on a lawful, properly settled basis’. But on this score, there is a long list of exemptions.


The official figures for health tourism suggest it’s quite low, but that may be because – as the piece illustrates – it is very easy to register. The same applies to expat Brits who are not technically allowed NHS treatment, but can easily fiddle the system (although he advises that ‘It’s a good idea, though, not to show the mammogram from Cyprus, the colonoscopy report from Spain or the CT scan from Thailand’.)

Can Britain afford an International Health Service, or does the government, as Meirion Thomas argues, need to tighten up its regulations? You can read the full piece here, or in this week’s Spectator magazine, in print and online from today. Click here to subscribe.

Subscribe to The Spectator today for a quality of argument not found in any other publication. Get more Spectator for less – just £12 for 12 issues.

Show comments
  • Dogsnob

    At last. One of the central, long-running scandals perpetrated on the British taxpayer, has been recognised at the Spectator.

    Our own people have to put up with long waiting lists, whilst those who have contributed nothing, consult their many – some state sponsored – advisers to find the quickest route into the operating theatre.

    I look forward to Dr Massie turning his gaze this way.

    Will action be taken to stop this dreadful injustice? Likely not.

  • Carlotty1222

    Having worked in the NHS for over 20 years as a clinician I have some idea about how things work and those crying out for ‘something to be done’ about health tourism need to ponder for a moment what ‘doing something will cost.’


    Because yes, Health tourism takes place all the time. What does it cost the NHS? Hard to tell because it tends to be bunched in certain areas like London. But no more than £100 million a year, tops.

    Now I can hear jaws dropping open and old colonels’ dropping their whisky tumblers with exclamations of ‘ye gods man, that much.’ Out of the NHS budget, take it from me, that’s not a lot.

    The problem is, if you try and police the problem, if you are not careful you will end up spending far more attempting to weed out those trying to diddle the system than simply the cost of ignoring the problem.

    Now I know it’s hard to look the other way when people are stealing, As those not entitled to NHS care are doing when they use the NHS. . Indeed, there is a principle at stake. But sometimes, practicality has to take precedence. For to find out if someone is genuinely entitled to NHS can be a formidable task. Without an ID card system like they have in America and most of Europe (and the Right were mostly against an ID card system remember) it takes a lot of man hours to finally prove someone’s eligibility. To police the entitlement to NHS care would mean employing huge numbers of people to chase and check people’s eligibility. And I know from experience employing lots of people very quickly becomes very, very expensive indeed.

    I am not exaggerating to say that it is not only possible, but probable that the cost of policing such eligibility would exceed the money saved on bogus claims within 5 years.

    Is that a sensible way forward? I am not sure it is. My wards are desperately short of qualified nurses because the Trust would rather employ unqualified HCA’s (because they are cheaper) and then wonder why mistakes happen. So to waste half a billion on policing NHS entitlement that could be spent on nurses to save less than a 5th of that figure on weeding out frauds, just seems knuckle headed.

    One way they could save money in the NHS is stop the endless re-organizations that drive us all barmy and stop spending money on obscenely expensive computer systems (£12 billion plus at the last count) that never work

    • Tom M

      As you say, you are a clinician. To suggest that £100million pounds is not much confirms that you are not an accountant. I know of no other orgnisation or company that runs on money that would remotely support that view. Imagine all the other £100m caches of money around the NHS that are “too difficult to collect”. Imagine the odd £50million bundles that “well if we don’t collect the £100millions why bother with anything less”. That sort of juvenile attitude to money is one of the very British reasons the NHS (and the government at large) is in the trouble it is in.
      Have a look at my post a bit further down and reflect. If the French (and Germany and Italy etc etc) can do it why do we find it so difficult?

      • Grrr8

        She is a clinician. I wonder if you are a househusband or one of those penny wise pound foolish types? Not to dog house husbands but any business person who does not understand proportionality won’t be in business for very long.

    • Dogsnob

      Very weak argument. Stopping this would be easy and you know it.

      • Grrr8

        As opposed to you who have no argument at all.

        • Dogsnob

          I’ve argued repeatedly here and over quite some time, that this is a situation which is very wrong. Previous responses have come from one or two idiots popping up who protested that I was either exaggerating or misguided. Wonder where said idiots are now?

          • Grrr8

            Saying a situation is wrong is not an argument. It’s an assertion. You need some data to back your argument. So where is it? Or are you like the bad doctor who has no data, just a rant?

    • Grrr8

      This is spot on. The NHS budget is £140B. Saving £100M is not even 1% point of the total. And you are correct: the admin burden on over-stretched staff may well exceed any such savings.

      What irritates me about the bad doctor’s article is that there isn’t a shred of data to support his assertion that there is a problem. Not one survey, not one numbers, not one bit of independent analysis. He says “there is a problem” so of course, “it must be so” and teeth must be gnashed and bile must be regurgitated (its already in short supply). Silly of the Spectator to publish this nonsense.

  • Bob339

    Please consider going here and signing the petition

  • dalai guevara

    Does the NHS invoice for costs incurred under the EHIC?
    Do physicians code their prescribed treatments themselves, or does some back room clerk keep dropping the pen half way through?

    There’s your answer…

  • Smithersjones2013

    Well given the number of people the NHS reportedly kills through its negligence and callousness each year I suppose its one way to reduce the immigrant problem……….

  • Hexhamgeezer

    BTW Another great reason to vote LibLabCon in Eastleigh.

  • Hexhamgeezer

    While there are rules doctors have mostly been very clear that they are will not act as gatekeepers against illegal immigrants and illegal users of the NHS. Many local authorities go out of their way to ensure that non-British applicants get social housing. Their children are educated no questions asked. Informal and formal networks ensure that the benefits system is hijacked with the collusion of those who support LibLabCons open borders policy.

    Well done doctor Thomas but he is up against the Left’s detoxifying the nation project.

  • Boudicca_Icenii

    No we can’t afford an International Health Service, but that’s what our Quisling Government has signed us up to provide.
    Just one more reason to vote UKIP.

  • Rhoda Klapp

    Last time I went they were all bloody foreigners. The ones working there, that is.

    Did I ever tell you about the time an Egyptian and a Chinese came at me with knives in the theatre?

    • Fergus Pickering

      Did they get you?

      • Rhoda Klapp

        Yep, still got the scar.

        • Grrr8

          Damn, wish they had finished the job 😉

  • CharlietheChump

    No no no.

  • Eddie

    This is a scandal that has been hushed up for many years. Now with the EU, anyone from the EU can come here, get expensive health treatment, public housing, benefits, schools for their kids etc.
    The thing is, in theory we can get the same in other EU countries – but in reality, if doesn’t usualy work out that way. How many Brits in social housing in the EU? Housing nefeit does not even exists in Spain or Italy – yet we give it for EU people who come here.
    Fair play is needed.
    Those who are not British and do not pay taxese here should not get any free healthcare.
    And no, I am not racistl and yes, I have lived in the EU (where I knew several women who came to the UK to have their babies).
    And as for immigrants from Africa or Asia. Well, has anyone worked out the cost of their treatment to the taxpayer?
    The knewjerk love-in of all lefties of pc hypocrites for anyone foreign, especially those with a dark skin, has to stop. We really are a laughing stock around the world for being so lax.

    • John McClane

      You can’t get the same sort of healthcare in the rest of the EU, even if you’re ‘ordinarily resident’ there. If you apply for residency you’re expected to show private healthcare insurance. I don’t see why the UK can’t do that. It’s not difficult. Additionally some Brits who live abroad keep an address in the UK, because they’re told if they live abroad they lose their NHS entitlement. How come Brits lose it so quickly & foreigners get it equally quickly?

  • Bert3000

    This is a classic bit of health service arrogance. The world’s population is desperate to get away from the NHS. Older British people are so frightened by the NHS that many thousands of them have moved to Spain and France in the hope of getting decent medical care in their declining years.

    There is nothing anywhere in medicine as bad as the ‘we’re far too important to bother with you’ attitude of NHS staff. The response of the NHS to the hundreds of unnecessary deaths at Stafford has been one of indifference, along with the usual demands for more money for all.

    • Fergus Pickering

      If what you say were true then nobody from a foreign country would come here for free treatment. Are you suggesting that this doctor is a liar? What nonsense you talk.

  • In2minds

    Normally NHS staff simply don’t bother about eligibility Professor J.Meirion
    Thomas is thus a noble exception. What happens is staff regard
    themselves above such detail as they work on a higher plane than cost, fools.

    • CharlietheChump

      And they are concerned to keep manning levels to 3 people per job

  • AnotherDaveB

    This government decided to give non-UK citizens free HIV treatment. A strong incentive for illegal immigration.

  • Count Dooku

    I live, work here and pay over half my income in tax here. I’m not a UK citizen but I’ll happily continue to use my private care if I got a tax rebate for it.
    I don’t use the NHS so I’m very happy for a blanket ban. As long as I pay less taxes!

  • HooksLaw

    So can we have a solution to a visitor becoming ill? Do we leave them on the street.

    And Brtish citizens abroad and without insurance?

    • Austin Barry

      Leave them on the street?

      No, certainly not.

      Our medics should offer a free piece of family planning advice, ‘Go forth and multiply’ and then turn their attention to an eligible patient.

    • Tom M

      Just come out of a hospital in France. Large notices everywhere for UK visitors. “You must register your health insurance and your UK address or pay the bill”.

      They send you a bill and you will only get emergency treatment if you are stupid enough not to have understood the requirements of going abroad and having health insurance. What would you expect from any other business you visited if you couldn’t pay the bill?
      In France if you work “on the black” for example and have an accident. The person you are working for gets the bill. If you have a car accident then the hospital bill goes to your insurer. It is enforced and it works.

      It is only in lackadaisical Britain that these things are tolerated. Funnily enough France, known for its revolutionary sentiments, accepts this. No-one is out on the streets chanting “free-at-the-point-of-delivery-or-die”.
      Trouble is in the UK, compared with the countries we think we are the equals of, that we just aren’t rigorous enough in what we do. A certain laissez-faire attitude persists and the article above is just another case in point.

      • CharlietheChump


      • Colonel Mustard

        The UK, thanks to its monumentally stupid governments, is going to laissez-faire itself to destruction. Rather like the captain of the Titanic being pleased that he kept all the passengers happy until the end.

      • 2trueblue

        It is just as you say but people do not want to believe it. The same pat excuse that it costs more to collect than it does to ignore the problem in the UK is parroted, which is rubbish.

    • CharlietheChump

      Make ’em pay

  • Archimedes

    So are we drifting into NHS mania where we have a multitude of accusations launched against it, which inevitably become too vast to ever solve and so politicians, in all the chaos, resort to meaningless statements rather than solutions? Call me simple, but I’ve always felt that scandals are more useful in the singular.

  • Andy

    In a word, NO. We can’t afford this and we shouldn’t be providing it either.

    • telemachus

      So the answer is firm rules and someone taking a grip
      Why is school prefect not doing so instead of grinning and being pleased with himself

      • Andy

        So why didn’t your useless and incompetent party do something about it during the 13 Glorious years of Soviet Socialist utopia ??? Ah I forgot: because they were useless.

        • Ron Todd

          They didn’t do any thing about it not because they were useless , which they were, but because they did not want to do anything about it. They would not want their immigrant client and future client base or any of their relatives to be refused treatment and accuse them of being nasty or wors racist. Too many votes to lose to ‘respect’

        • telemachus

          Now advised by a senior surgeon Andy Burnham will work on it and sort it in 2015

          • Colonel Mustard

            Andy Burnham couldn’t work the rubber out of the end of a pencil. He had his crack at health and proved himself spectacularly incapable. Now he obstructs others trying to do a better job.

            If you think 2015 is in the bag then job done, you don’t need to post here any more. Or is it like a cult chanting?

            • telemachus

              On the contrary
              I was recently priveleged to observe him on a visit to a minor hospital and was impressed by his empathy
              A contrast to the leering self satisfaction of Hunt
              Added to which he has a grip of the health and linked social care issues which will become increasingly important as we progress the century with an increasingly aged population
              I have confidence as we approach 2015 on health in a way that no-one could going up to 2010 with Lansley
              And just look what happened.

              • realfish

                ‘…Added to which he has a grip of the health and linked social care issues …’
                Which is why he recommended Stafford District General for foundation status and ignored evidence presented to him about death rates.
                Oh…as for empathy, he blamed patients and their families for not speaking up (even though they did), repeatedly refused their requests for a public inquiry and refused to meet them. There’s empathy for you.
                The only mystery is why Miliband re-appointed Burnham to the health brief

                • telemachus

                  I fear there is corporate guilt in the poorly briefed politicians
                  What have Hunt and Cameron done
                  Why is Sir Nicholson still there?

                • Colonel Mustard

                  Guilt is with Labour. Every sensible person who is not a member of their cult knows it.

                • Colonel Mustard

                  “The only mystery is why Miliband re-appointed Burnham to the health brief”

                  Because they are the same old incestuous New Labour gang, regardless of re-inventions. And I guarantee that if they win Brown will be back on the scene.

              • Dogsnob

                So, you base you opinion of politicians on the warmth of their smile and the twinkle in their eye? A bit of growing up to do here my friend.

              • Colonel Mustard

                Yes, I’ve seen him too like you he avoids awkward questions. His bogus empathy and sanctimony act is well-practiced, as it is with most Labour politicians. Underneath he is a nasty little fascist – just like you.

            • iviv44

              telewhatsit is just banking on the hope that surgeons will be able to give Andy B and his mates competency transplants before they next get their paws on the NHS.

          • DWWolds

            Well the Stafford scandal occurred under his watch and that of Alan Johnson.

            • telemachus

              Andy began the cleanup

              • John McClane

                Cleaning up his personal expenses.

          • John McClane

            Does Burnham ever take advice? He didn’t on Mid-Staffs.