J. Meirion Thomas is a former Professor of Surgery and Consultant Surgeon in the NHS.

I have previously described the Immigration Health Surcharge (IHS) on this site as “a rotten deal for the NHS, patients and taxpayers”. This week, the Department of Health has announced a desperate last-minute rescue plan in an attempt to avoid an embarrassing, if inevitable failure of its Cost Recovery Programme.

In brief, migrants and students who came to live in UK for six months or more after April 2015 will have to pay the IHS a charge set at £200 for migrants and £150 for students, per person per year. This will be despite a report commissioned by the Government in 2013 which that estimated the cost of treating non-EU citizens in the NHS as £736 per person per year. Clearly, the IHS would need a huge taxpayer subsidy to cover the additional costs incurred.

But, of even greater risk to the taxpayer, the IHS did not exclude pre-existing illnesses, as would happen in any application for a commercial travel or health insurance policy. How utterly naiive and uninformed of those who drafted and failed to oppose this legistlation, which was included in the 2014 Immigration Act.

I argued at the time that the IHS was creating an obvious loophole for health tourists to exploit, and this has happened. It has become the legal way for health tourists from outside the EU to access NHS care. One of my Overseas Visitor Manager colleagues from an out-of-London hospital told me today: “Not a day goes by without a surcharged patient arriving at my hospital. They come as frequently as newly arrived Europeans, who are also entitled to immediate free NHS care. During the winter crisis, we only saw pictures of the elderly on trolleys, but migrants also take up vital hospital capacity”.

Embarrassed by its failure to control health tourism from outside the EU, the Government launched a Cost Recovery Programme in 2014 which was intended to collect £500 million annually by 2017-2018. Of this amount, £200 million was to come from the IHS, £200 million from better recovery of European Health Insurance Card charges and £100 million from a 50 per cent surcharge on invoiced health tourists.

In its evidence to the Public Accounts Committee (PAC) on October 28th 2016, the National Audit Office estimated that the Cost Recovery Programme would collect only £346 million of the £500 million target during 2017-2018, leaving a £154 million shortfall. Specifically, with regard to the IHS in 2015-2016, the surcharge generated £164 million of the £200 million intended. Meg Hillier, the Chair of PAC,  said that “the Government’s failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds”.

In response to this policy failure, last June’s Conservative Manifesto promised that the IHS would be trebled to £600/£450 if the party was re-elected: a promise the new Governmenr was forced to drop. And his week, the Department of Health announced that the IHS will be doubled to £400/£300 from “later this year”. They have recalculated the spend on surcharge payers as £470 per person per year, down from £736 as predicted by PREDERI in 2013. Really?

In truth, neither of these estimates is evidence-based. Once the IHS is paid, a “green banner” appears on the patient’s NHS records, and hospitals are not required to record or report the costs of treatment. Therefore, there is no way of calculating the cost to the NHS of treating surcharged patients in relation to the amount collected. Assuming that either of the two estimates of individual patient treatment costs are correct (£736 or £470), then the account is in serious deficit, at the taxpayer’s expense.

By April, the IHS will have been law for three years, and about 1.4million non-EU migrants and students will have been given unlimited access to the NHS for a pittance. The real risk to the tax payer is that the IHS does not exclude pre-exiting illnesses and that must change as a matter of urgency. Otherwise this flawed policy should be abolished and replaced by compulsory travel insurance as is expected of British citizens travelling abroad.