As a caseworker working on the front line, I witness first-hand some of the barriers that make it difficult for refugee friends to access quality healthcare. This can range from having difficulty registering with a GP where a friend cannot provide proof of address or ID, to being charged thousands of pounds for urgent NHS care.
What is NHS Charging?
NHS charging is the phenomenon by which someone without leave to remain (except asylum seekers and refused asylum seekers in receipt of Home Office support) are chargeable for secondary healthcare provided by the NHS.
Secondary Care refers to specialised care that often needs referrals from primary carer workers such as GPs, dentists and pharmacists. This includes services that are vital for the vulnerable group of refugee friends we work with -including mental health, maternity care and specialist hospitals. Care/treatment that is deemed ‘immediate and necessary’ is provided first and then the person will be charged afterwards.
In one such case, I recall one of refugee friends had a fall and went to A&E. The doctors referred immediately for surgery on her knee. She was later charged for this treatment, leaving her with a debt of a few thousand pounds. She was so distraught with how she would repay this, she said she would not go to the doctor again.
Often what we see is refugee friends will undergo a critical operation or test at a specialist hospital and then they will be left with a hefty medical bill that can often run into the thousands of pounds.
Why was it introduced?
In part, NHS charging was introduced to counter “health tourism” (the scale of which is highly contested).1 The other more sinister reason is that NHS charging is part of the measures used to enforce the “hostile environment” and create additional pressure on undocumented migrants, including refused asylum seekers, to encourage them to leave the UK.
“Sometimes, if you don’t have immigration status, you have to pay. And the Home Office gets people’s data from the hospitals. I have known people who are too scared to get help when they’re sick because they are afraid the hospital will pass their details to the Home Office and they’ll be deported.
By the time they go to hospital, it’s too late. And I have been scared of this myself. There was a day when I received a letter from the GP about an appointment. I had also received a letter from immigration enforcement saying they were reviewing my case. I was worried the appointment was a trap.”
Peter
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In addition, people experiencing the hostile environment will have no right to work, claim benefits or rent accommodation- effectively rendering them destitute with none of the statutory safeguards that a British or settled person would have.
What impact does this have?
This enforced destitution consequently increases vulnerability and this can in turn magnify the need for more specialised care. This because the hostile environment means people could be rough sleeping or living under insecure housing arrangements with frequent moves, increasing stress and mental health issues as well as the risk of being exploited.
“When you are on the streets, you cannot eat when or what you want, you cannot follow your medical treatment precisely, you can’t shower, you can’t wash your clothes and dress properly. You can just drop dead anytime when you don’t have accommodation. Everyone needs somewhere to rest and feel safe”
Joyce, Destitute and in Danger
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In addition, not only are these bills difficult if not impossible to repay for people experiencing destitution but they can also adversely impact any future immigration application refugee friends make.
As JRS UK is not a debt advice service, a lot of our work involves referring refugee friends with substantial NHS charges to access advice on their debts. This could mean a refugee friend might be obliged to make an agreement with the hospital to repay the debt in many instalments to prevent the hospital from reporting to the Home Office.
Even worse, it could stop refugee friends going to get medical treatment all together. I have heard friends who have been charged say that they would be reticent to go again to the doctor as they don’t want to end up with another bill. This could mean vital check-ups and emergency treatments are missed.
It is well documented that NHS charging is dangerous and unworkable. A Doctor’s of the World Report in 2020 reported on the devastating impact and found that “medical care charges are being applied to those least able to pay – people who are homeless, destitute, and already struggling to meet their basic needs – as well as those with a legal barrier to removal from the UK, which means the patient cannot travel to another country to seek treatment.”2
It is clear that it is fundamental for to rethink NHS charging as it negatively impacting the most vulnerable in our society.
Read Destitute and in Danger report
1-www.jrsuk.net/news/new-nhs-charges-strip-healthcare-from-asylum-seekers-made-destitute-by-government-policy/
2- www.doctorsoftheworld.org.uk/news/press-release-new-report-reveals-the-devastating-impact-of-nhs-charging-on-migrants-in-vulnerable-circumstances/
