We must recognise the actual and opportunity costs of treating immigrants in the NHS

I am surprised by Steele et al.’s article decrying the health aspects of the Government’s Immigration Bill 2013–2014. ¹ The authors work in East London, as I do. They should therefore be well aware of the burden of infectious diseases associated with London’s immigrant populations, e.g. tuberculosis (TB), HIV and viral hepatitis. Treating these infections is costly. For example, treating Extensively Drug Resistant TB (XDR-TB), which occurs mostly in immigrants, is very expensive compared to drug-sensitive TB. ²

Some of the statistics quoted are questionable. The authors state that ‘immigrants account for 4.5% of the population of England’. However, the 2011 Census stated that 9.4% of the population of England are immigrants. ³

Health tourism is a vague term. It refers both to wealthy foreigners availing themselves of UK private healthcare and to NHS healthcare provided to immigrants not entitled to free care. The former is beneficial to the UK, the latter is not.

Like the authors, I am aware of the potential benefits of immigration. The NHS could not function without its foreign staff. However, unlike the authors (perhaps), I recognise the significant costs of treating immigrants. We must recognise the opportunity cost of expending limited NHS resources on those who are not entitled to it. Every pound spent on immigrants not entitled to free NHS care is a pound we cannot spend on Britons who are entitled to this care. As public servants, we have a responsibility to ensure that publicly funded resources are expended properly on those who are entitled to it.

Finally, most NHS Trusts, including the authors’ local NHS Trust (Barts Health), have an overseas patient policy which requires staff to identify patients not entitled to free NHS care. These policies apply to all NHS Trust staff and for good reason.