“The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practise a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.”
This is what founder of the health service Aneurin Bevan wrote in his book In Place of Fear in 1952. Yet in 2019 individuals are systematically being denied essential medical treatment due to their immigration status. Applying policies to deny people access to care drains resources and costs money in itself. This initiative is not logical, not civilised, and it’s not right.
Earlier this month Esayas Welday an Eritrean asylum seeker was denied cancer treatment after hospital staff forced premature discharge over his inability to pay. Mr Welday’s treatment was later resumed when it was realised that staff had made an error in stopping it but the distress this policy has caused has been significant. This is merely one recent example of which there are sadly many.
An impossible situation
There exists widespread ignorance and confusion in the NHS over how to implement government legislation when dealing with migrants. In October 2017 the government brought in legislation that applied a hostile approach to immigration, including healthcare. English trusts must now charge most undocumented migrants, including refused asylum seekers, upfront for many forms of hospital-based treatment such as maternity, paediatric and cancer care.
NHS staff are put in an impossible situation and can face disciplinary action or charges of fraud for treating a patient without the proven means or entitlements. A spokesperson from the organisation Docs Not Cops a group of NHS professionals and patients who campaign to end ID checks and charges, told Keep Our NHS Public:
“As healthcare workers we have a responsibility to fight for a system that is a safe, non-judgemental, and universally accessible space for anyone that needs to use it. Upfront charging, which involves billing migrants at 150% of the cost for a range of NHS services, and the introduction and then doubling of the NHS surcharge on visa applications, fundamentally undermines the founding principle of the NHS – that care should be provided on the basis of need, not ability to pay. Patient confidentiality and the provision of care without judgement are also undermined by data-sharing programmes between the NHS and Home Office. Together these policies erode trust and mean patients may delay or not seek medical advice, which threatens not only the health and lives of those individuals – but public health too.”
In December the Royal College of Physicians, the Royal College of Paediatrics and Child Health, the Royal College of Obstetricians and Gynaecologists and the Faculty of Public Health, representing over 70,000 doctors, urged the government to suspend regulations that force hospitals to charge overseas visitors upfront for NHS care. These organisations maintained that charges should not be enforced until a full independent review is undertaken of how they are affecting migrants’ access to healthcare. They said:
“The role of doctors in this process has the potential to damage the vital trust between us and our patients, and is likely to lead to poorer outcomes and contribute to already low morale in our profession.”
Migrants, along with other ill and vulnerable people, are being scapegoated to distract from nine years of government underfunding. Yet denying all of them treatment will not solve the NHS crisis, it will not even scratch the surface of what is really needed.
Migrant women are sometimes giving birth without access to any medical support - denying vital medical treatment is inhumane and dangerous. A recent Freedom of Information request by the Save Lewisham Hospital Campaign revealed that of 9,000 deliveries in 2017/18 in the two hospitals in Lewisham and Greenwich 541 women were charged whilst 1,100 were deemed eligible only after checks – 18% faced this challenge.
There are some organisations working hard to make sure migrants are not disadvantaged by these cruel policies, but their reach is limited. Doctors of the World provides a free clinic that helps migrants access healthcare and runs an accompanying advice line for those affected. They run a a safe surgeries project that supports existing GP surgeries to remove barriers to access healthcare. Dr Elizabeth Bates from the organisation told Keep Our NHS Public:
"‘Every day in our clinic we see the painful incompatibility of healthcare and border control. Last year, 89% of the patients we saw were not registered with a doctor. That’s why we’re working to support primary care doctors build Safe Surgeries - and keep immigration checks and other administrative barriers out of primary care. The asylum and immigration process in the UK is nuanced, complicated and most importantly – inconsistent...it seems illogical to allow somebody’s life to depend upon it."
Dispelling the myths
Central to depriving migrants NHS treatment is the belief that these ‘health tourists’ will bleed the system dry and that there are insufficient funds to allow for their care. However, the money spent on treating migrants amounts to less than the NHS office stationery budget. The Kings Fund estimates that health tourism costs the UK between £60 – 80 million per year. This compares to the annual NHS budget of £126 billion (2017 spend). It costs less than a tenth of one per cent of the total NHS budget.
Early intervention is also better for public health. The World Health Organisation considers it is more cost-effective long term to treat people so as to limit the impact of serious illnesses before they escalate. Treating conditions such as TB reduces any health threat to the host population. Dr Santino Severoni WHO Europe’s co-ordinator for public health and migration says:
“Countries tend to use costs as a justification of limiting or delaying healthcare access to newcomers or providing emergency access only, but this is not cost-effective – early identification costs less than delaying until absolutely necessary hospital treatment”.
The government must scrap these discriminatory rules imposed upon the NHS in order to reverse the hostile environment and to treat every patient the same. They should ensure no one suffers or dies due to being refused treatment. Staff must be able to do their job without fear of disciplinary action, and the national health service must be able to do what it was created for, namely to treat all regardless of situation or ability to pay. That is the social advance we are all surely most proud of, and one which is slowly being eroded by a government whose own ideology fundamentally disagrees with that democratic vision.
Samantha Wathen, Press and Media Officer for Keep our NHS Public
Keep Our NHS Public have a wealth of information on the subject of migration and access to healthcare. For further reading please visit our website.
For more information on Docs Not Cops please visit http://patientsnotpassports.co.uk/?fbclid=IwAR0GtluaQT0htayBwSsDH4KWV3M_jDCG9vZq9s3N6DuHcGebzhDrcRNXcmU