Charging migrants to use the NHS is a public health threat
by Daniel Button
During a pandemic, the last thing we should be doing is putting more barriers in the way of access to healthcare.
Rishi Sunak has announced increases to the Immigration Health Surcharge – the annual visa payments that migrants living in Britain must make to use the NHS — from £400 to £624.
This policy is the latest development of a package of policies brought in since 2014. As well as the Immigration Health Surcharge, NHS Trusts are now required to check the eligibility of people seeking care, and bill those who are not able to prove their entitlement, at 150% of the cost price for secondary and community care services. In a major shift in the way the NHS operates, all non-urgent care is now charged upfront, before treatment is given. The charging system is underpinned by a series of data sharing arrangements through which NHS Trusts pass patient information to the Home Office which is then used for immigration enforcement and to influence decisions on visa applications.
Sunak argued that the measure was put in place to ensure that “what people get out, they also put in”, but this logic reveals two fundamental misunderstandings about the NHS’s founding principles and history.
First off, contributions have never been a factor in a person’s entitlement to the NHS. It is not a system that relies on someone having to ‘put in’ to access it. Rather, it is about pooling risk and guaranteeing everyone’s right to health.
There are many reasons why this is important, but coronavirus highlights one major reason: the provision of healthcare is a public good, the benefits of which go far beyond the individual with entitlement to care.
Because of this collection of hostile environment policies, evidence suggests that migrants are disengaging with healthcare services. This is dangerous, both for migrant health and the health of the public at large. As the editorial board at the NYT argue, “proponents of closed borders and small social safety nets have a tendency to highlight the tension between citizen and noncitizen […] infectious diseases, especially those like Covid-19, have a knack for penetrating and exposing such false dichotomies.” It is worth noting that migrants rarely bring infections that pose a significant risk to host countries — indeed migrants are more likely to contract infectious diseases after their arrival — but public health systems only function when everyone can access services without fear or judgement. Placing barriers in the way of access to healthcare risks everyone’s health when faced with a threat like coronavirus.
Secondly, Sunak’s arguments misrepresent the economic reality of migration and healthcare. Not only do migrants pay more in taxes than they take out in benefits and services, but the NHS has always run on the back of migrant labour. At the election, the Tories said that they wanted to recruit 50,000 nurses, 12,500 of which would come from abroad. The new surcharge alone would cost a nurse £3120 over five years, not accounting for the sky high visa fees that sit underneath this. What’s more, if that nurse has a family, things get drastically more expensive. Hardly the draw needed to meet those targets.
Rather than giving the NHS the funding it needs after a decade of underfunding – again, exposed by the pandemic — the government has been scapegoating migrants. The increase in the Immigration Health Surcharge demonstrates that they are cynically doubling down on this set of policies post-election. Unfortunately, restricting access might even make matters worse. A study of policies restricting migrant access to the health system in Germany found that it cost the health system over a billion euros, by driving up demand for more costly acute emergency care.
Coronavirus has shone a light on the importance of universal healthcare and the underfunding of our health system. The government should take notice.
This was originally posted on the New Economics Foundation blog on the 13th February 2020.