Jeremy Laurance: It is much easier to have a go at foreigners than beat hospital consultants into submission

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The Independent Online

An American academic who had a child with a rare genetic disorder got a job at a British university a few years ago with the specific intention of obtaining treatment for the child on the NHS. The cost was £750,000 a year. The health authority, outraged by what it saw as a clear abuse of Britain's open door NHS, tried to recover the money - but failed.

This anecdote, related by a senior NHS manager, lies behind yesterday's announcement of a government crackdown on the health tourists who come to this country to take advantage of our free health service. Many doctors tell similar tales, and patients naturally feel aggrieved when they learn that already lengthy queues for treatment are being made longer by people who do not have a right to be there.

Yet, despite this, it is difficult to see the announcement as anything other than political opportunism. The veteran political bruiser, John Reid, looks as if he is adopting the xenophobic policies of his cabinet colleague David Blunkett, in targeting what a health department press release yesterday labelled as "health cheats".

The story was leaked two days ahead of the official announcement, to make maximum capital out of it at a slow news time. But this latest piece of government spin whirred rapidly out of control when doctors and opposition politicians rounded on ministers for taking cheap shots at a vulnerable group - foreigners - without any substantive evidence of abuse or hope of significant gain.

There is little doubt that some foreigners do abuse the NHS - not only immigrants from poorer parts of the world but also refugees from countries such as the US who cannot meet ruinous health insurance charges. Another example described yesterday involved a Greek couple with a two-year-old child seriously ill with heart disease who caught a flight to London and promptly got their child admitted to hospital for treatment. They made no secret of their intentions and demanded free treatment as of right.

Cases such as this angered some London consultants who raised their concerns in the media six months ago. Some claimed that as much as 70 per cent of their work was taken up by freeloading foreigners, but subsequent investigations by the NHS Confederation found this to be a wild exaggeration.

Nonetheless the claims hit a political nerve and at the end of July ministers announced a three month consultation on proposed new checks on eligibility for NHS treatment. Yesterday, the Government claimed the results of the consultation showed broad support for its plans, and draft regulations will now be laid before Parliament for implementation from April.

The Conservatives, who last summer demanded a crackdown of the kind the Government announced this week, now complain it is too late. The British Medical Association also supported the moves in the summer but has since had second thoughts about their practicality, complaining that it is "not the role of doctors to be agents of the state in policing eligibility for healthcare."

The most baffling aspect of the episode is that the new policy to curb the abuse of the NHS is being introduced without any clear idea of how extensive the abuse is, what it will cost or what the damage may be to race relations, to the doctor/patient relationship, or to the reputation of the NHS as a service that offers treatment to all who need it without first checking their credit card balance.

Mr Reid, the Health secretary, did not dispute a figure of £200m put to him as the estimated cost. That estimate was apparently based on research in two London trusts, which came up with a figure of £50m to £200m each year across the NHS. One of the trusts - Newham - has since cast doubt on the accuracy by disclosing the costs over a three month period were just £32,000 - rather less than the £1m a year it was said to cost the trust.

In the face of these figures it is difficult to disagree with Dr Borman of the BMA who accused the Government of taking a sledgehammer to crack a nut. The Department of Health claims there should be no extra paperwork involved in making the checks - only a more thorough application of residency tests and other measures that should already be in place.

John Hutton, a Health minister, cornered on the Today programme yesterday when it emerged just how slender the Government's evidence was on the costs of treating ineligible foreigners, later played down the importance of cost savings and focused instead on the need for fairness. "The NHS is there to provide free treatment for those who live here, not those who don't," he said, adding: "Irrespective of the financial scale of abuse, it is important we establish a closer link between free use of the NHS and residency in the UK."

This is easy to say but a lot more difficult to implement. And if, as the NHS Confederation argues, this is about ensuring every pound spent on the NHS is correctly spent then there are many other areas likely to yield greater savings.

To take one example, there is a huge variation between the treatment ordered by different consultants with many operations and much other treatment regarded as unnecessary. Yet little work is going on into clinical variability. Perhaps that should not surprise us. For ministers it is much easier to have a go at foreigners than to beat hospital consultants into submission.

j.laurance@independent.co.uk

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