Health Tourism

I'm note at all sure there are many 'facts' in this piece on health tourism by Nick Cohen in the Guardian - although I don't know where the 0.1% figure from the Royal College of GPs comes from since the NHS does not appear to be particularly good at keeping proper records.

The issue has gathered momentum since the Guardian article because the health secretary at Westminster - Jeremy Hunt - has since outlined proposals to save £500 million a year by introducing new rules on exactly who should be entitled to free treatment from the NHS in England and Wales.

Now the proposed changes seem pretty uncontroversial to me, but I listened to a rather ill-tempered 'debate' on the topic the other day - where some people argued that doctors and nurses would be turned into the equivalent of 'border guards' - who would be put in the position of demanding to know whether potential patients should go free or be charged for their treatment.  

So the issues are worth debating because my own experience tells me that people do access the NHS for free - when they should be paying for treatment they receive while in the UK - which is not about turning health staff into border guards, but about having efficient and effective administrative procedures in place. 

For example, I've had family visiting from Canada on a regular basis and I can well  remember trips to hospital A&E, the GP and/or the dentist - without anyone being asked to pay a penny.

Now whether that amounts to 0.1% I don't know, but I do know when I was at the doctor's recently one of the practice nurses told me - unsolicited - that repeat prescriptions would in future be issued at two monthly intervals because of so many people abusing the system - by stocking up with pills and suchlike for the rest of the year before heading off to live abroad.   
    
Apparently, the problem was particularly bad with 'patients' who lived in Pakistan for most of their time - but who came to Scotland once a year to access NHS services and pick up prescriptions which are free in Scotland, of course.

I suppose it's the NHS equivalent of making 'cold weather' payments to UK citizens who live abroad, for example in Spain, who no longer reside in the UK - yet still feel entitled to claim UK benefits.

I was on holiday in Spain a few years ago and needed emergency dental work - of the dreaded root canal kind - the treatment was first class, but I had to pay for it at the time and claim the cost back from my insurance - which is exactly what I expected.

If I go to visit family in Canada or America I would arrange insurance to cover the cost of any medical or dental treatment - but my personal experience of the NHS in the UK is different, as if asking for payment or an insurance policy is out of order just because the NHS is paid for out of general taxation. 

So, I would welcome some hard evidence about the true cost position facing the NHS - but I whatever the amount the real issue is that there should be always be a rigorous attitude in place when it comes to using public funds.     

In Theresa May's surreal world, feelings trump facts

The home secretary's claims about health tourists are both wrong and an insult to voters



By Nick Cohen


Theresa May: short of answers. Photograph: REX/Ray Tang

When historians of modern folly write their accounts of our capacity to ignore inconvenient truths, I hope they find the space to mention the performance of Theresa May on BBC Radio 4 on 10 October 2013 .

Britain's home secretary announced that she was cracking down on the "health tourists" who were using Britain's hospitals for free. The interviewer pressed her. How much money were these health tourists stealing from our pockets? May did not know. The Royal College of GPs, which ought to know, puts the cost at 0.01% of Britain's health budget – or next to nothing. When the European Commission asked Britain for proof that sly continentals were sneaking into our hospital beds, Whitehall replied that its demand for hard facts was an affront. "We consider that these questions place too much emphasis on quantitative evidence," it huffed.

Far from being embarrassed, Mrs May was triumphant. Feelings mattered more than facts. Her job as a senior politician with ill-disguised ambitions to become prime minister was to pander to popular prejudice rather than tell the public the truth.

People feel it is unfair that illegal immigrants can use services, she said. They "feel it's too easy to stay here illegally". They had the "feeling that people who are here illegally were accessing services", she continued, before degenerating into a babble of random noise, from which I just about made out that the "people" who had these "feelings" were, of course "hard working".

In For the Time Being, Auden has Herod explain why he must save the classical world by killing the infant Jesus. If religion triumphed, "Reason will be replaced by Revelation. Instead of Rational Law, objective truths perceptible to any who will undergo the necessary intellectual discipline, knowledge will degenerate into a riot of subjective visions... The Rough Diamond, the Consumptive Whore, the bandit who is good to his mother, the epileptic girl who has a way with animals will be the heroes and heroines of the New Age".

Mrs May can make you feel that way, as, indeed, can an hour spent watching prime-time television or reading the tabloid press. As Ukip threatens its core vote, the Conservatives will spend 18 months trying to flatter the deluded into voting Tory by telling them that they are right to put their "riot of subjective visions" before paltry facts.

In July, the opinion pollsters Mori innocently provided what now looks like a draft of the next Conservative manifesto when it published a list of popular misconceptions. Most people believed that crime was rising when it has been falling for years, it said. They overestimated the number of immigrants by threefold, the number of teenage pregnancies 25-fold and the amount of benefit fraud 34-fold.

If one wanted to fall into an Audenesque melancholy, one could note that the above is a mere taster of evidence-free beliefs. There is self-interested wrong-headedness. Ninety-seven per cent of climate scientists believe in global warming. But because combating climate change will be expensive and difficult, the American public prefers to think instead that scientists are split down the middle.

Public sector workers maintain that job losses will inevitably lead to poorer services. A BBC poll showed that a majority of the public had found that the overall quality of services had improved since the cuts began. Meanwhile, the British Bankers' Association and its backers in the Conservative party say that the only thing wrong with the public providing the City with subsidies on a Himalayan scale is that it encourages "destructive" outbreaks of "banker-bashing".

Religiously inspired wrong-headedness – the belief that a policy must be followed because a non-existent deity or manmade holy book mandates it – is becoming rarer in developed countries. But it can still motivate opposition to gay marriage in Europe and North America, while bringing terror and the denial of rights to hundreds of millions in much of the rest of the planet. Above them all stands the inability to think clearly about the despised minorities – foreigners, loose women, criminals and scroungers – that Mrs May was so anxious to endorse.

Everyone from money-grubbing TV executives to seedy politicians hit their critics with a dictionary of ready-made insults when you try to take these cognitive biases on. You are "an elitist" and a "snob" who lives in an "ivory tower". You "don't get it," and think you "know better" than the common people who make their choices in the ballot box or marketplace. Unless you are careful, the old reactionary argument that democracy is just mob rule can creep into your mind and you find yourself wishing for an enlightened dictatorship of experts and bureaucrats .

The road back to sanity begins by understanding that a free country is engaged in arguments that never end. We have been here before. In the 1990s, New Labour and the Conservatives dreamed up ever more ludicrous and ineffective anti-crime initiatives. Their arms race culminated on 6 December 2000 when Tony Blair asked the then Conservative leader William Hague why he had "made a policy-free speech apart from a load of nonsense from the shadow home secretary, most of which we are doing in any event".

That was a moment when the cynicism of the establishment was plain to see. Our leaders were treating the public as fools and offering policies they knew to be nonsense in the hope of conning them into the polling booths. Hearteningly, the public saw through the swindle. "Spin" became a dirty word. Populism became unpopular – turnout in elections collapsed – and self-defeating. Leaders who relied on fear were not believed when they said, truthfully, that crime had fallen. Worse than that, the politicians who wasted their days searching for "eye-catching initiatives", to use Blair's language, looked paltry and ridiculous figures even in the good times of the 1990s. How much worse will politicians such as May look when they play silly games in the middle of the worst economic crisis in a century?

Auden warned that when populist heroes are worshiped, "the general, the statesman and the philosopher become the butt of every farce and satire". If our statesmen (and women) choose to put feeling and prejudice before thought and evidence, however, a butt is what they deserve to be. Let us hope they become one. Let us hope that the mocking laughter becomes so loud it drives them out public life.