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Violence in Britain: migrants, the NHS and the threat of exclusion

Free at the point of delivery: the NHS founding principle. Dave Thompson/PA Wire

Brace yourself for another round of innuendo and ignorance about immigration as the Office for National Statistics prepares to release its latest figures showing that 30,000 new migrants have arrived from Bulgaria and Romania since restrictions were lifted on January 1.

Amid the huffing and puffing will be the insidious suggestion that the first thing these new migrants will do, once they’ve signed up for a council house and weekly dole payments, that is, will be to barge in front of you and other hard-working Britons in the queue for healthcare.

No matter that this is clearly an inaccurate picture – for reasons we will get on to – the ill-feeling this sort of dog-whistling creates is in direct contravention of the principles by which the National Health Service was originally established.

When the NHS was launched in 1948, its architect, Aneurin Bevan, made clear that healthcare would be available for all, free at the point of use.

Now the UK Immigration Bill 2013-2014 will radically reconfigure these foundational principles. The bill, which looks certain to become law later this year, will implement an NHS levy on visas and permit the Secretary of State to extend charging to visitors and non-EEA migrants for NHS services when they do not fall into a handful of exemptions. If the bill comes into effect many migrants will likely face substantial treatment costs.

David Cameron and his health secretary Jeremy Hunt, among other members of the coalition, argue the immigration bill is a painful, yet necessary, step to ensuring the long-term viability of the NHS. They claim that the bill is essential to establish that the NHS is “a national health service not an international health service”, so as to “wipe out abuse in the system” to “make sure it is sustainable for years to come”.

This attack on migrants’ access to the NHS is not new. As far back as the late 1940s, Conservatives sought to limit healthcare access to those groups whom it deemed “deserving”. Bevan robustly defended universal access for all individuals in the UK, arguing:

How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.

A closer look at the data shows that Bevan’s critique is as on target today as it was then. First, to set up an elaborate system of charging will require the Home Office and NHS to share data. This will necessitate a new information system, along with staff training about how to use it. The bill is likely to increases NHS administration costs, bringing in less money from charging migrants than it costs to administer.

Second, there is no data supporting the claim that migrants cost the system. Indeed, the evidence points to the contrary. A budgetary analysis found that non-EEA migrants contribute 2% more than they take out during their time in the UK. This contribution offsets the less than 2% of NHS expenditure spent on migrants. At the same time, 36% of doctors registered with the General Medical Council are foreign, so that the NHS workforce relies heavily on the contributions of migrants.

Adding injury to insult

So if the bill appears unlikely to be cost-saving and may pose risks to the NHS’ viability, what then is the basis for the government’s attack on migrants?

The bill is violent because it is likely to cause injury to people. Apart from a few exceptions, migrants generally come to the UK in better health than the local population. UK living and working conditions and diets, however, expose migrants to increased risk of non-communicable diseases. Screening and interventions are essential to reduce this risk and long-term healthcare costs. There is clear evidence that introducing charges and user fees for care reduces both necessary and unnecessary healthcare utilisation, with direct consequences for health.

Thus, both the British Medical Association and Council of the Royal College of General Practitioners regard the bill as troubling since it drives immigrants from seeking early interventions and routine healthcare, mainly because many will fear incurring substantial bills.

Leaders of professional NHS organisations are speaking out against the reforms. The British Medical Association, for example, has voiced concern that the changes conflicted with professional ethics and specifically doctors’ duty to provide care. Many healthcare workers may be unwilling or simply refuse to implement the changes as protest.

The bill may also coalesce opposition from nurses, doctors, and healthcare workers into a wider social movement. This could build on the nascent National Health Action Party, whose sole aim is to restore the NHS foundational principles. This initially focused on reversing the Health and Social Care Act and now more recently includes the immigration bill.

Without directed and organised action, individuals, especially migrants, are unlikely to succeed in counteracting structural violence. If we do not intervene, it may not be long until the rest of the UK population is harmed.

Meanwhile the media and pressure groups such as Migration Watch will continue to raise the temperature of this debate. It doesn’t bode well for the future.

A conference in Liverpool on May 16 – How Violent is Britain?– will examine this issue in detail. This is part of a series of articles on this theme on The Conversation.

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