First They Came For The Jews

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.



  1. I will never understand what the Lib Dems were thinking, when they decided to throw their support to the Conservatives instead of Labor.

    I imagine, given the ass-kicking that all polls indicate awaits for the Tories and the LibDems the next time the British people get a chance to vote, that they will drag the date of their reckoning all the way to the maximum latest date. But I feel sorry for all of you until then.

    Strength, sister.

  2. I agree with your post. People are treating the NHS as an infinite resource and within the UK there seems to be a sense of entitlement. The NHS simply cannot continue with the way things are currently.
    Well said.

    • You don’t agree with my post at all, Jess.

      I am an old fashioned liberal, and I believe that it’s the privilege of the best off in society to look after the worst off. I am also a doctor, and I will never be willing to turn away any patient because of their status in society. I believe in the founding principles of the NHS. I believe that faith to those principles lies in treating the person in front of me, not refusing to treat their immigration status or economic standing or employment history.

      I also don’t believe that the alleged abuses are actually happening, not in the way this legislation claims. That was the point of citing numbers. It was also the point of the story about the ingrown toenail.

      You know when someone suggests something so outlandish, so ludicrous, so appalling, that they have to be being ironic? Right. That.

      We clearly disagree.

  3. Following the most recent comment by Jess, I’m wondering if I mis-read your piece as ironic since I certainly don’t think people treat the NHS as ‘an infinite resource’ or have a ‘sense of entitlement’. Yes, we pay into the system in the hope that it will be there when we need it but I pay into it also in the hope it will treat those in need, regardless of their ability to pay or their country of origin. Immigration in the UK is one of the lowest in Europe and most of those people are working. It’s believing the skewed statistics spouted by the coalition and the right-wing press that is giving the erroneous impression that we’re over-run by thieving immigrants and full of ‘scroungers’ and ‘skivers.’ The only scroungers I know are the politicians that make up the coalition who take and take from those least able to support or defend themselves.

  4. Beth, agree with you. But is any sort of nation-hood right when we some nations have so much and others have so little?

      • We have a loyalty to our country. We pay into it. We feel that we have a right to expect things of it. We feel that we are part of a nation.

        But is that fair and correct? We’ve got loads of things, and it’s only by an accident of birth that we live in a wealthy country. So should we share out our wealth with other less fortunate countries? Should we expect to live in a privileged position just because of where we were born? And have we in fact got a right to these things?

        I hope that I have explained better, but I know that i’s difficult to explain these things, especially if you were not that good at English at school ;-)

        • Ah.

          I see where you’re coming from and to a certain extent I agree with you. I think the first thing is, do you understand that everything I’ve written here was ironic? I disagree entirely with the new policies and I think that the NHS should treat everyone without a race/religion/socioeconomic background/employment/immigration status check — I think that to do otherwise is to miss the original point of the NHS.

          As to the rest of it, i see where you’re coming from. It isn’t fair that we live in a wealthy country and that others live in abject poverty, but we do live in a wealthy country. I find it more helpful to acknowledge that and to acknowledge our privilege and to then do what we can, through for example charitable giving and lobbying for fair international policies, than I do to renounce a privilege that, due to the unfairness of the way the world is set up to work, we can’t truthfully renounce.

          • Yes. I got the irony. But I’m not sure that everyone will buy it. And kind of on a related issue – would you refuse a liver transplant to someone who has not, so far, stopped drinking, or a heart transplant to someone who has not stopped smoking?

          • I think it is reasonable to treat people for (and expect people to accept treatment for) one medical condition before addressing a second medical condition with a treatment that will not work if the first one isn’t sorted out first.

  5. Pingback: Wishlist for 2014 | The Road Less Travelled

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