The British Medical Association is one of the most effective trade unions in existence. It might prefer to think of itself as a professional body rather than a union, and its chairman, Dr Mark Porter, does not look or sound like Len McCluskey, but it fights for its members with the same single-mindedness of any obstinate shop steward.
So when there is a sequence of motions on the agenda of a BMA Annual Representative Meeting protesting that doctors should not have to do something that the Government wants them to do, a natural first reaction is to assume this is a union putting the sectional interests of its members before the good of the public. It has happened before.
The issue in this case concerns the working of the 2014 Immigration Act, which was intended to lay to rest fears that the NHS is being abused by migrants who come to the UK as health tourists to take advantage of free treatment. The law, which came into effect in April, stipulates that people from outside Europe, Australia or New Zealand should be required to prove that they are entitled to free healthcare, and to pay for it if they are not.
In this way, the Government hopes to raise about £500m a year towards the cost of running the NHS, and at the same time deter economic migrants and maybe catch a few who are here when they should not be.
But the Home Office is not proposing to station an immigration officer in every doctor’s surgery or accident and emergency department to check every patient’s status. It wants NHS staff to do the job.
That is what has provoked objections from BMA divisions in London and Manchester. The Tower Hamlets division wants the BMA to tell its members not to get involved in the question of whether their patients have a right to free treatment, and to undertake to protect any doctor who runs into trouble for arranging free treatment for a patient who was not entitled to it.
The Manchester and Salford division wants the BMA to go a step further and enlist other health unions and professional bodies in an NHS-wide boycott. The Waltham Forest division, less controversially, is “amazed” that GPs are being asked to shoulder this responsibility and wants the Government to think again.
This is one of those cases where what a trade union is demanding in its members’ interest is also right for ethical reasons. This is not simply a matter of doctors being asked to do a bit of extra work to help the Government root out illegal immigrants. It threatens the doctor-patient relationship, and will have a particularly severe impact in places like Tower Hamlets, where the population is made up mostly of immigrants or the children of immigrants, and where there is poverty and social deprivation.
Consider the case of someone who comes into the doctor’s surgery with a contagious disease, who is not white and might be a recent arrival from Asia or Africa. It is in the interests of public health – let alone the patient’s interest – that the doctor makes sure the patient is given appropriate treatment. Worrying about the person’s status and about who is going to pay can come later.
The Health Secretary, Jeremy Hunt, is right when he says that the NHS is a national health service, not an international health service. It is right that the NHS should recover the cost of treating non-nationals where possible, but leave the doctors and other health professionals out of it. They have a far more important job to do.