“It cannot be a coincidence that 2004 — the year in which A&E attendance jumped so noticeably — was the year that Labour changed GPs’ contracts to let them opt out of out-of-hours care, and also the year that east European countries…acceded to the EU, allowing their people free migration to the UK.”
Chris Skidmore MP, 2 June 2013
Conservative backbencher Chris Skidmore provoked an angry response from Labour this week when he suggested that immigration may be partly to blame for soaring demand at accident and emergency departments.
Mr Skidmore, who sits on the Commons select committee on health, put the theory forward in a Daily Mail article headlined “How soaring immigration has piled on the pressure”.
He wrote: “Crucially, there are concerns that the extra demands placed upon A&E also stem from a rise in immigration.
“It cannot be a coincidence that 2004 — the year in which A&E attendance jumped so noticeably — was the year that Labour changed GPs’ contracts to let them opt out of out-of-hours care, and also the year that east European countries such as Poland and the Czech Republic acceded to the EU, allowing their people free migration to the UK.”
Shadow health secretary Andy Burnham tweeted that Mr Skidmore’s argument was “beneath contempt”.
Mr Skidmore is correct to say that immigration from eastern European countries rose sharply after 2004, when Estonia, Latvia, Lithuania, Poland, the Czech Republic, Slovakia, Hungary and Slovenia joined the EU and were given access to the UK labour market.
Net migration from these “A8” countries rose by perhaps 800,000 people between 2001 and 2011, according to ONS estimates.
It’s also right to say that accident and emergency admissions rose during the same period. That’s about all we agree with.
Mr Skidmore says: “Between 1987 and 2003, attendances at A&E remained steady, with around 14 million people each year. Then, in 2004, the numbers jumped by 18 per cent to 16.5 million. By last year, the figure was 21.7 million — a 50 per cent increase in 10 years.”
Those are indeed the figures, but as John Appleby from NHS think tank the King’s Fund has pointed out, this sudden rise in 2003/04 is probably due to a change in the way the data was recorded.
Mr Appleby writes: “Much of the increase in 2003/4 was due to previously unrecorded attendances now being collected.”
How about the idea that the rise in A&E attendance that we see since 2003/04 was driven by immigrants?
There’s simply no evidence that this is true. The NHS does not record the nationality of people who turn up at emergency units.
But there is some evidence immigrants are less likely to access NHS services than British-born citizens, because they tend to be younger and healthier.
In his article, Mr Skidmore quotes research from the Nuffield Trust which shows that the number of migrants registering with GPs is going up.
But he fails to quote the very next sentence in researcher Adam Steventon’s blog on the subject: “We found that the group of probable immigrants used hospital care relatively rarely – in fact, admission rates were around half that of English-born people of the same age and sex.
“The patterns of lower admission rates among international migrants to England persisted for at least three years after their initial registration with a GP.
“And they were similar for three different cohorts of international migrants that we studied (arrivals in 2003/4, 2004/5 and 2005/6) – so before and after the eastwards expansion of the European Union in May 2004.”
This research isn’t perfect: it looked at hospital admissions, not A&E specifically, and the Nuffield Trust had to do some detective work to identify probable migrants in the figures.
But the findings chimed with other analyses carried out in other European countries including Norway and Germany: immigrants tend to go to hospital less.
Mr Steventon suggests three possible explanations for this, none of which are likely to please Mr Skidmore: people who migrate are generally healthier than average; international immigrants tend to return to their country of origin when they need healthcare; some migrants will find it harder to access services here than English-born people.
The backbencher also quotes from a UK Border Agency study into the impact of migration which quoted from a survey of 700 migrants of whom only half had registered with a GP.
Again, he only quotes part of the evidence, failing to mention these conclusions from the same paper: “There is some evidence of disproportionate use of accident and emergency services as a substitute for primary care, but there is limited evidence of additional strain on these services.
“Migrants are generally healthier than average, compared to non-migrants in their countries of origin and in the UK.”
And of course migrant workers contribute to the NHS by working for it: about 30 per cent of health workers are foreign-born.
Labour’s shadow immigration minister tweeted: “Chris Skidmore’s argument about A&E and immigration was a disgrace, not based on evidenced facts, but on surmise, anecdote and prejudice.”
We’re not going to go that far, although we don’t think there is any hard evidence of a link between immigration from eastern Europe and increased A&E attendances.
Mr Skidmore does quote some important anecdotal evidence from Dr John Heyworth, president of the College of Emergency Medicine, who has talked about “increases in the number of immigrants who tend to visit A&E routinely and not register with family doctors”.
Dr Heyworth is not the only doctor to make this point – but we don’t know whether we are talking about significant numbers of people, enough to seriously add to the pressure on emergency rooms.
The Department of Health told us that Mr Skidmore’s views on this do not representing the government’s official stance.
The Health Secretary, Jeremy Hunt, has not focused on immigration, preferring to highlight Labour’s changes to out-of-hours care in 2004 as one of the main drivers of pressure on A&E.
By Patrick Worrall