The patient who was in my consulting room at the Royal Marsden Hospital in London was clearly a cheater, and rather impudent.
He didn't live in Britain, he said with a smile. He had flown to the NHS to this country for free treatment only.
There was no doubt that he needed urgent operations. He had a colossal cancer, a sarcoma weighing nearly 30 pounds was behind his intestines. But his prognosis was remarkably good – he was able to fully recover with rapid surgery.
You could assume he was from a poor Third World country. But you would be wrong.
During our first consultation, the man told me that he was of British descent but lived and worked in the Far East. He had left the UK 20 years earlier after completing his education. He had never paid a cent tax here.
But although he was a British citizen, 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 do.
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 was ten days in the hospital, two of them in intensive care, with at least six digits.
So it was perfectly financially sound, he said without a hint of shame, to make it happen in Britain for nothing.
The cost of the flights was insignificant compared to the medical costs at home, and the quality of care on the Royal Marsden was second to nowhere in the world.
No one will be surprised if patients from low-income countries want to use the NHS – for example, pregnant women whose country of origin has a much higher incidence of fetal death. But to claim that it is racist to suggest that these patients have to pay their way is insulting, manipulative and deeply illogical nonsense, says Professor J. T Meirion Thomas
I challenged my managers to tell them what I considered a blatant health tourist who admitted that he had deliberately deceived the NHS and British taxpayers.
But to my surprise, I was not told that I had no choice but to treat the man.
I predicted that we would never see him again once he had surgery and that he would not come to our outpatient clinic for follow-up. Of course I was right.
I tell this story because doctors this month at the annual conference of the British Medical Association (BMA) voted overwhelmingly to stop charging foreign patients for NHS care. To send a bill to foreigners, the medical staff & # 39; complicit in racism & # 39 ;, they said.
This is madness. Racism has nothing to do with it.
The cruel fact is that so-called health tourism is supposed to cost between £ 200 million and £ 2 billion a year. It is difficult to know precisely because it is extremely difficult to keep track of these cases.
The patient I described is the perfect proof of this scandal and how the NHS and British taxpayers are taken cynically for a ride. He was a self-proclaimed freeloader and our health authorities should have sent him a bill for the costs of his treatment.
To send a bill to foreigners, the medical staff & # 39; complicit in racism & # 39 ;, they said. This is madness. Racism has nothing to do with it, says Professor J. T Meirion Thomas
The argument that the NHS is internationally a & # 39; free-for-all & # 39; is simply about economics.
But the BMA delegates accusing health tourism critics of racism use a powerful weapon designed to end the discussion without debate.
Lonely voices who bravely tried to resist the movement were jeered and tampered with.
& # 39; We are doctors, not border guards & # 39 ;, said Dr. Omar Risk. & # 39; Charging migrants for access to NHS services is a fundamentally racist venture. & # 39;
How can that be true if so many & # 39; migrants & # 39; white, British born and cynical play the system for all it's worth?
Unfortunately our system is a system that is already easy to manipulate. It is easy to book a doctor's appointment. Once you have a GP number, you are there and it is almost impossible to weed the cheaters, even if they confess.
Not every hospital has a foreign visitor manager (OVM) to pursue patients from abroad for a fee, and those who do are often lax.
It is so easy to prevent that those attempts to prevent this fraud are actually a waste of time.
I have reported a blatant example to my managers. He was a man who had presented himself in my office, requested treatment that he was not allowed to receive, and who had no intention of paying for it.
My managers told me to take care of the treatment regardless. But by the time I contacted the patient, he had left – booked with a consultant at another hospital.
Health chefs constantly complain that they do not have sufficient resources to combat long waiting lists and delays in examinations and treatments. Certainly the priority should be to treat patients who are entitled to care at the NHS and to ensure that people from abroad pay their way. We can't have it in either way.
And of course, if we stop charging foreign patients for NHS care, this will only stimulate more health tourism.
No one will be surprised if patients from low-income countries want to use the NHS – for example, pregnant women whose country of origin has a much higher incidence of fetal death.
But to claim that it is racist to suggest that these patients have to pay their way is insulting, manipulative, and profoundly illogical.
I wrote about this topic in the Mail for the first time six years ago. The problem is not that patients have an accident or suffer from unforeseen illnesses during their stay in the UK. They are people looking for specialized and expensive treatments who travel to the UK to receive it without having to pay for it.
Professor Meirion Thomas recently treated a man born in England who left the UK, but returned for treatment in the Royal Marsden (photo). He had never paid a cent tax here
Unless they pay, their care is paid for by you and me – the British taxpayers.
An urgent solution is needed to save us from the catastrophe, especially since the BMA claims that & # 39; Tory cuts & # 39; and overburdened doctors have left the NHS in a crisis. What we should do is make the loopholes disappear.
The most obvious of these is the issue of the patient who usually resides in the country. This is someone who normally lives in the UK and covers people who have come here to work, study or stay for other reasons. They are entitled to NHS care.
That seems fair and sensible, until you see how indecent the system is being exploited. About ten years ago, when I was head of a surgical cancer department at the Royal Marsden, I realized that I was approached by health tourists because my specialty was so unusual and I often wrote for medical magazines.
Anyone looking on the internet for & # 39; sarcoma specialist London & # 39 ;, would find my name.
Many new patients with a & # 39; usual residence & # 39; had recently arrived from other EU countries. Similar treatment requests do not stop as long as the UK stays in the EU.
In its current form, this is the largest loophole in the law for health tourists.
We also need a system for detecting fraudsters.
The only glimmer of hope is that NHS England and the Department of Health will ignore the left wing of the BMA.
Any doctor who has time for such a political attitude is, in my opinion, neglecting his real duties. It is no exaggeration to say that these people are bullies and poseurs trying to take over our health service.
If the BMA proposals were accepted, we would open 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 has worked in the NHS for 30 years.
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