North-East GP Zak Uddin looks at the issue...

PLANS to charge foreign tourists for non-essential medical treatment up front has strongly divided opinions, with some sources claiming that the rise of so called “health tourism”, where individuals arrive in the UK with the sole purpose of accessing routine medical care, is costing the NHS up to £500 million a year.

On the other hand, advocates of the “free at point of entry” principle, upon which the NHS was founded, state that policing of the service will lead to vulnerable persons being denied essential treatment, or worse, not attending due to fear of being refused much needed healthcare.

At present, individuals from abroad who specifically come to the UK for non-urgent treatments only make up a small deficit in the amount of money lost by the NHS every year.

Non-essential treatments are defined as those which if not carried out would not pose any risk to life or limb. Examples would include elective hip replacement or cataract surgery. And although the figure of £500m, later revised down to £300m, seems massive in isolation, in reality it is 0.3 per cent of the total NHS budget, or even less if you use the smaller figure.

The real headline figure is the £1.8bn in costs incurred when persons from abroad are in the UK and become ill requiring either immediate or urgent treatment. This stark figure was highlighted last week by the unfortunate case of a 43-year-old Nigerian woman, named only as Priscilla, who was six months pregnant with quadruplets, travelling back from the US to her native country, after not having the appropriate paperwork to access US health facilities. Sadly, she went into premature labour and ended up in a London Hospital where, tragically, only two of the four babies survived childbirth. Her treatment bill of more than £20,000, and estimated to be more than £300,000, is a figure she herself admits she will never be able to pay.

From April this year, the Government hopes to set up a system whereby foreign nationals from outside the European Economic Area (EEA) and Switzerland, are advised of and billed for any treatment at point of commencement. This will replace the previous practice of allowing treatment and then invoicing after the event, which the Parliamentary public accounts committee labelled as utterly “chaotic” and has led to a vast loss of revenue. An important point is that this will not stop persons accessing urgent or emergency care, only that they will be aware of the costs up front.

One of the major issues is how to identify persons who should be paying. Free NHS care is based upon being “ordinarily resident” in the UK. And although presenting a passport and a utility bill with a UK address seems a good idea, it is not actually a complete guarantee of genuine residency in the United Kingdom.

On top of this there is widespread upset as to who will police the system. Many healthcare professionals have voiced concerns that they do not wish to be made into another form of border guard, and with only one properly trained individual for three London hospitals, the system is still under resourced.

Despite this, some trusts have already implemented the system, and with encouraging results. One healthcare trust has already recovered £350,000 in the past year, noting that there has been no real reduction in attendances from individuals asked to pay for their treatment. This money has then been directly recycled back into the same trust to improve services.

It is very important to state that any victims of torture or those seeking asylum are exempt from all charges, and I hope that this is actively implemented to prevent the most vulnerable members of our global society from any further unnecessary suffering, and being able to access world leading health facilities without further issue.

So, although there are pros and cons to the new system, with a potential for obtaining much lost revenue that may be reinvested into improving healthcare, there is also the genuine worry that the most vulnerable aspects of society, for example those fleeing torture or genocide, will be too afraid to attempt the system, or worse be turned away by under-trained and overzealous proponents of the new concept.

My advice to anyone travelling abroad, especially outside the EEA, would be that in addition to making sure that you have the appropriate and up-to-date immunisations, you also have robust travel insurance that guarantees to cover any treatment in the unfortunate case of falling ill whilst away from home.