Proposed charging of migrants for use of the NHS is against government principles

By Sally Robertson, B.Sc.Apr 7 2016

Proposals put forward by the government to charge non-EEA residents for access to the NHS have failed to comply with principles the government originally set.

In an essay by public health experts from the London School of Hygiene & Tropical Medicine, the proposals have been referred to as ideologically driven and unlikely to lead to any significant savings.

In a document called Making a Fair Contribution (PDF), the government suggest that non-EEA residents be charged 150% of the amount paid by NHS purchasers for using ambulances or inpatient services and for visiting emergency departments. Consultations with doctors and nurses in primary care, however, would remain available at no charge.

As reported in the Journal of the Royal Society of Medicine, public health experts tested the proposals against the four principles outlined by the government for the NHS which say that it should meet the needs of everyone, be free at the point of delivery, be based on clinical need and not based on ability to pay. Their conclusion was that the changes fail to abide by those principles and represent a subtle adaptation from those the NHS is based on.

“The imposition of charges sends an implicit message that migrants do not already contribute to the NHS. Yet between 2001 and 2011 non-EEA migrants contributed 2% more in taxes than they took out, amounting to a net fiscal contribution of £2.9 billion,” says author of the paper Lucinda Hiam.

Hiam and co-author Martin McKee think that the majority of NHS staff will find the proposals offensive and difficult to work with, thereby creating low morale and tension in the NHS environment. The charging criteria are ambiguous and assessment would take up a lot of time and create a significant administrative burden, they say.

“The notion of a ‘fair contribution’ is ultimately flawed and against the founding principles of the NHS which strives to protect the most vulnerable,” says McKee.

McKee also refers to the words of NHS founder Aneurin Bevan, who stated that “ Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the costs of which should be shared by the community.’