I’ve had a lot of kids on my ward in the last fortnight or so. My ward has a handful of beds on it that are meant for the use of oncology subspecialties that disproportionately affect teenagers, and that means I get quite a lot of sixteen and seventeen year olds who have sarcomas and germ cell tumours.
(If you are seventeen years old, you should be deciding that what you really want is a new computer or a gap year in Australia or to go to that gig on Tuesday night and so what if you’ve got an exam on Wednesday. If you are seventeen years old, you should not have to decide that what you really want is to die at home.)
Anyway, I’ve come to a decision about my teenage patients. I’m not going to look after them anymore.
I’m going to stop giving them chemotherapy. I won’t get them surgical opinions. I don’t really see the point of doing CTs or MRIs, because I’m not going to cut their tumour out or put a chest drain in or send them for radiotherapy to their spinal cord compression. Sure, they won’t be able to walk or control their own bowels, and they’ll die fast and drowning in their own body fluids, but I don’t really care. Then, when they are dying and terrified and in agonising pain, I’m not going to give them anything to relieve their pain or distress. It won’t matter, because I won’t have let them into the hospital in the first place.
You see, the British government rolled out its new immigration policy today and part of that is a change to the way the NHS provides healthcare to people who were born in someplace other than Britain. Theresa May, the Home Secretary, went on the Today programme this morning and explained why we need to end what she calls “health tourism” in Britain. Now, what most people mean by that is a situation where a person has gone to a country specifically to avail themselves of the medical care in that country — for example, a Somali national who has been diagnosed with HIV and has then come to the UK because he cannot afford HIV medications in Somalia and has heard that the NHS will provide them for free if he comes to Britain. But what the Home Secretary is actually talking about is a situation where a foreign national has already come to Britain and then finds that they need to use the NHS, and the government’s very straightforward strategy to combat the drain that this has on NHS resources is to simply charge a fee to all non-British people who use the NHS.
The drain that this has on NHS resources is 0.01% of the total NHS budget, but, you know, a tenth of a tenth of one percent is an incredibly small number to comprehend and so I’m not even going to try. Theresa May had that incredibly small number put to her several times over the course of a fifteen minute interview and she managed not even to acknowledge it, so I won’t bother. I don’t need to deal in facts.
Incidentally, the most sterling example of health tourism I’ve ever encountered was during the two weeks I was looking after the business finance desk for the community services department of one of my local Trusts when I fielded an email from a British woman who needed to have an ingrown toenail removed and wanted to know how she went about getting reimbursed medical costs and travel expenses from the NHS if she chose to have it removed in Italy. But clearly it’s the HIV-positive Somalian who is doing his best to waste NHS time and resources.
It’s a very fair policy. It’s very fair to all the hardworking British people who contribute to the NHS and who are very angry that foreign people who have never contributed to a system can still use it. It’s very fair even if the problem that is being solved actually doesn’t really exist, because hardworking British people who contribute to the NHS are still afraid that foreign people who haven’t contributed to a system can use it. It’s very fair, because foreign people haven’t contributed to the system. You see?
I think that’s terrific.
The trouble is, I don’t think it goes far enough.
I think there are plenty of other kinds of people that we could stop allowing to use the NHS.
I shouldn’t have to treat people who come from prison. A person who is incarcerated is by definition not making a contribution to the system. If you arrive handcuffed to a prison guard or a nice man from G4S, no NHS for you.
I’m also not going to treat people who are on benefits anymore. That’s OK, right? They probably aren’t contributing to the system. And the ones on disability benefits aren’t just not contributing to the system, they’re actively trying to drain it. So I think I should stop treating people who are disabled. Actually, I imagine that’s all pretty popular with the current government.
I don’t like stay-at-home mums and dads. I know, I know, working in the home is work, I believe you, but the bottom line is, work that you don’t get paid for isn’t work that you can be taxed on or pay National Insurance on, and so, you don’t get to use the NHS.
I don’t think there should be any need for paediatric hospitals. A child hasn’t contributed to society at all so why on Earth should they expect to use the system? It isn’t fair to the adults. And the white British teenagers who I’ve been looking after this week? I’m not going to do it anymore. I mean, they haven’t contributed anything to the NHS. I don’t want them using a system that I’m paying for and that they never have.
But… oh, what if I behaved like the pansy ass liberal that I really am and bent the rules just a little bit? I’ll treat them if their parents are contributing into the system. Is that OK? Sorry, what’s that you say? — their parents aren’t — not right now — maybe never — they can’t work — not when all of their energy and focus is taken up with taking care of their kid who has cancer.
Well, fine. What about if I agree to look after them if they promise to contribute to the system when they’re adults? Yeah?
But the guy from Somalia can do that, too.
The kid with osteosarcoma? He can’t pay it back. He’ll be dead.
And there was no one left to speak out for me.