Intended for healthcare professionals

Rapid response to:

Feature Migrant Health

Restricting access to the NHS for undocumented migrants is bad policy at high cost

BMJ 2015; 350 doi: (Published 16 June 2015) Cite this as: BMJ 2015;350:h3056

Rapid Response:

Re: Restricting access to the NHS for undocumented migrants is bad policy at high cost

We write with regard to the article in BMJ (20.6.2015) by Ginneken & Keith entitled "Restricting Access to the NHS for Migrants is Wrong".

Sadly this article demonstrates a lack of understanding of the facts. The authors fail to mention the Schengen Agreement signed by every EU/EEA country (other than UK and Ireland) which abolished passport and border controls at their common borders. Therefore these countries function as a single country for international travel purposes and have a common visa policy. It is an absolute requirement to have health insurance cover of at least €30,000 before a Schengen visa will be issued. In other words there is a mandatory structural link between immigration application and access to health services throughout the Schengen countries. The UK is not a signatory and therefore no mandatory health insurance is necessary to achieve a migrant or student visa to the UK which is why the Government, mistakenly, in our view is demanding the migrant and student visa surcharge. We have described this as the cheapest travel insurance on the planet and the cost is minimal compared to the health insurance required for a Schengen visa.

Furthermore the authors confuse undocumented migrants with "health tourists". That displays further misunderstanding. A health tourist is a person who arrives in the UK with a pre-existing illness and the purpose of their visit is solely to access free NHS care. Therefore health tourists should be considered in a separate category from illegal/undocumented migrants and asylum seekers.

The article mentions 618,000 undocumented migrants who "contribute to the economy through their employment…" but it is unclear whether this figure includes their dependents who will themselves need schools, housing, medical services etc.

As with other compassionate nations, asylum seekers cannot work but they receive a subsidy (£72.52 a week) as well as free accommodation, access to the NHS and schooling for their children. Illegal immigrants are not entitled to those benefits but they can get NHS care as GPs and A&E departments do not require evidence of "right of residency" before care is administered.

Health tourists, as stated above, are in an entirely different category. The cumulative invoices raised for health tourists is £500million but only 16% of this amount is recovered. Furthermore this estimate is based on the NHS tariff which is a fraction of the private tariff.

Add to the calculation the fact that most health tourists are difficult to identify or are exempt from payment for a variety of reasons and the undeniable conclusion is that health tourism costs £billions and not £millions.

Yours sincerely,

Liz Edmunds (former Immigration Officer)

J Meirion Thomas FRCS

Competing interests: No competing interests

30 June 2015
J Meirion Thomas
Consultant Surgeon
Liz Edmunds