Who should be eligible for NHS care?


         The government aims to legislate and change the administrative arrangements governing the rights of visitors, recently arrived people and illegal migrants to health care on the NHS.  They are currently consulting on what changes they should make, so your views are particularly relevant on this issue whilst the government is making up its mind on the detail.

          The government believes that there should still be an entitlement to free emergency care if a visitor, recent migrant or an illegal migrant is caught in a bad accident or develops a serious condition that needs rapid treatment. The issues to be settled are what entitlement if any do these categories of people have to the rest of  NHS care.

           If someone comes to work or stay here for a longer time period on a legal visa they currently can register with a GP for free primary care. If a visitor needs GP care during a shorter visit they too can currently onbtain free care from a GP. A visitor is not meant to receive free hospital treatment for anything other than an emergency whilst staying here. They can obtain health insurance or pay cash for any treatment they do want in a UK hospital, or wait until they return home.

          People exercising their right to work here under EU movement of labour rules qualify for free treatment like all UK citizens. The NHS is meant to cross charge the country they have come from for the treatment offered.  

          The government has suggested charging other new arrivals £200 as an initial payment or contribution to NHS costs, to be followed by a continuation of current practice of free treatment thereafter.

          Is this a sufficient levy and a fair approach, covering people like students and short term workers coming to the UK with a visa? Should temporary residents qualify for free GP care? Should hospitals have to take more care over charging people from 0verseas receiving treatment? How far should we go to ensure that we are running a National Health Service, rather than a World Health Service?

           I see this morning’s papers are full of news of high death rates and poor performance by a number of NHS hospitals. What should the government do about that?




  1. Nina Andreeva
    July 14, 2013

    You need to get “back to basics” on this one and wind back the welfare state back to what it was intended to be i.e. a form of social insurance. So if you do not have a complete NI record, sorry there is no hand out for you. Everything should be contribution based only.

    With regard to “health tourists” you also need to stop the idea of the “anchor baby”. In that the mother flies in just before she is due to give birth and because of her condition cannot be turned back. The child is born in the UK and qualifies for citizenship giving both of them a key to all the goodies the welfare state says they are then entitled too.

    1. Jerry
      July 15, 2013

      @Nina Andreeva: “So if you do not have a complete NI record, sorry there is no hand out for you.

      Well first that would also mean winding back the “socail state” too, no more sexual equality, otherwise there is going to be a lot of woman (who have taken time away from the workplace to have, raise and care for family) who have little prospect of either NHS care or a pension if they6 are not covered on their hubbies contributions. Also what about all those who have taken jobs outside of the UK but then to return? Sorry Nina you really haven’t though this all through…

      1. David Price
        July 15, 2013

        Contribution based social insurance should certainly be the starting point and basis rather than the current approach which strives to be a world health/welfare service and damn the taxpayer.

        Thinking that the latter can be achieved and maintained independent of the ability to fund it is unrealistic and hasn’t been thought through at all …

        1. uanime5
          July 15, 2013

          By your logic people who work minimum wage jobs won’t be entitled to healthcare or welfare because they won’t have contributed enough to be able to afford any treatment.

          Until the UK has the employment rate and GDP per capita of Switzerland a contribution based system isn’t viable.

          1. David Price
            July 16, 2013

            Logic is wasted on you.

            What I said was that contribution should be the basis and starting point so, for example, if someone has contributed to the economy but not at a level that attracts NI payments then they would be eligible.

            Your approach that anyone and everyone from absolutely anywhere should be treated at no charge at all, as appears to be the case now, is not viable.

          2. David Price
            July 16, 2013

            Are you even aware of NI credits?

            Do you even live and work in this country?

        2. Jerry
          July 15, 2013

          @David Price: Compared to how many totally legitimate cases the NHS deals with the abuse you cite is a mere dot on a page in the book dealing with the history of the British nation since 1066 – I’m not defending the abuse, just suggesting we don’t start throwing babies out with the bath water.

          How would one class a adult man or woman of 18, they hold UK citizenship (and passport) but have only just entered the country after a childhood of living elsewhere, the persons parents do not have a very good UK contribution record because their work took them abroad outside of UK contribution whilst they do have medical insurance in the country they reside, would such a 18 year old be refused free NHS treatment because they do not have any NI record themselves and their parents have little, would they have their parents medical insurance charged, would they have to obtain their own medical insurance?

          1. David Price
            July 16, 2013

            Now you are asking the right questions … much better than the situation where no-one wonders whether someone has any eligibility at all.

            I don’t claim to have the answers but I believe elibility must have a clear and straightforward basis.

          2. Chris S
            July 16, 2013

            It’s simple : anyone working abroad and has made three years NI contributions before they leave can make voluntary contributions why working abroad. I worked abroad for 5 years and did this to maintain my state pension and NHS rights.

            National INSURANCE should be just that :

            You pay premiums and get benefits if and when you need them. Some people like non-working mothers with children have their contribution record maintained while the children are in school. Similarly, if you earn less that the minimum for NI Contributions you get credits.

            Everyone coming here should be required to have medical insurance including immigrants applying to live here.

            If you aren’t insured, you don’t get treated, it’s as simple as that. The odd emergency has to be covered but the money owed needs to be vigorously pursued.

            If someone is visiting relatives then the relatives should be responsible if the patient doesn’t pay up.

            We’ve been a soft touch for far too long.

      2. Chris S
        July 15, 2013

        Jerry, I’m sorry, but you are not correct on this :

        A woman bringing up children is given credits for the number of years she is not in employment while they are of school age. She therefore is not disadvantaged.

        Anyone who works outside the EU can pay voluntary contributions to maintain their NI record, as I did.

        I believe that working within the EU maintains your NI record although I’m not certain of this. In any case they can always pay the same voluntary contributions which are inexpensive.

        Nina is absolutely right on the matter of reverting to a proper form of social insurance rather than just writing a blank cheque for every one who comes here.

        Many will have heard Ian Duncan Smith’s excellent and robust performance this morning on the today program about capping of benefits.

        (Goes on to criticise one individual claiming benefits ed)
        The huge increase in immigration into this crowded island from both outside and within the EU was the responsibility of the last Labour government who failed to put any controls in place.

        Someone should be asking Tony Blair, Gordon Brown and Ed Milliband how they expect us to continue to pay for all this ?

        The sums simply don’t add up.

    2. Iain Gill
      July 15, 2013

      actually being born here no longer entitles you on its own to British citizenship like it still does in the USA. although in practise you will never get thrown out. I believe this is correct, and even more babies here should not be entitled to citizenship. citizenship is precious and we dilute it too much by giving it away too freely.

      1. Jerry
        July 15, 2013

        @Lifelogic: People might not want the USA health care system but if the free market ideology is taken to its logical conclusion that is exactly what we will get if people are allowed to start chipping away at the foundations of the NHS. Basically, be very careful of what one wishes for, because one might not get what was intend – remember – no one intended to create the disaster that has turned out to be the NHS Trusts either…

        1. Jerry
          July 15, 2013

          Sorry, that was intended to be a reply to Lifelogic’s reply to Nina below.

    3. bigneil
      July 20, 2013

      agree that the anchor baby is a big problem – -also used by asylum seekers as a ticket to stay – – – -and £200 – -so if they know they have a massive problem they can come here – pay – -knowing it is going to cost us thousands ?? – -or am I misunderstanding this point?? – -if I am right then doesn’t it entitle millions to full care for a pittance? – -we clearly cannot treat the whole world – but some people seem to think we can.

  2. Nina Andreeva
    July 14, 2013

    Incidentally here is a bit of research from Goldman Sachs showing the cost of an appendectomy. As you can see the two hundred pound bond would not even cover a simple procedure such as this. It also shows the anti NHS headbangers just how expensive the US model is that they would like to get into and that the NHS is not inefficient in comparison to the other European health services. Oh and by the way remember trial lawyers in America make a very good living out of malpractice work. So if you can afford the insurance you still have no guarantee that the surgeon will not saw the wrong leg off

    1. lifelogic
      July 15, 2013

      No one sensible is suggesting the US system is the aim, there are far better health systems. The last thing we need is more Lawyers.

  3. lifelogic
    July 14, 2013

    They should charge everyone (able to afford it) something. Even for emergency treatments they should charge the going rate. They should clearly not refuse emergency treatments at the time, but this is no reason not to chase payment later.

    The full charge for anyone not paying NI for a substantial time and a small charge should also be made for UK tax payers too. Only where they really do not have the money should they escape the charge. Anyone who can afford to pay for haircuts and runs a car can clearly afford to pay for all but the most expensive treatments.

    They should give tax relief on private medical insurance premiums too, as it takes the pressure off the NHS and encourages alternatives & competition. There should be many private GPs too but this will not happen much when the NHS (subsidised & unfair) competition is free. The same applies to social housing, energy generation, prescriptions and other areas the government chooses to distort the market with the usual negative effects.

    This would have the effect of establishing proper competition and alternatives to the often appalling NHS. Paying customers with other options would demand a proper service from the NHS instead of the take it or leave it and you just have to wait 4 hours attitude currently prevalent. We have your money already so rationing, poor service and inconvenience at the point of use is what the NHS does to control demand.

    1. uanime5
      July 15, 2013

      Given that most medical treatments cost vastly more than a haircut it’s ridiculous to use this as a measure for what is affordable. Trying to get the full charge from someone who hasn’t paid NI for a substantial period of time is equally daft because if you haven’t worked in years you’re unlikely to have any money.

      Tax relief on private medical insurance premiums will just end up costing the NHS more in the long run. It will not increase competition as it will be beneficial for NHS hospitals if all their patients go private because it will reduce the NHS hospitals’ budget costs.

      All GPs are private practitioners who sell their services to the NHS. So it would be difficult to have more private GPs.

      Unsure about private prescriptions as this may allow people to legally buy narcotics, such as morphine.

      In the past there used to be local alternatives in the NHS but this was expensive, so Governments closed down local hospitals and made everyone go to the one central hospital.

    2. Bazman
      July 16, 2013

      What you find is that peole with contagious diseases would be unwilling to pay and many others would put off treatment until it was to late and how do you pay for treatment when you are to ill to work lifhgic? They would often spend the money on a child needing treatment before themselves too. Cars and haircuts are usually paid for by work and most just live from one pay packet to the next with the repo man not far behind them.Do you think that millions have got spare cash just waiting to be spent? How ‘absurd’.

  4. M Davis
    July 14, 2013

    All visitors who have not paid into the system should have health insurance. £200 is so small as to be derisory! As to poor performance and care in NHS hospitals and other NHS places of care, people should be sacked and especially those in charge at the top with obscene salaries.

    There is another scandal waiting to come out, in the County I live in.

  5. lifelogic
    July 14, 2013

    More trouble in Ireland thanks to the religious cleavages in society. Maintained as they are by government funding of faith schools and preferential places for religious leaders in government. When will the government stop exacerbating and incubating these divisions and problems all over the country? Should it be allowed for young & immature minds to be systematically indoctrinated in “belief systems” and cleavages in society in this way at all?

    1. Jerry
      July 15, 2013

      @Lifelogic: Most the the beliefs you talk about are being handed down from (grand)parent to child, not from within the schools or even church -both of which tend to be a lot more measured than you think, just as your political views will have been formed out of your parents, had your parents been of the hard left you would be ranting way on the “Red Blogs” rather than the Blue Blogs – so unless you are suggesting that these children are taken into care…

      1. lifelogic
        July 15, 2013

        My father as it happens is of the left and my mother quite middle of the road. My politics come from observing what works and applying logic. On education I am merely suggesting that the state should not give taxes to fund, and thus augment, religious cleavages in society as it often ends badly.

        1. Jerry
          July 15, 2013

          @Lifelogic: You do many things but you all to often do NOT apply any logic! 🙂

          1. lifelogic
            July 15, 2013

            Then just point out, logically and rationally, anywhere you think my logic errs – rather than just making such empty claims.

          2. Hope
            July 15, 2013

            Well said life logic. Some of us agree with you. Cameron is dead int he water. Tories should have woken up to that after the first dozen or so Uturns, or his actions in contrast to his claims of being Eurosceptic. No believes him or trusts him. And he still continues to insult Tory supporters.

          3. Jerry
            July 16, 2013

            @Lifelogic: Indeed many try but you tend to just shout louder that it is correct ‘cos you think it is correct – no one is a Doctor just because they claim to be a Doctor!

            @Hope: Indeed but one doesn’t have to be in agreement with LL to think that…

  6. English Pensioner
    July 14, 2013

    Certainly £200 is insufficient. We all think of Europeans and third world visitors, but a friend working at a hospital near Heathrow says the get Americans with serious heart conditions who fly here deliberately for treatment as they don’t have appropriate insurance at home. The airfare is cheaper than the US hospital charges and another £200 wouldn’t make much difference.
    I also suspect that a pregnant woman coming here from most places might find £200 a reasonable fee to pay for childbirth and any treatment, and her child would get British citizenship as well!

  7. RobertK
    July 14, 2013

    When an overseas visitor needs to buy food there is no question of UK taxpayers having to foot the bill. If they face a disaster like a car crash there is no suggestion that the taxpayer should pay for the repair bills. What is so problematic about telling visitors that they cannot help themselves to healthcare without regard to cost? If I travel to the US I have to take out insurance or face bankruptcy if I fall seriously ill.

    1. Jerry
      July 15, 2013

      @RobertK: That says far more about the USA health care system than it does the UK’s health care system, even citizens of the USA have face bankruptcy or perhaps simply curl up and die…

  8. colliemum
    July 14, 2013

    I think it is time to stop regarding all who come here as charity cases who are entitled to free health care.
    I well remember the times when you couldn’t travel to the USA unless you had proof that you had a huge health insurance and that you were free of contagious diseases. It shouldn’t be difficult to institute similar legal requirements here. After all, if you’re rich enough to fly here from e.g. Nigeria, you are rich enough to afford personal health insurance!

    A down-payment of £200 is absolutely ludicrous in face of the sums we are paying as NI contributions. If the Government thinks this is a way to go, make it £2000 to be more equitable.

    Regarding the EU immigrants – it is surely proper to give the NHS management a proper kick up their collective backsides and force them to collect the money due to the NHS.

    Btw – how come immigrants are apparently able to access GPs because of health ’emergencies’ when we natives have to wait 2 weeks for appointments?

  9. Leslie Singleton
    July 14, 2013

    For what it is worth, I well remember trying and failing to explain to a visiting American how and why the NHS is “free”. A very bright chap, he was nevertheless flummoxed and in due course explained in his turn, and vehemently, that “If I or a member of my family get sick and need treatment by a doctor I want to pay him”……….understood of course being “because that way I can sue him if need be”.

    Again for what worth, I had to go to hospital in America for a minor emergency and despite being a foreigner to them I was treated immediately and without question………and only later sent a bill (which I of course paid).

    1. margaret brandreth-j
      July 16, 2013

      Talk about lack of understanding. The NHS is not free, we all pay for it and support those who are not able to support themselves. I refused recently to write a script out for someone for paracetamol saying that the problem did not warrant a script (which still has to be paid for ) when Tesco and other supermarkets were selling paracetamol at 15p-19p. The reply was “you don’t pay for it, so what are you worrying about” Why can’t people perform this simple exercise of thinking individual and then building every individual into a collection of individuals , who make up the whole. It is not logic, as logic is actually mostly a metaphysical feat in that it needs to be exactly reversed. Even identical twins are not truly identical and cannot be truly changed around.

  10. alan jutson
    July 14, 2013

    “Who should be eligible for NHS care”

    The short answer is those who are or who have, paid for it.

    Clearly children do not pay, so they should qualify under their parents rights until a sensible age (probably 21 years of age after further education).

    All others should be charged, be it cross country (as should be the case now) in the case of visitors, or by direct charging to the user before they leave (retain Passport).

    I see absolutely no reason why people already here, should not have to prove (National Insurance number) that they are in the system before they receive treatment.

    Clearly visitiors from abroad if there is no cross charging agreement with their Country, should be able to prove medical health cover before being allowed into the Country.
    The £200 fee suggested is a joke sum, as this is a lower cost than insurance cover.

    So perhaps we should fix the figure at a more sensible level, and call it Medical Insurance cover which would be compulsary and paid for at the point of entry.
    No need for a complicated scheme’s with a huge number odf employees., why not use machines as currently exist at most airports which are available for travel insurance.
    Travel insurance shown with passport to immigration control on entry.

    Why would someone who is just visiting want to pre register with a Doctor for possible health treatment ?
    I think this needs to be looked at rather more closely.

    Think the above is too harsh, then try to get free medical treatment anywhere abroad without going through a number of hoops first.
    In many cases it is pay first, claim back later.

  11. alan jutson
    July 14, 2013

    “Problems with the NHS”.

    First of all we all have to recognise and accept that there is a real problem, if that is the case.
    Thus we must have the will to want to correct it, and not just bury bad news as well as patients.

    Clearly anyone who has been in Hospital or been an outpatient knows that the NHS is not the most efficient organisation in the World, and works other than for those who are already on a ward, from 8.00-5.00 Monday to Friday with the exception of A&E for emergency admissions.

    So how to improve, because most of us are available at other times apart from 8.00am – 5.00pm.
    Why not operate a split shift system for outpatients from 6.00am – 8.00pm or work a 7 day week instead of 5.
    Yes it would need more Doctors and Nurses which is an extra cost, but at least the buildings and theatres would be used to their maximum, rather than stay unused.

    In private industry overtime is the most profitable form of working because all fixed overheads are calculated and paid for over 40 hours, only the variable overhead is the added cost.

    Advantages of working longer hours or weekends for outpatients would mean, less crowded waiting areas/car parks, less time needed off of work, more patients seen more quickly so waiting times reduced.
    It may also mean that patients could spend a little more time with Doctors, rather than simply being rushed through the system.

    In recent years we seem to have had Hospitals pride themselves on cutting bed numbers, I have never understood this form of action, as it means higher bed use, more chance of infection (almost hot bedding) and less flexibility in the system for availability.

    Many many more points could be made, but working efficiently, effectively for each patients needs should be the key.

  12. JoolsB
    July 14, 2013

    The UK Government including it’s Scottish & Welsh MPs cannot enforce this policy or any other policy on UK hospitals as health is devolved. The UK Government, as in most other matters, can only determine policy for hospitals in ENGLAND so why not say the NHS in England?

    Unlike England, the Scots, Welsh & NI are allowed their own legislatures to make their own decisions on health as they do on most matters nowadays.

  13. Andyvan
    July 14, 2013

    In response to high death rates and poor performance by NHS hospitals the government should do exactly as they would if it were a private company, scream and shout, hold press conferences, call the police in to prosecute and nationalize the hospital- oh hang on it’s because they’re nationalized that they have high death rates and poor performance isn’t it?

  14. Kenneth
    July 14, 2013

    The NHS is not geared up collect fees.

    The answer is simple and that is a bond payable on entry to the UK for all incomers with no UK passport. I would suggest £30,000. This will be refundable when they leave the UK. Collective schemes would take care of funding this bond for tourism and other short term stays.

    All the hospital/doctor would need to do is mark their visa with the treatment that was carried out and this would be deducted from their refund.

    Anyone with no visa and no proof of UK citizenship would be treated in an emergency but the hospital/doctor will be obliged to call the police (or whoever deals with illegal immigration these days). I presume this bit happens already.

    The principle is up-front payment by using bonds and the totting up to be done by the customs people. This allows the doctors and nurses to concentrate on doing what they do best.

    I am sure bonds will also solve our immigration problem overnight.

    As far as death rates etc are concerned what we need is to find a way of calibrating performance.

    The BBC’s and Labour’s favourite measure is to simply measure how much is spent on the NHS, despite this being a mindless way of doing it.

    On many measures the NHS performed very well during Mrs Thatcher’s tenure, though the media coverage tended to put forward the opposite view.

    We need to bring together death rates/longevity under care; quality of life under care; fully discharge rates (back to health), etc etc in order to come up with some calibration which will elevate the debate above the current level of mud-slinging and media posturing.

  15. Timaction
    July 14, 2013

    Politicians should consider health care costs as if they were paying them themselves for foreign people. Then they might start to get it right instead of taxing me and others to pay for it. All new arrivals except the EU citizens should have health insurance or pay for private care. This should include students as why should we subsidise their health care whilst further education establishments profit from their courses? £200 follows on from the stupidity of Hazel Blears and her £50 recovery costs! This should be for a minimum of 5 years when they should have returned home if immigration rules were beefed up to stop abuse. Education should also be charged for these people if they have children. Again why should the indigenous population be paying for foreign children? 20% of our school population (50% in London, do not have English as their first language). All EU citizens should have their health care costs reimbursed from its member states at our rates so it won’t act as a pull for poorer EU countries (Romania/Bulgaria are coming in January). Why do we want to give A&E free when we know that is the first port of call for illegal immigrants who haven’t registered with a GP? Insurance and recharging should apply as well. I am fed up with being grossly over taxed to pay for all things foreign whether it be foreign aid, health, housing, the EU, education and other public service costs provided free by our Government. 3 years in office and just starting to consult seems ridiculous to me and can’t be taken seriously. I have a feeling that immigration, public service costs and the looming EU elections next year are the real wake up call to the LibLabCons.

  16. Terry
    July 14, 2013

    I would have thought the easiest and most efficient way to establish a firm free health policy, is to compare those in operation in other countries around the world. That would reveal the features most appropriate for our own NHS. But allow the Private Sector to do the research. The Public Sector takes far too long and spends far too much to do anything – which is why we have this problem in the first place.

  17. Jerry
    July 14, 2013

    “I see this morning’s papers are full of news of high death rates and poor performance by a number of NHS hospitals. What should the government do about that?

    Fund the NHS properly by scarping the worse than useless management structures, scraping the pen-pushing Trusts and internal markets etc. How about get a few of the people who the media have been interviewing about their Careers or or otherwise at the birth of the NHS to run it, perhaps clone William Beveridge?…

  18. lifelogic
    July 14, 2013

    Listening to Ed Davy on the Sunday politics just now, interviewed by Andrew Neil (perhaps the only decent & balanced political interviewer the BBC has) one has to conclude that Davy is just deranged, and in the grip of a mad religion. He should not be put in charge of so much as a whelk store, let alone the wasting of £20 Billion PA of others money. Oxford PPE again I note, no science or logic as usual with these people.

    He now seems now to think the £20 Billion PA is an “insurance policy” even if the “proven science” proved to be bogus exaggerated rubbish. Much drivel about biomass, carbon capture, wind, battery storage of electricity, wave, PV, hydrogen, hydro ………….all economic nonsense with current technology. Cameron surely needs to sack him now but Cameron is hooked on the daft religion too. Either that or he foolishly & cynically thinks there are votes in it.

    1. Bazman
      July 16, 2013

      Clean energy is a must for the future as China and the dirt of London proves. Are you against clean and efficient energy? This will produce low CO2 emissions by default. Green is not very green and this is the crux of the problem. You would just abandon this like powered flight was years ago until one day it worked. Not very well for sure, but still worked.

  19. Patryk
    July 14, 2013

    The only way forward is contributory system. If you work, you pay National Insurance, you get “free” treatment. If you don’t contribute, you must pay insurance. Regardless of nationality. Simple.

    1. uanime5
      July 15, 2013

      That would deprive anyone working in a minimum wage job of healthcare because their contributions would be negligible. It would also mean that people who don’t earn enough to pay NI would also be denied healthcare.

  20. behindthefrogs
    July 14, 2013

    We need to ensure that any treatment under EU arrangements is crosscharged to the appropriate health authority. This should be based on presentation of a green card and include GP treatment. Where no green card is available, and no NI number is available, either an insurance certificate or a cash payment should be required, as for people from outside the EU. Except in an emergency this should be prior to treatment.

    The £200 levy that would cover access to GPs and emergency treatment is good idea, but it should only be applicable for the time of a visa.

    GPs and hospitals should be encouraged to collect these fees as they will generate income outside what they normally receive from the NHS.

  21. Iain Gill
    July 14, 2013

    No 200 pounds is not enough. Especially for some groups who tend to come here when they are already ill and in need of an operation etc, they are disproportionately likely to need expensive treatment.

    My view is free treatment should go to:

    1 British citizens, regardless of whether they have been out of the country a lot recently or not

    2 Anyone with indefinite leave to remain (Although I would be happy to see ILR removed from some groups)

    3 Children born here while they are still children if they are not entitled to British Citizenship.

    4 Anyone married to a British Citizen, during the period after the marriage before they are entitled to ILR.

    5 Anyone here already and seriously ill before you introduce these new rules.

    6 Anyone who is a national of country which provides reciprocal care to a British citizen in similar circumstances.

    Everyone else should have to pay full commercial medical insurance rate before they are granted a visa, for many especially the already seriously ill it will be a lot more than 200 quid. However for stuff that’s basically not insurable such as insulin dependant diabetics, and where in the UK there is basically no care available except through the NHS, then it needs to remain affordable for folk to visit this country, so some special payment maybe before visa is granted.

    Once people are here don’t deny treatment. However large numbers of people should be getting kicked out of the country and I seriously question why this is not being done, and much fewer people should be entitled to certain visas such as work visas. Strictly restrict the numbers of family members allowed in, etc.
    Re “Is this a sufficient levy and a fair approach” no as above.
    Re “covering people like students and short term workers coming to the UK with a visa?” no as above
    Re “Should temporary residents qualify for free GP care?” no their medical insurance should be paying unless covered by above criteria.
    Re “Should hospitals have to take more care over charging people from 0verseas receiving treatment?” very definitely.
    Re “How far should we go to ensure that we are running a National Health Service, rather than a World Health Service?” put the emphasis on not giving visas to come here if they don’t have full medical insurance rather than stopping treatment once they are here.
    Re “I see this morning’s papers are full of news of high death rates and poor performance by a number of NHS hospitals. What should the government do about that?” turn the NHS into a state backed medical insurance scheme, people pay in according to ability and get out according to need, but get the state out of owning and running providers of care, and let each individual patient take his medical insurance payout cheque to any provider they choose. Don’t reinvent the wheel just copy the best of the rest of the world such as New Zealand or Belgium.

  22. Nick
    July 14, 2013

    Entitlement to free treatment?

    No. They are clearly entitled to treatment on moral grounds. If you are run over, you get treated – no questions.

    However, after the treatment, again on moral grounds, you should pay for it. That either means stumping up the cash, or having insurance to pay for it.

    The government has suggested charging other new arrivals £200 as an initial payment or contribution to NHS costs

    How racist can you be?

    I can hear it now. It’s not racist. But it is.

    http://www.ukpublicspending.co.uk/ 130.2 bn a year spent on the NHS, for 63 million. That works out to 2,066 pounds a year.

    And what do you propose charging foreigners? 200 quid.

    It’s racist because you are charging British people more.

    I see this morning’s papers are full of news of high death rates and poor performance by a number of NHS hospitals. What should the government do about that?

    How about some prosecutions for killing people?

    1. Jerry
      July 15, 2013

      @Nick: “How about some prosecutions for killing people?

      First one would have to prove that the patient would not have dies anyway, all you are proposing is for doctors not to even attempt to save a life.

      As an aside, I was once told by a first-aid trainer from one of the well known voluntary first-aid charity that unless one is covered by suitable indemnity insurance to just pass-by on the other side if one comes across a injured person, even if there is risk of death, the patient or relatives can’t sue for non treatment but can for bad or inappropriate treatment – things would get even crazier if medical staff could be prosecuted for manslaughter for simply doing their best.

  23. Anonymous
    July 14, 2013

    ‘Free’ to everyone… except UK taxpayers who pay a fortune for it !

    1. lifelogic
      July 15, 2013


    2. Jerry
      July 15, 2013

      @Anonymous: I think you mean those whop pay tax in the UK, think about it, there is a subtle difference…

    3. Bazman
      July 16, 2013

      £18 a week for the taxpayer on 25k a year according to HMRC. Not bad and if you are an employer you benefit by having the state pay for your employees medical bills and keeping them fit. If you are just rich them we live in a democracy and pay you will.

  24. Rods
    July 14, 2013

    I agree emergency treatment after an accident should always be given first and then worrying about the recovery of the cost afterwards. If they are non-UK and non-EU citizens here on a short visit or temporary visa then the cost of treatment should be recovered. If this means court action and bankruptcy in the country they come from so be it. A few well publicised cases would show the moral hazard in not spending what is relatively small amount on basic medical cover travel insurance compared to the cost of the flights, accommodation and spending money. If the courts in a country are not prepared to enforce this, then the person proving they have minimum medical travel insurance from a reputable insurance company should be enforced as part of the visa application process. People that arrive from non-EU countries where visas are not required should provide proof of medical insurance or be forced to purchase it at an office in the airport before they are allowed into the country. Ukraine operates a system where if you take your car into the country, you have to purchase insurance against 3rd party damage before you are let through the border. You can purchase it from immigration at a higher price of from one of a number of agents before you go through the border, so these sort of systems can be set up and enforced. I personally disagree with the across the board £200 as all you are doing is discouraging business meetings and tourism. This should be the minimum insurance cost (or more if they are in a senior age group and / or have pre-existing conditions that are a greater risk) from immigration if they choose to buy their medical insurance at the point of entry rather than beforehand. I’m sure visitors will quickly realise it is much cheaper to purchase the insurance beforehand. I do a lot of web development work in the insurance industry, so I have a good insiders view of travel and some other types of insurance, risk calculation and FCA compliance.

    Pregnant women should always be treated, but if they are from abroad then the same rules should apply as for emergency treatment above.

    Non-emergency treatment should always be charged.

    Long term students and migrant workers and visitors could also be included in the above system. Spouses is an awkward one where if they are not working and paying NI, they should gain a full entitlement once they have full residency, but would be required to have medical insurance as part of their visa application for temporary residency.

    The last Government to try and discourage open house mass immigration where they realised it was a vote losing political issue, by significantly increased visa fees and other countries have retaliated by raising their fees for UK visitors, I know this from where the Ukraine have done this. This is bad for bilateral trade, tourism, student exchange, education research and overseas work experience. The UK is a trading global nation as this is another and not insignificant fee when trying to do business abroad, especially if it entails setting up a local office with UK management.

    If you want to get the National Health System back to this from what at the moment IMHO is (not delivering the good quality care needed sufficiently ed), then there is a very simple step you can take. Keep it free at the point of entry, but like the French system, the National Health Fund would only pay the hospital public or private for treatment given at pre-agreed rates. You would like the French have a choice so you could choose your hospital for treatment and would avoid the bad ones. The French system costs about the same percentage of GDP as the UK, but is much better on quality of treatment and outcomes. Until you establish the link between customer and payment then you will continue to misallocate capital by central planning committees setting budgets instead of the money flowing to where it is needed. You can have as many 5 year tractor plans as you like with targets, but it will make no difference to the quality and cost of treatment as the NHS managers and staff aren’t stupid, they will play the system to provide the correct statistics and at the same time make they NHS even more inefficient. An example is somebody I know was getting the runaround for a chronic back problem that need injections or an operation. When he asked, why do I keep being sent to different doctors for second opinions, the consultant replied, because we do not have the budget until next year for your treatment, but we have to show that you are receiving further treatment in ‘n’ days as part of the hospital statistics! Yes the BBC, unions and other people would squeal where they try to protect their vested interests, but electoral fortune favours the brave as Margaret Thatcher showed and to me one of politicians fundamental jobs should be to protect the public from from public and private monopolies and vested interests.

    Going slightly off-topic on the unions funding of the Labour party through the political levy. One of the reasons why a Labour government always have and always will increase public spending to the point of potentially bankrupting the country is that there is a positive financial feedback loop. But increasing the heavily unionised public sector workforce, so the number of union members and the funds they get from the political levy increases, so giving them more funds to increase their chances of electoral success. There is also the problem where they are being paid by the poacher while being the gamekeeper when it comes to the management of pay, terms and conditions in the public sector. As Einstein said: “Insanity is doing the same thing again and again and expecting a different result.” So why do Labour voters expect each time they vote in a Labour government it will be different next time? If Milliband suggests public funding of political parties instead of the political levy then the nationalization of politics will be an even worse outcome! Political parties should rely on their funding from their popularity or not with donations from private individuals and companies. If they complain they cannot live on the money received, then they need to do like the rest of us have to by increasing productivity and doing more for less.

  25. Bert Young
    July 14, 2013

    A genuine visitor ought to be entitled to free GP/Hospital treatment – with the proviso that the costs are reclaimable from the visitor’s country ( particularly if from an EU country ). It should be a straightforward process to eliminate those “visitors” who are simply here to receive free treatment at a GP level .The question of poor records at certain hospitals is a tricky one . A couple of years ago I tackled a heart surgeon friend of mine from an outstanding training hospital on this question , he pointed out that he was prepared to take on the “no hopers” with the consequent risk of a seemingly “poor” record . He gave me evidence of a heart surgeon at a not so respected hospital who would not contemplate taking on such cases ( his record was in the top league ) . Well , I know who I would rather consult if confronted with a heart problem . League tables are extremely misleading and should be dustbinned ; a system of supervision administered by properly qualified specialists is the only way of determining whether someone else in the NHS is doing their job to the standards required . In those cases where evidence shows a performance is unsatisfactory , the system has to be empowered with suspension and dismissal conditions . The NHS is , by and large , a fine institution that provides the community with a level of service not matched anywhere else in the world . The central leadership is where a lot of its problems lie ; it should never be led by , so-called , business skills unless they are medically qualified . I cringe when I think of certain individuals who have been charged with its leadership in the past .

  26. Richard1
    July 14, 2013

    Does anyone reading know how it used to work before the NHS? Presumably foreigners who fell ill or suffered injury in the UK got treated. Let’s just go back to however it was pre-1948.

    On performance of the NHS, we need to recognize that the objective is to provide the most effective free healthcare according to need. Some of the structures in the current NHS, especially the lack of patient choice, don’t bring about that outcome. There also seems to be a dreadful culture of cover-up. Not surprising given responsibility for any mistakes seem to land on the minister’s table. Let’s have much more choice, competition, decentralization and delegation of authority.

    1. Jerry
      July 15, 2013

      @Richard1: Does anyone reading know how it used to work before the NHS? Presumably foreigners who fell ill or suffered injury in the UK got treated.”

      Yes, they paid for their treatment like everyone else…

      Let’s just go back to however it was pre-1948.

      No thanks.

      1. libertarian
        July 18, 2013

        They paid like everyone else? Really?

        Think you need to read a bit of history. After the introduction of the NHS in 1948 not one new hospital was built and no more Dr’s or Nurses were instantly hired.

        Prior to the NHS workers were treated free by hospitals and GP’s their families weren’t. However The Royal Free hospital and many other charities and religions ran free facilities. Municiple hospitals run by local councils were available for those with infectious, life threatening and long term illnesses and were free to use.

        I’m not suggesting that this was a better way of providing healthcare I’m just telling you it wasn’t totally as bad as people make out.

        Lots of people who did pay also got their fees reinbursed and it was this cashflow issue that caused the greatest problem. The benefit of the NHS was that it was and is free at the point of use.

        1. Jerry
          July 18, 2013

          @libertarian: Total Fantasy…

  27. Old Albion
    July 14, 2013

    Which NHS are you referring to?

  28. margaret brandreth-j
    July 14, 2013

    I think your article has said it all. £200 seems a reasonable cover for all those short term temporary residents. They have to register with a GP , have an initial assessment and then be prescribed all on going medication . Already more than £200 has been spent.
    I, as many other UK residents, have paid NI all my life , actually serve the clients in the NHS and use very little of the resource.
    The recent scandals of the high death rates must be taken on an individual basis.

  29. Acorn
    July 14, 2013

    Regarding your last paragraph, the government has put a lot of Quangos between it and the service “point of delivery”, so it always has someone, other than itself, to hang the blame on. Hence, if it insists on running everything; and, I mean, every little thing, from Downing Street and Whitehall; then the voters will automatically (cos they ain’t very bright), blame it on the Prime Minister of the day.

    Recently, it has been interesting to find that voters in my (ex) patch, see parliament as somewhat irrelevant. The country appears to be run by one man, (even constituency Tories are starting to call him El Presidente Cameron) and some other people whose names they can’t remember; except for a really fat guy called Pickles; like the characters in the children’s “Rugrats” television series.

    Otherwise, the NHS should introduce co-payment for starters. Say a few percent of the cost of any element of the service. Then gradually introduce a state operated insurance to cover a basic service of treatment. Say about £2000 worth a year (what it costs now). Then gradually move it all to an insurance based service with premium rates for five star service and no claims discounts for non use. JR likes discounts from public sector providers. 😉 .

  30. forthurst
    July 14, 2013

    “The government has suggested charging other new arrivals £200 as an initial payment or contribution to NHS costs, to be followed by a continuation of current practice of free treatment thereafter.”

    A nice round figure actuarially based, no doubt. Presumably, there will be a full medical examination, probably costing more than £200, to ensure that the NHS will not be treating HIV, and other blood born infections, tuberculosis, kidney failure, problematic pregnancy etc for that sum? Even if £200, hypothetically were an appropriate amount, is there any particular reason why the NHS should be so organised as to facilitate a world healthcare system? Bearing in mind the recently exposed gross failures in hospital care, which PRISM unaccountably has failed to uncover, would the NHS not be wiser to focus treatment on those patients who should be entitled to treatment?

    With regards to the recent exposures, to what extent has the GMC been sitting on evidence concerning dangerous practitioners? Should not the police be investigating possible cases of manslaughter and serious injury rather than the prior alleged gropings of dead and aged entertainers?

    Ultimately, the government has to take responsibility for what has gone wrong. Clearly, disallowing, as happened recently, newly qualified English medics from training posts in favour of those who are not English and were not trained here has meant the pool of potentially reliable medical staff has been deliberately shrunk (etc ed)

  31. uanime5
    July 14, 2013

    Given how many thousands of pounds non-EU students have to pay to study in the UK (higher rate tuition fees and living costs) a £200 contribution shouldn’t cause too many problems.

    Regarding poor hospital treatment I believe this was caused by hospital managers focusing more on Government targets than promoting patient welfare. The fact that the regulator covered this up to prevent themselves looking bad also didn’t help. I therefore recommend tougher penalties for NHS managers who sacrifice patient care to please politicians, along with punishment for politicians who come up with such poor systems. After all it’s hardly fair to blame managers for doing what politicians ordered them to do if they weren’t given an adequate budget.

    1. Kevin Dabson
      July 15, 2013

      I love how you are mentally calloused into negating the role of doctors and nurses in all this. It’s always the fault of NHS managers etc.

      As far as I am aware, it’s doctors and nurses that deal directly with patients and the horrendous conditions endured by patients in some of these hospitals not managers. As if these some of the medical staff never knew!

      Some of these people are very highly paid and should be sacked and struck off the register. As some people have already pointed out, their doesn’t seem to be any direct responsibility/accountabilty for medical staff and they are difficult to fire.


  32. NickW
    July 14, 2013

    In nearly every case of premature death through neglect, the patients had visitors who saw what was happening and were powerless to intervene.

    Now that GP practices are commissioning hospital services, they should be formally made responsible for receiving complaints about hospital care and instigating an investigation.

    Why and how have the relatives and friends of the victims been rendered so powerless to take any action to address patient abuse and serious neglect?

  33. zorro
    July 14, 2013

    I have previously posted the rules for obtaining ‘free’ NHS treatment. The current requirements are residency based rather than nationality based. For example, you could be a GBR citizen and have paid a lot of taxes, but if you left the UK and have no registered domicile when you come back, you are not entitled to ‘free’ NHS treatment. The requirements do need to be looked at to take account of a person’s contributions.

    In the case of the proposed £200 charge on visa applications for students initially (from my understanding)…. I think that this is a generous charge. One of my children recently studied in the USA for a year and was required to undertake medical insurance of several times that amount to qualify for entry. Part from her university and the rest had to be obtained from the receiving university. If students plan to study several years, it needs to be an annual charge. With respect to insurance for visitors, that should also be at the market rate. I pay yearly travel insurance which allows me to travel worldwide for a maximum of 30 days at a time. Visitors to the UK can stay up to six months so the appropriate risk should be factored into the cost.

    I wonder how much of this £200 fee will be caught up in bureaucracy rather than pay for treatment. In either case, the figure is far too low.


  34. Mark
    July 14, 2013

    Cross-charging other EU countries for welfare benefits might be an interesting approach to apply more generally than just health care. Perhaps if those countries had to pay the housing benefit bills etc. they might be less keen on encouraging their citizens to come here in the first place, and our budget would not be so strained.

    Logically, those who are granted indefinite leave to remain after their probationary year are accepted as taxpayers who should be given the same benefit as other long term residents. We probably need to be more selective about granting ILR, as Liam Fox has been suggesting – those who integrate getting priority, although it is hard to see that those who would pass a primary test on marriage should be excluded, even if their extended family is denied entry.

    Screening the health of people who come to the country on anything other than temporary short term visas as part of the visa process seems an obvious way to reduce the problems of those who come here intending to seek medical care on the NHS. Those who wish to come here to pay for care should be accepted provided their funding is adequate. Those who do not have an indefinite right of abode should have health insurance: that should probably be extended to the first year after return for British citizens who spend more than say three consecutive years abroad.

    It is important to break the myth that the NHS is a consistently wonderful organisation, but to do so in a way that doesn’t smack of party propaganda. In reviewing the recent history of NHS satisfaction polls it is notable that satisfaction fell sharply after the real extent of the Stafford scandal started to become more apparent – yet the spin that the fall was due to the unimplemented Lansley reform plans was blindly accepted by the usual suspects including the BBC, who didn’t mention Stafford at all in this context. Only when we have acceptance that the NHS needs reform will it be possible to make changes effectively, without backlash from vested interests.

  35. Martin
    July 15, 2013

    This £200 thing strikes me as another pile of tax/paperwork guaranteed to hack off most visitors to the UK who are not NHS tourists despite what the tabloids tell folk.

    A better solution might be to encourage more travellers to have travel insurance – perhaps with access to faster immigration queues at Heathrow or even a lower rate of APD?

  36. a-tracy
    July 15, 2013

    What do we do about charging at the moment? If a French, Spanish, German or American tourist has treatment in the UK does the hospital always raise a bill, is there a billing clerk in each hospital or a central resource in the NHS England Head Office (do they even have a HQ)? I thought they would already be doing this. How much are we billed to the NHS England from Spain or France say in 2012? Don’t we just contra off the charges to each other? What would the balance of payments be each year at an estimated guess.

    My understanding is that if my family go to Spain without getting a card from the Post Office I can’t get health treatment unless I have private medical insurance. If we did get treatment it would just be the very basic treatment to get us home. I had a family friend who travelled to Spain without insurance and they wouldn’t treat her without credit card pre-payment when she fell ill with meningitis on a student holiday, her parents had to pay up front for her treatment.

  37. Deborah
    July 15, 2013

    £200 is far too low.

    Access to the NHS should be restricted to those without a clear major pre-existing medical condition (eg pregnancy, heart trouble). The charge should be at least £2,000.
    Other visitors should be required to have their own private health insurance.

  38. alan jutson
    July 15, 2013


    Have noticed recently that a number of my comments are taking about a couple of days in moderation, thus they are probably lost for debate/comment by others given mainly immediate responses are the norm.

    Have I unknowingly crossed the line, are they too close to the truth, not worthy of publication, too long (although I try to keep a limit on them). Poor spelling (certainly guilty), not aware that I have slandered anyone.

    Aware that you are a very busy man, but would appreciate if comments are not going to be published, perhaps a very short courtesy mail to let us know the reason would be helpful.

    Reply I put all long ones to the back of the queue

  39. Chris S
    July 15, 2013

    It appears that my comment has been “moderated” even though all the figures quoted were factual and largely indisputable.

    If so, I”m very disappointed.

  40. sm
    July 16, 2013

    Anyone who is not fully resident and or who opts for non-domiciled status should not get NHS treatment without a charge being raised.

    As suggested ANY emergency treatment OR other needed routine should be given and recharged to the relevant country be they EU or non EU. (Avoids problems with epidemics etc)

    Deduct it directly from payments to the EU and Overseas aid or via some net off arrangement for UK citizens costs abroad.

    This is not just a UK problem for us to solve alone so deductions at the government level should concentrate minds.

    Or Border clearance and visa issue should require medical certification with insurance for the period.

    Time to leave the EU or start derogating unilaterally which will hopefully get us kicked out.

    We also really should be asking why so many highly paid people create such a ….
    mess!! and still remain in post in the NHS. (ref £80 for cod liver oil tablets) More fraud? or mis-management?

    We need caps on salaries, pensions, early termination and then rehires in the NHS – relating them to reality.

  41. Lindsay McDougall
    July 17, 2013

    Why should not everybody be required to carry proof of citizenship when visiting medical facilities that are free at the point of consumption? Passport / driving licence / birth certificate / ID card? And why not require the same when people register to vote?

    1. alan jutson
      July 17, 2013



      all that is needed is your NI Number and proof of identity.

      Problem is the Government seems to give these (NI numbers) out, it is reported, without much checking on who they are giving them to.

      This would be an area that certainly needs to be tightened up.

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