Nye Bevin on the Treatment of Foreign Citizens by the NHS

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practise a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.

The Tories and UKIP are both advocating cutting back welfare payments to foreign residents in Britain. In the case of the Kippers, this has even gone so far as demanding that they should be excluded from treatment by the NHS. This came up a year or so ago, and was properly denounced. I can remember that both Mike and I blogged about this horrendous attack on the poorest sections of our society under the guise of preserving the welfare state for the British at the time.

Nye Bevan, the founder of the NHS, was well aware that people would come to this country, seeking treatment by our health service, and was quite prepared to tolerate this. In his book, In Place of Fear (London: William Heineman 1952) he explains why. He believed that Britain should treat foreigners, because there was no way to separate the British from foreign citizens without creating the instruments of a surveillance state. It was also moral, and would have a civilising effect of encouraging other nations to create their own National Health Service.

Here’s the passage:

One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the Free Service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together.

The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to strive at an approximate estimate. All we have to do is look up this number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year.

Obviously this is an over-estimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is for what it is worth and you will see it does not justify the fuss that has been made about it.

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practise a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.

Naturally when Britons go abroad they are incensed because they are not similarly treated if they need the attention of a doctor. But that also I am convinced will come when other nations follow our example and have Health Services of their own. When that happens we shall be able to work out scheme of reciprocity, and yet one more amenity will have been added to social intercourse. In the meantime, let us keep in mind that, here, example is better than precept.

And there are reciprocal system in place, as anyone who has signed the various forms to give them medical treatment abroad when they go on holiday has found.

Bevin was clearly writing before the era of mass migration to Britain, and the attendant social and political strains this has caused. But his argument still holds water. Migrants do contribute to the NHS and the welfare state the moment they start paying taxes in Britain, either by working or purchasing goods, on which VAT is levied. Which is just about all of them, but particularly if they smoke or drink alcohol.

And the attempt to deprive migrants of access to healthcare and welfare benefits it an assault on the NHS and welfare state as a whole. It’s salami tactics, a way of getting the public used to these services being withdrawn. And once you withdraw it from one group, then process is then extended to others, until finally British citizens have a private medical service like that suffered by the Americans.

We must stop this, and defend migrant’s rights to treatment on the NHS. For once they’ve done it to them, you can be sure the Tories will do it to the rest of us.

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Tags: 'In Place of Fear', Aneurin Bevan, Conservatives, Cost, Migrants, Migration, NHS, Private Healthcare, Privatisation, Surveillance, Tax, UKIP