Failure to tackle health tourism will kill the NHS, says Ross Clark

That is not because our doctors, nurses, hospitals and surgeries are no good, it is just that it raises the question: why should foreigners feel envious of the NHS when they too can use it?

The Government claimed years ago to be tackling health tourism but the extent of its failure has been laid bare by a freedom of information request revealing that 283 foreign patients were fast-tracked for cataract operations last year.

Meanwhile Britons who have been paying their taxes here for years were kept waiting an average of eight months in some parts of the country.

There is huge support in Britain for a national health service that is free at the point of delivery and that is available to everyone. But the system rapidly breaks down if the NHS is allowed to become an international health service.

It is simply not possible for 64 million British taxpayers to support a health system which is open and free to use for a global population of seven billion.
The inevitable result, if health tourism is allowed to continue unchecked, is that the NHS will collapse under the burden of trying to support so many people who have contributed nothing to its cost.

While NHS treatment is theoretically available only to people who are “ordinarily resident” in the UK, that definition is open to abuse.
Department of Health guidance issued to doctors states that foreigners are entitled to free NHS care “even if they have only been in the UK for a few days”, adding that “a person can ordinarily be resident in more than one country at once”.

Such rules allowed one patient of Professor J Meirion Thomas, a former NHS oncologist, to claim free cancer surgery at taxpayers’ expense even though she had spent 48 years abroad and had not contributed a penny to the NHS in all her working life. When she developed cancer she chose to return to an NHS hospital rather than one in the country where she had been living and paying her tax – but successfully claimed that she was “ordinarily resident” in Britain on the grounds that one day she might decide to return.


Even when people are clearly not ordinarily resident in Britain the NHS often fails to check their status or demand any payment.

One who took advantage of the laxity was Nigerian Bimbo Ayelabola who, while pregnant with quintuplets in 2011, entered Britain on a visitor’s visa. I do not blame her for calculating that an NHS hospital would be a safer place for her to give birth than a Nigerian one, and I wish her and her children – delivered successfully at the Homerton hospital in London and now being privately educated in Nigeria – the best. But it does grate that the NHS failed properly to pursue the £145,000 cost of her care and last year wrote it off.

The NHS also provides free medical treatment to some tax havens such as the British Virgin Islands – which is sucking tax revenues out of Britain but which is allowed to refer patients with complex conditions to NHS hospitals for free treatment.


The NHS is open to health tourism because unlike most national healthcare systems it has no contributory element. You do not need to have paid a subscription fee or insurance premium in order to access its services. That is one of its strengths because it means that no one falls through the net.

If you are the child of parents who have never worked or paid taxes you are still as eligible for treatment as anyone else. But it is also a fatal weakness if the rules are lax regarding foreigners who ought to be treated under their own country’s health systems.
Trouble is, many of those systems are not as inclusive as ours. When foreigners find themselves barred from their own health systems they start to look to the NHS. Matters have reached the bizarre stage where nationals of other European countries are coming to Britain to register for British European Health Insurance Cards.

The cards allow them to claim treatment in hospitals in their home countries at our expense. According to the Government, deliberate health tourism costs the UK taxpayer between £110million and £280million a year. Another £1.8billion, it claims, is racked up in costs treating people who did not come to Britain to seek free healthcare but who fell ill while they were here.

This figure is shocking enough in that it represents two per cent of the NHS budget. But how can anyone know the full cost when hospitals and surgeries often do not bother to check whether someone is entitled to treatment or not?

When the NHS was founded in the 1940s the potential problem of health tourism perhaps did not occur as there was relatively little international travel. But it matters hugely now.

Far from being the envy of the world the NHS is becoming an object lesson in how not to run a health service.