The case of Albert Thompson*, a 63-year-old man originally from Jamaica who has lived in the UK for 30 years being denied cancer treatment, has raised a worrying precedent that should worry all NHS workers and patients alike. Over the past year, NHS staff have been used as an unofficial arm of the immigration service. For those of us who work in the health service to help people in their hour or need, to demand to look at someone’s passport is anathema to why we chose to work in this sector. When I see a patient with a brain tumour, my instincts are not to ask where they were born, check their back accounts and look at their visa stamp.

I am a brain surgeon and putting me in a position where I distribute care according to an immigration status puts unnecessary strain on a patient relationship where trust must be established quickly and effectively. It also flies in the face of the underlying principle of the NHS.

Thompson has prostate cancer and needs radiotherapy. He currently lives in a hostel while his cancer goes untreated after being evicted from council housing when the Home Office questioned his immigration status. His situation was looked at by Theresa May who decided not to intervene, stating it was a matter for his hospital – the Royal Marsden in London. Thompson has paid taxes for 30 years.

His situation raises the spectre of another problem as yet not considered in the current discourse – one I have not encountered during my practice as a doctor in the UK for 10 years. Such a problem is illustrated by a case I was involved with, however, in India, where I regularly go back to talk to patients with poor access to healthcare.

Four years ago, I saw a patient in my home state of Assam in the north-east of that country called Horen. He was a thin wiry man in his mid-50s who worked as a manual labourer. His salary was equivalent to £80 per month. He had been diagnosed with a very aggressive brain tumour, had undergone surgery and made a very good recovery – and he showed me his scans (on film – no computer or electronic records in remote rural Assam).

As I held up his pre-operative film to the sliver of sunlight creaking into the dark room we were sat in, my heart sank. This was a large tumour that Horen had no hope of surviving. His surgeon had fought a valiant battle and taken as much could be safely taken while ensuring Horen remained with as little disability as possible.

While I was peering at the film, with the dust dancing and forming a halo around the blue-black plastic, Horen’s husky-voiced Assamese asked me the question that jerked me back to the reality of his situation. “My doctor says I can have radiotherapy, but I don’t know whether I should pay for it or not. How much time will it give me if I pay for it? It’s a lot of money that I can give to my son or daughter.”

Seven years of working in the NHS at that point had made me forget about such dilemmas. Payment was not an issue for those I treated. Horen sat opposite to me, back at work just a few weeks after major brain surgery; he faced this decision in a context of very limited funds, even by Indian standards.

I was frank with him. Horen deserved to know the truth so he could make his decisions as fully informed as possible. Radiotherapy would give him a few months at best. Horen nodded as I confirmed what he had already worked out for himself. His eyes took on a familiar look, one I’ve witnessed in too many patients over the years.

He nodded with finality. “This money is for my family,” he said. He thanked me for my time and left, his shoulders more hunched than before, as if weighed down by his decision. Horen represented the reality for so many in Assam – money for a family’s future or an extension of life.

His choice raises ethical questions that all will find tough to answer. His answer and the virtue of its decision is a matter forhis surviving family. But the dilemma, after what we have witnessed with Thompson’s situation, is no longer a developing world problem.

The NHS already rations its treatment, and to argue otherwise ignores the reality of healthcare in the UK in 2018. The Royal Marsden has argued that in Thompson’s case radiotherapy is not urgent and therefore requires payment. Such an argument is the first step in applying the same logic to all patients, regardless of passport.

At which point, Horen’s choice hangs over every person in the UK – what price our health, what price the limited time we have left? What matters more: more time for ourselves or our family’s future?

*Albert Thompson and Horen are pseudonyms

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