NHS implications of the hostile environment

Zia Yusuf has reiterated Reform’s plans to link NHS data to immigration enforcement. This is not something I oppose in principle, but I do wonder how much thought has gone into this policy. It’s been tried before and met maximum resistance from the BMA. Immigration status is difficult for hospitals to screen, while GPs have refused to collect such data.

I think it’s going to require an overhaul of the funding model for GPs to overcome the institutional resistance. Without a detailed plan, this policy will not survive first contact with the NHS. It will probably end up bogged down in lawfare (in or out of the ECHR).

One thing you tend to notice (if you do any kind of research) is that many of the policy proposals of the slop right have been tried before - from prisoners picking up litter to using hospital data to track illegal immigrants, and you find they meet a lot of internal resistance - either for practical or political reasons. As such, before you even begin to implement such polices you need to anticipate where exactly the resistance and opposition will come from, and take steps to head it off at the pass.

The problem is that the slop right doesn’t do this kind of thinking and will thus fail as many have before. This is why you shouldn’t accept lazy slop from political parties, because if they haven’t done the hard yards on policy, there is no reason to believe they can actually accomplish anything with power.

Some suggest that we could link to a legal requirement for an NHS number and/or national insurance details to be input for any service for accountancy purposes and cost claiming from NHS.

This, though, is quite the minefield. Leaving aside the additional NHS bureaucracy and obstacles for those entitled to treatment, it’s also another step towards digital ID and integrated government systems - which the populist right opposes.

I’m not saying there’s no way to crack this nut, and I’m of the view that previous attempts have failed because governments have lacked the political will to take on the NHS blob, but even with iron will, I don’t see that this is straightforward.

I think, though, that it’s going to require a broader reform of the GP system, taking into account leakage caused by illegal immigration, but as much to solve the systemic dysfunction. Instead, though, I think we’re going to see more fiddling around the edges. This is certainly the case with Restore. They’re looking to publish a paper on banning non-stun slaughter, when it actually requires a major overhaul of the meat industry and the SPS system if any sort of ban is to be effective.

Given the scale of reforms required to tackle the NHS problem it’s probably not going to be the first port of call and will take time to yield any real results (if at all). This is why order of execution is as important as spelling out your policy plans. If, though, Yusuf thinks it’s as simple as winning an election and barking orders at civil servants, he will get nowhere.