The patient sitting in my consulting room at the Royal Marsden Hospital in London was clearly a fraud, and quite unashamed about it.
He didn’t live in Britain, he said with a smile. He had flown to this country solely for free treatment on the NHS.
There was no doubt he needed urgent surgery. He had a colossal cancer, a sarcoma that weighed nearly 30lb was sitting behind his intestines. But his prognosis was remarkably good — with swift surgery, he might make a full recovery.
You might assume he was from a poor Third World country. But you would be wrong.
During our first consultation, the man told me he was British-born but lived and worked in the Far East. He had left the UK 20 years before, after completing his education. He had never paid a penny in tax here.
But even though he was a UK national, those living outside the European Economic Area or in a country without a bilateral healthcare agreement with the UK are not entitled to free NHS treatment unless they meet certain conditions, which this man did not.
This week, at the annual conference of the British Medical Association (BMA), doctors voted overwhelmingly to stop charging foreign patients for NHS care
He knew this but the operation was very expensive where he lived. It involved ten days in hospital, including two in intensive care, with costs in six figures at least.
So it made complete financial sense, he said without a hint of embarrassment, to get it done for nothing in Britain.
The cost of the flights was insignificant in comparison with the medical expenses at home, and quality of care at the Royal Marsden was second to nowhere in the world.
I challenged my managers, telling them what I considered to be a blatant health tourist had confessed to deliberately defrauding the NHS and British taxpayers.
But, not at all to my surprise, I was informed that I had no choice but to treat the man.
I predicted that as soon as the surgery was done, we would never see him again and he would fail to attend our outpatients’ clinic for follow-up care. Of course, I was right.
I tell this story because this week, at the annual conference of the British Medical Association (BMA), doctors voted overwhelmingly to stop charging foreign patients for NHS care. To send a bill to foreigners made medical staff ‘complicit in racism’, they said.
This is madness. Racism has nothing to do with it.
The brutal fact is that so-called health tourism is believed to cost between £200 million and £2 billion a year. It is hard to know precisely because keeping track of these cases is extremely difficult.
The patient I described is perfect proof of this scandal and of how the NHS and British taxpayers are being cynically taken for a ride. He was a self-confessed freeloader and our health authorities should have sent him a bill for the cost of his treatment.
To send a bill to foreigners made medical staff ‘complicit in racism’, they said. This is madness. Racism has nothing to do with it, says Professor J. T Meirion Thomas
The argument against the NHS becoming an international free-for-all is simply about economics.
But the BMA delegates who accuse critics of health tourism of racism are using a powerful weapon intended to shut down the discussion without debate.
Lone voices that bravely tried to oppose the motion were booed and heckled.
‘We are doctors, not border guards,’ said Dr Omar Risk. ‘Charging migrants for accessing NHS services is a fundamentally racist endeavour.’
How can that be true when so many ‘migrants’ are white, British-born and cynically playing the system for all it’s worth?
Sadly, our system is one that is already simple to manipulate. It is easy to book a GP appointment. Once you have a GP number, you’re in, and it is nearly impossible to weed out the impostors — even if they confess.
Not every hospital has an overseas visitor manager (OVM) to pursue patients from abroad for payment, and those that do are often lax.
It is so easy to avoid paying that attempts to prevent these frauds are effectively a waste of time.
I reported one egregious example to my managers. He was a man who had presented himself in my offices, requesting treatment that he wasn’t entitled to receive and had not the slightest intention of paying for.
My managers told me to provide treatment regardless. But by the time I contacted the patient, he had gone — booked in with a consultant at a different hospital.
Health chiefs continually complain that they don’t have enough resources to combat long waiting lists and delays for investigations and treatment. Surely the priority should be to treat patients who are entitled to care on the NHS and to ensure that people from overseas pay their way. We can’t have it both ways.
And, of course, if we stop charging foreign patients for NHS care, it will only encourage even more health tourism.
No one should be surprised when patients from low-income countries want to use the NHS — for instance, pregnant women whose country of origin has a much higher incidence of foetal fatality.
But to claim it is racist to suggest these patients should pay their way is insulting, manipulative and deeply illogical nonsense.
I first wrote in the Mail about this issue six years ago. The problem is not patients who have accidents or suffer from unforeseen illnesses while visiting the UK. It is those looking for specialist and expensive treatment who travel to the UK to receive it without having to pay for it.
Professor Meirion Thomas recently treated a British-born man who left the UK but returned for treatment at the Royal Marsden (pictured). He had never paid a penny in tax here
Unless they pay, their care is paid for by you and me — the UK’s taxpayers.
An urgent solution is needed to save us from catastrophe, particularly as the BMA claims ‘Tory cuts’ and overstretched doctors have left the NHS in crisis. What we should be doing is closing the loopholes.
The most obvious of these is the issue of the ‘ordinarily resident’ patient. This is someone who ordinarily lives in the UK and covers those who have come to here to work, study or stay for other reasons. They are entitled to NHS care.
That seems fair and sensible, until you see how callously the system is exploited. About ten years ago, while head of a surgical cancer unit at the Royal Marsden, I realised I was being approached by health tourists because my speciality was so unusual and I also wrote frequently for medical journals.
Anyone who did an internet search for ‘sarcoma specialist London’ would find my name.
Many new ‘ordinarily resident’ patients were recent arrivals from other EU countries. Similar requests for treatment will not stop as long as the UK remains in the EU.
As it stands, this is the biggest loophole for health tourists.
We also need a system for tracking fraudsters.
The only glimmer of hope is that NHS England and the Department of Health will ignore the cabal of BMA Left-wingers.
Any doctor who has time for such political posturing is, I believe, neglecting their real duties. It is no exaggeration to say these people are bullies and poseurs, trying to take over our health service.
If the BMA proposals are accepted, we would be opening our health service to the rest of the world — and that could lead to the collapse of the NHS.
At all costs, we cannot allow this to happen.
J. Meirion Thomas is a retired consultant surgeon who worked in the NHS for 30 years.