Journal of Public Health | p. 1 Correspondence Implications of upfront charging for NHS care: a threat a clear illustration of a gradual change to the way in which to health and human rights access to healthcare and its delivery is now to be understood; as a service inextricably linked to one’s ability to pay. In October 2017, additional restrictions were placed on access Acknowledging concerns raised by a multitude of stake- to the UK National Health Service (NHS). Only individuals holders, the Department of Health have since launched a considered ‘ordinarily resident’ in England are now eligible to hastily prepared and poorly coordinated review of the impact receive all treatment free of charge. Everyone else—including of charging changes. As states reafﬁrm a commitment to uni- some of the most socially and politically marginalized people versal health coverage at the global level, it is imperative that living in the country—are chargeable in advance for the use of practitioners, policy-makers and the general public alike, most non-emergency, secondary and community care services. acknowledge the harmful and divisive impact of charging for These changes, progressively implemented over the access to healthcare, and proactively resist political efforts to course of recent years, represent a threat to the foundational suppress our moral duty of care. principles that once underpinned the NHS: that healthcare should be provided to all according to need, and that this care should be free at point of access. Encouraged by a References shift in global support for a popularist, exclusionary politics 1 Hiam L, McKee M. Upfront charging of overseas visitors using the in recent years, the current Conservative government—in NHS. Br Med J 2017;359:j4713. doi:10.1136/bmj.j4713. keeping with the rhetoric traditionally adopted by right-wing 2 Steele S, Stuckler D, McKee M et al. The Immigration Bill: extending political parties—have sought to attribute inefﬁciencies in charging regimes and scapegoating the vulnerable will pose risks to the NHS to the UK’s migrant population. Such ideologic- public health. J R Soc Med 2014;107(4):132–33. ally driven policy-making, with its attendant racialised and 3 Hanefeld J, Mandeville K, Smith R. Making ‘health tourists’ pay for nationalistic overtones, attempts to construct foreign nationals care. Br Med J 2017;356:j771. doi:10.1136/bmj.j771. in the public imagination as a threat to the NHS. Despite evi- 4 House of Commons. NHS Treatment of Overseas Patients: Thirty-seventh Report of Session 2016–17. London: House of Commons Committee dence that the cost of care provided to so-called ‘health tour- of Public Accounts, 2017. ists’ constitutes only 0.3% of the total annual budget allocated 5 Ipsos MORI. Overseas Visitor and Migrant NHS Cost Recovery to the NHS, the government’s strategic political posturing Programme: Formative Evaluation—Final Report. London: Ipsos MORI has distracted from the far more important issue of chronic Social Science Institute, 2017. underfunding of the UK health—and other public—services. 6 UHC 2030. (2017) Tokyo Declaration on Universal Health Coverage [online]. Speaking in November 2016, Chris Wormald, Permanent https://www.uhc2030.org/news-events/uhc2030-news/article/tokyo- Secretary at the UK Department of Health, hesitated over the declaration-on-universal-health-coverage−441190/ (28 December 2017, use of ‘symbolic’ to describe the target for ﬁnancial recuperation date last accessed). under this policy. Later in the same proceedings, Wormald 1 2 spoke of the need for a change of ‘culture in the NHS’,where James Smith , Erin Dexter staff show concern not only for patient care but also ‘ﬁnancial London School of Hygiene & Tropical Medicine rigour’. This same aim is reiterated in a government-funded (LSHTM), 15-17 Tavistock Place, London WC1H 9SH, UK report published three months later, in which the authors speak University College London (UCL), London, UK of the need for NHS staff to embrace a ‘duty to charge’. This alarming turn is not only revealing of the principles that Address correspondence to James Smith, the government and senior leadership in the NHS are presently E-mail: firstname.lastname@example.org prepared to sacriﬁce in pursuit of ﬁnancial remuneration, but is doi: 10.1093/pubmed/fdy050 © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com 1 Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy050/4953709 by Ed 'DeepDyve' Gillespie user on 12 July 2018
Journal of Public Health – Oxford University Press
Published: Mar 26, 2018
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