Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

Rather than use World Health Day to draw attention to global health priorities, this year, healthcare providers are being asked to implement racist government policies and compromise our professional values. Earlier this year, health minister Jeremy Hunt announced that, from April 2017, NHS trusts would be legally obliged to check patients’ eligibility for NHS services upfront, and to demand payment before providing care.

These checks lead to racial profiling and will prevent those most in need of care from getting the treatment they need. This is already evident with pregnant women delaying or avoiding seeking necessary medical advice or treatment because of fears they will be unable to pay or will be reported to the Home Office.

As doctors, we are acutely aware of the devastating impacts of delayed medical attention. In my field – obstetrics and gynaecology – we know that getting the right care at the right time is critically important for the health of women and their babies. In 2014, a woman thought to be carrying a dead foetus declined induction of labour because she feared she would be denied re-entry into the UK if she was unable to pay her bill of thousands of pounds.

The amount of money [lost to "health tourism"] is a drop in the ocean for the NHS

Dena Bryant, a lifelong resident of Grantham, had her eligibility for care at her local hospital questioned by a nurse who justified her questioning because Bryant was “not white” and did not “look English”.

The reality is that these policies represent yet another instance of the government attempting to blame migrants for the devastating impact of their austerity agenda. The Department of Health’s own estimate is that “deliberate health tourism” costs at most 0.3% of the NHS budget annually. This amount of money is a drop in the ocean for the NHS, while a £5,000 charge may be everything to a patient seeking treatment.

We should be concerned about the sustainability of NHS funding, but this focus is a distraction from the real issues, such as the billions of pounds spent annually on PFI repayments. Checking passports at the point of care will not rectify budget concerns, and directly contradicts the values on which the NHS was founded. We are being asked to prioritise recouping costs over providing care to those who need it.

Docs not Cops, a group comprised of NHS staff and patients, has been campaigning against these changes. On Wednesday, the group blocked the entrance to the Department of Health with a makeshift immigration checkpoint. We believe everyone has a right to access the healthcare they need, regardless of their immigration status or ability to pay. NHS workers should not be forced to police the people we treat.

The relationship between the doctor or health professional and a patient relies on respect and trust. A policy that demands we verify eligibility and report ineligible patients prioritises money over care, and jeopardises the relationship between a patient and their care provider. As a doctor, the Declaration of Geneva and the International Code of Medical Ethics require that my patient is my first consideration, and declares that I owe my patients complete loyalty. Policing people seeking my care would directly contravene these guidelines that say we cannot allow race, ethnic origin, or social standing, among other characteristics, to intervene between our duty and our patient.

As NHS staff and patients we will continue to fight divisive policies that fuel racism and threaten the values on which our NHS was built. Docs Not Cops is working with groups around the country to build a network of sanctuary GP surgeries, hospitals and wards. These would be sites of non-compliance with ID checks. We encourage wards, GP surgeries and individuals to sign a pledge to never ask to see ID or deny anyone healthcare, and to sign our petition calling for an end to bedside charging.

The National Health Service was built on the principle that healthcare is a right not a privilege. Almost 70 years after its inception, we are here to demand that this core principle remains.

Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

Can we - and should we - make laws against cancer? | BERNARD STEWART

Despite extraordinary advances in medical science, we won’t beat cancer with treatments alone. We need new legislation that will force us to ask ourselves many very difficult questions about what aspects of our daily lives we are willing regulate to help turn back the rising tide of cancer diagnoses and deaths worldwide.

In Australia, we have already taken a global lead on plain packaging for cigarettes and, four decades or so after the devastating link to mesothelioma and other cancers was first observed, the world looks set to finally legislate against asbestos. But what about banning supersized soft drinks, as was attempted last year in New York, or taxing sugar in soft drinks, currently on the cards in Brazil?

And, what should we be doing right now about the emissions from diesel fuel? Sales of diesel vehicles in Australia tripled over the last 10 years but the world’s most pre-eminent authority on cancer, the International Agency for Research on Cancer (IARC), issued an unequivocal “carcinogenic to humans” classification in 2012 based on internationally verified and accepted scientific evidence that diesel emissions cause lung cancer and increase risks for bladder cancer.

The World Cancer Report published today by the World Health Organisation reveals the global cancer burden is growing alarmingly and threatens to overwhelm healthcare systems in high income countries and developing countries alike.

Although the causes of some cancers – cancers of the brain, of the ovary and of the blood (leukaemia), for example – are largely unknown or poorly understood, the vast knowledge we now have about cancer tells us that most adult cancers are a consequence of personal choice. The risks of some of those choices are now widely understood; like smoking, excessive sun exposure and solariums. Some cancers cannot be identified with particular carcinogens, but still involve personal choice, like the multitude of minor everyday decisions we all make around food, exercise, lifestyle and alcohol that can add up to obesity and poor fitness. Choices around alcohol too are important. Higher risks of breast cancer and excessive drinking are linked. Others risks are out of the hands of most individuals, like exposure to environmental carcinogens, but not out reach of the governments we individuals elect.

It is true that there’s also plenty of good news to be had in the cancer field. Exponential advances in cancer treatment and care are saving lives and reducing suffering in the communities that can afford them. But, given the extent of the cancer challenge – a global US$ 1.16 trillion economic burden alone in 2010 – it is regulations and laws to influence behaviour that will likely prove our most effective weapon.

We already know regulation works because of the success we’ve had – particularly in Australia – against the major known cause of cancer: tobacco smoking. Because cancer occurs years, and often decades after exposure to carcinogens, preventive measures may take years to show an effect. In the case of smoking, those years have passed and the outcome is clear. Decades after “Every cigarette is doing you damage” was first heard, smoking rates and lung cancer rates are successively down. It was not just the slogan that worked. Success in Australia and some other countries came down to a raft of legislation restricting the availability of cigarettes, banning advertising in all its forms and increasing prices.

Legislative and regulatory measures to discourage use of tobacco are now proven to the extent that their adoption worldwide is subject to the first international treaty to be negotiated through World Health Organization, The Framework Convention on Tobacco Control. Worldwide, there’s still much to be done, but the path forward is clear. That prospect must invite consideration of how legislation could address cancer causes commonly identified with lifestyle.

Beer, wine and spirits are legal products, as are cigarettes. Outright bans are not the subject of credible debate. However, the impact on the community from irresponsible use of alcohol is well known. That burden is already being addressed by legislation, mainly in response to concerns over alcohol fuelled violence, although no-one recognises this as cancer control.

If such legislative measures around alcohol are acceptable, what of, for example, the availability of sugar-sweetened soft drinks? Soft drinks are proven to contribute to overweight/obesity and excessive consumption increases the risk of chronic disease. Are legislative initiatives around advertising, volume size and/or the imposition of tax acceptable, or even essential, when they promise to deliver better general health, reduced diabetes and less cancer?

When the first legislative measures were considered around smoking, the challenge seemed insurmountable. Legislating against less clear cut personal choices seems ever more complicated and, to date, health issues have been sidelined by a louder debate over personal choice and freedom and condemnation of the “nanny state”.

But, the bottom line is can we – and should we – be making laws against cancer? In my opinion, given the clear upwards trajectory of cancer worldwide it is the hallmark of an informed and caring society that we do.

Can we - and should we - make laws against cancer? | BERNARD STEWART