Migrants will be charged to go to a GP under proposals being unveiled by the Government this week. The plans, to be announced by the Health Secretary, Jeremy Hunt, are part of a crack-down on "health tourists" – those who live outside the EU but use the NHS to obtain free healthcare.
The measures are being launched to coincide with the 65th anniversary of the NHS this Friday, at a time of uncertainty about the future of the health service following a series of hospital scandals.
That disquiet was underscored yesterday when fresh evidence emerged that the new non-emergency NHS 111 service was rushed out because of pressure from ministers. A report reveals that NHS Direct has cancelled contracts to provide 111 in North Essex and Cornwall and that the quango believes all of its contracts, covering nine areas, are "financially unsustainable". A separate report by Deloitte, entitled NHS 'Go Live' Review, found there was "considerable pressure" to launch 111 in early April because of increased waiting times in A&E departments.
This week Mr Hunt will try to focus attention away from the A&E crisis and the cover-up scandal involving the Care Quality Commission with new plans to save the NHS money by ensuring that "health tourists" pay their way. Anyone who lives outside the EU and seeks NHS treatment has to pay for care, but patients will be invoiced after treatment. Last year, the NHS identified that foreign nationals had cost hospitals £33m, and was forced to write off £12m of this sum, but some estimates put this figure far higher. Under the new plans, non-EU patients will face charges when they seek treatment at a GP surgery if they cannot provide proof of residency.
Critics say it will be left to those on the NHS frontline, such as GPs, to make snap decisions on patients' eligibility for treatment.
Mr Hunt will also announce plans for a new tracking system which may be linked to patients' NHS numbers, spotting those not allowed free care before they enter the system. Plans to allow ex-pat Britons living abroad to gain free access to NHS healthcare as long as they have paid 10 years of national insurance, will also be considered.
Mr Hunt said yesterday: "No one expects health workers to become immigration guards and we want to work alongside doctors to bring about improvements, but I'm clear we must all work together to protect the NHS from costly abuse. We want a system that is fair for the British taxpayer by ensuring that foreign nationals pay for their NHS treatment."
But Clare Gerada, of the Royal College of Practitioners, said that GPs should not become part of the immigration system. She said: "Our view from the college is that the GP must not be used as the 'Border Agency'. Who is meant to determine whether or not someone is eligible? A receptionist? The GP?
"I work in Tower Hamlets in east London, where 90 per cent of patients originate from overseas – how am I meant to know which one is or isn't entitled and who is going to do the checking and how? The NHS has always been free at the point of use and this is now going to change it: we're going to have a till at the point of use."
According to government figures, the NHS treats a million people every 36 hours but the current system does not capture every chargeable visitor who passes through. Alongside the proposals, Mr Hunt has ordered an audit of the true cost of use of the NHS by foreign nationals.
Ahead of the 65th anniversary, the head of one influential health think-tank predicted that the NHS was entering "treacherous waters".
Chris Ham, chief executive of the King's Fund, said the health service would struggle in coming years to balance its ever-tighter budgets with rising public expectation of what it should be providing.
He cautioned that the Government was too obsessed with reorganising the NHS instead of improving patient care. The latest attempt to reshape the service had only made it more complex and "confusing", he said, rather than slashing red tape as was originally promised.
"When Andrew Lansley published his plans, he said this is all about streamlining and simplifying how the NHS is run. It has had directly the opposite consequence," Professor Ham said.
Laurence Buckman, of the British Medical Association's GP committee, said: "The NHS arose from the ashes of the war and was seen as a way to create a society where we don't have sick people wandering around, we don't have cripples in the street and we don't have people dying of disease that's treatable.
"But slowly bits have fallen off this thing until you get an NHS that's heading for the buffers.
"I want to believe it's fixable, but I have a bad feeling that it's been fiddled with so much that it just won't go any more," said Dr Buckman.
To mark 65 years of the NHS, the Fabian Society is publishing a pamphlet on the future of healthcare in Britain. Here we quote five of the views in the document:
Clare Gerada, chair of the Royal College of General Practitioners
The concept of a fixed 10-minute GP-patient consultation is outdated and does not allow us to focus on the complex needs of our patients. Consultations in the future should be flexible in duration, depending on individual patient needs. The GP's role will increasingly become one of the patient advocate and navigator – helping to co-ordinate their patient's care across an increasingly complicated provider network.
Alastair Campbell, author and ambassador for Time to Change
We still put up with things that should never be tolerated – in society, in our communities, in our NHS. If you show up with a mental healthcare crisis, you are not guaranteed access to treatment. But with a truly integrated, person-centred service, things can and will change.
Richard Hawkes, chief executive, Scope
A third of people using care services are working-age disabled adults, and in many areas they take up half of the local budget. With whole-person care, Labour could create a care system fit for disabled people – but only if it works out how a free health system can be merged with a care system so dependent on eligibility and assessment.
Angela Coulter, senior research scientist at the Department of Public Health, University of Oxford
More than 10 years after a Labour government first introduced the provider choice policy, it remains difficult to judge whether either its proponents or its critics have been proved right. What's needed is a shift away from a reactive, disease-focused model of care, towards one that is more proactive, holistic and preventative, in which people are encouraged to play a central role in managing their own care.
Joan Bakewell, broadcaster and older people's advocate
Caring for people at home is the most effective option. This calls for a revised culture of caring that draws from the very best people have to offer. This will require a high degree of personal training, focusing on a sense of dedication such as we have seen slip away from many of the institutions we turn to for help. In some places the culture of box-ticking and clock-watching became too dominant. We need to recover what has been lost.