Doctors' fears that charging foreigners to access NHS treatment could result in infected people "wandering around" the UK have been dismissed by Jeremy Hunt.
The Health Secretary said he would not do anything that put public health at risk as he prepared to unveil a consultation on plans to ensure migrants contribute to health costs. Proposals include a levy on visa charges of around £200 on any students or foreign workers who come to the UK for more than half a year. Free access to GPs for tourists and those staying less than six months may also be curbed under the reforms.
Mr Hunt said it was "extraordinary" that visitors do not pay for GP and emergency care and he was determined to tackle illegal immigration. "We have been clear that we are a national health service, not an international health service, and I am determined to wipe out abuse in the system. It is right to ask whether that is fair to hard-working British families who pay about £5,000 a year in taxes or whether we need to have a fairer system."
Doctors claim the "rushed" reforms could put UK citizens' health at risk, end up costing more money by pushing people to A&E and turn GP surgeries into border control posts.
Royal College of General Practitioners chair Clare Gerada said immigrants with highly infectious conditions could end up "wandering around for fear of being charged" or going to emergency units that were far more expensive to run than doctors' surgeries. "I don't think we should be turning the GP surgery into a border agency," she told BBC Radio 4's Today programme. "It is a very rushed consultation. Whatever happens, we need to make sure that what comes out the other end is sensible, proportionate and fair, and doesn't cost us all much more money and put us at much more risk than the current situation which is one that, even at the worst estimates, is a tiny proportion of NHS costs."
National AIDS Trust chief executive Deborah Jack said the changes would "undermine years of work" to encourage marginalised at-risk groups to access HIV testing and treatment. "If they go ahead, they risk putting lives at risk and accelerating the spread of HIV in the general population," she said.
Mr Hunt told Today there would be an "exemption on all public health grounds" and pointed to other countries which charge for healthcare but do not suffer TB or other problems. "One of the things we want to consult on is that we don't want to do anything that puts public health at risk. But we are one of the only countries in the world that has completely free access to primary care and there are many other countries that do have a charging system that don't have public health problems like TB. So I think there is a way we can find to deal with this." Foreign patients would not be refused treatment in emergency cases, he insisted.
Estimates of the cost of "health tourism" vary from the £12 million known to have been written off by the NHS in 2011/12 to tens of billions of pounds. Mr Hunt, who has previously claimed the figure is closer to £200 million, conceded an accurate figure would have to await an audit being carried out by the Department of Health.
His reforms are also looking to change rules so hospitals are no longer individually required to recoup money from other countries for treatment of their nationals - which has led some not to declare patients as foreign to avoid the burden. Fees could in future be collected centrally to remove the incentive to fiddle the figures. "We want to make sure we have a non-bureaucratic system in place so that where someone should be paying for their care, we actually do charge them and we do collect the money later," Mr Hunt told the BBC. "That's what most other countries manage. We are the most generous country in the world when it comes to that kind of thing." Asked about claims that costs would go up because of extra A&E visits, he pointed out that a £200 levy "would pay for about 1,000 GPs".
Shadow health minister Liz Kendall said: "In its three years in power, the Government has a poor record on announcing policies that sound good but prove to be completely unworkable. We will have many questions to ask about the details when they are published but the key tests for their proposals are: can they be properly enforced and will they save more money than they cost to put in place? The public and NHS staff must be confident that any new measures are about getting taxpayers a better deal and ensuring fairness, not playing politics with our NHS."