A CAN of worms is opening up about who is — and who is not — entitled to public services. It is an issue that prompts grimaces of discomfort among those who discuss it, and frustration among many public workers. Last week the Department of Health pushed the idea of identity cards to weed out those who shouldn’t be using the NHS, while Tony Blair said identity cards would prove whether people are entitled to other public services.
Many newspapers have been decrying “health tourism”, whereby foreigners and British expatriates use the NHS illegally. The Government is no doubt using the issue to gain public acceptance of ID cards — The Sun has given the thumbs up, calling for them as soon as possible — but that doesn’t mean there is not a genuine issue. The Liberal Democrats’ health spokesman, Evan Harris, said the Government was drumming up a non-issue to play up to an extremist agenda, proving that he has not visited a central London A&E department recently.
Several A&E nurses have fumed to me about the abuses they see every day. One Central London medical professor told me that he reckons between a third and a half of his patients have no right to treatment. What made them angry was not so much the expense to the taxpayer, but that they can’t talk openly about it and that NHS management insists on ducking the issue. The Healthcare Finance Management Association, which represents NHS finance directors who are normally keen to root out financial abuse, told me that they couldn’t look at such a political “hot potato”.
Last week I got a call from a housing official, outraged that council houses were being taken up by people with no legal residence in this country — but council officials were not meant to ask awkward questions. A teacher told me that she was sure that children she was teaching were smuggled into Britain to get a free education, but she couldn’t discuss the matter with the authorities.
This all raises a fascinating set of moral dilemmas. One commentator told me that, since all people in the world are equal, they have an equal right to healthcare, education and other public services, and so to turn someone away even if they had no right to the services was immoral.
Advertisement
Understandable though it is, the trouble with this “universalism” is that — taken to extremes — it undermines the welfare state. The more widespread use of a service — education, health or welfare — by people who have not contributed to it, the more that those who have contributed to it will withdraw their support and want to keep their money for themselves. All people in the world are equal, but a society can only grant to its members rights, such as free healthcare, that it can afford to offer, and Britain, obviously, can’t afford to offer free healthcare to the rest of the world.
Of course, no one knows the scale of the abuse, largely because everyone refuses to investigate. But this avoidance of the issue just fuels the frustration of public servants and the public alike, who feel they are being taken advantage of. It is best to assess how widespread the abuse is, and deal with it if it is unacceptable. Just ducking the issue risks undermining public confidence in public services and the morale of people who work in them. The Government may be opening a can of worms, but in the long run being honest about it will help to underpin a healthy welfare state.
Anthony Browne is a Times writer
E-mail: anthony.browne@thetimes.co.uk