The Bristol Cable

Yet another part of Theresa May’s ‘hostile environment’ policy – but NHS staff are fighting back.

Illustration: Sam Knock

Amina, a disabled asylum seeker who walks with a zimmer frame, has been waiting for three years for her replacement knee. She eventually got a date, only for it to be cancelled literally as the surgeons were drawing the line on her leg.

The Home Office had just refused to grant her refugee status and had informed the hospital. She would now be obliged to pay up or get out. While Amina was seeking asylum she was entitled to free healthcare, but as soon as the Home Office refused her application she was subject to extortionate charges that further disabled her. She believes that the timing was no coincidence.

“I was told to pay £6,000 per knee, but I am not allowed to work and I live on £37 per week”

“I was told to pay £6,000 per knee,” she says, “but I am not allowed to work and I live on £37 per week.” A year later, although she would be eligible again for the care, she is still on the waiting list and struggling to access vital support services.

Such charges for migrants in the NHS are a key pillar of the ‘hostile environment’, the harsh regime of immigration policies introduced by Theresa May when she was Home Secretary. Since April, patients are required to prove they are eligible for treatment that is not deemed “immediately necessary”, or pay upfront.

The Department of Health claim that these new regulations reduce “hostility or misconception about what visitors and migrants receive at the expense of the taxpayers”. However, there is evidence that the policies are discriminatory, inefficient and undermining staff and the basis of the NHS itself. The former chief executive of NHS England David Nicholson has described the current charging regime as “nothing short of a national scandal based on fake evidence” while others see it as yet another back door attempt at privatisation.

Racial profiling in the waiting room

Similar to the Police or Immigration Enforcement’s use of stop and search, these status checks are likely to have a disproportionate impact on people who look or sound ‘foreign’. Although the government have produced an Equalities Impact Assessment looking at the risks of the policy, they have refused to make it public.

However, there are previous examples of how related policies have affected certain groups. In 2015, the Department of Health admitted that ”non-white people or people for whom English is not their first language are, on some occasions, targeted in the application of the 2011 regulations due to speculation or assumption that they are not resident in the UK.”

“It definitely felt like racial profiling, if she was white they wouldn’t have spoken to her like that”

As the the Windrush scandal revealed, the need to prove eligibility can sometimes result in major injustices, for example because millions in the UK do not have a passport. Stories are already beginning to emerge.

Born in Zambia, Frances has been a UK resident for her entire adult life and worked for 10 years in the NHS as a midwife.

In December 2017 she was visiting Bristol and was admitted for treatment at A&E. The morning after admission she was asked by staff, in front of other patients, whether her children had brought her to the UK from Africa for treatment.

“It being the Christmas period, they couldn’t locate her NHS number so it took a week to resolve,” her daughter explained. “As well as dealing with the stress of mum being in hospital, we didn’t know if the operation was not happening because of medical reasons, lack of capacity or because she hadn’t passed the test for free care yet. It definitely felt like racial profiling, if she was white they wouldn’t have spoken to her like that.”

Such encounters and the confusion around their implementation may deter people from accessing care, with potentially tragic results, both to the individual and to wider public health.

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Adam Hundt, a Bristol solicitor at leading human rights law firm Deighton Pierce Glynn, thinks this is exactly what the new laws are intended for. Hundt said: “If these regulations deter migrants from seeking healthcare through the NHS then the government will have achieved their objective.”

The tactics seem to be working.

The national AIDS Trust has found that migrants who are HIV+ are delaying seeking treatment, risking the spread of infectious diseases. Even though patients with HIV are not required to pay, the fear factor is pushing people away from accessing healthcare.

The GP-led charity Doctors of the World have launched a ‘Safe Surgeries’ campaign after finding that patients are being wrongfully turned away 20% of the time despite being fully entitled to visit the doctor.

What NHS services are free and what can be charged for?

Free for everyone: Gps, Accident & Emergency services, NHS walk-in centres and minor injury units, plus treatment for contagious diseases such as TB or HIV.

Chargeable for anyone not “ordinarily resident”, including refused asylum seekers and others under immigration control: Planned care in a hospital or clinic, referrals by a GP or from A&E, community healthcare, mental health services, termination of pregnancy, community midwifery, and drug and alcohol services

A false economy

The government argues that these charges can reduce “health tourism” and improve NHS services. But the figures don’t seem to back this up. The Cable found that North Bristol Trust spent more chasing down the charges than they recovered, resulting in a £75,000 loss for the NHS.

According to researchers, about 0.3% of the NHS’s total budget at most is spent on “health tourism” with one Labour politician calling it an inefficient policy “designed to show the government is tough on immigration”.

The government’s own estimates of the amount of money that can be saved through excluding migrants do not take into account the cost of the infrastructure to implement checks across the board. Furthermore, from a public health and cost perspective it is always more efficient to get the right care early on, rather than wait for something to become an emergency before it is treated.

More pressure on already struggling staff and a fightback

And it’s not just patients that are suffering, says Peggy Woodward, a retired midwife and campaigner with Bristol activists Protect Our NHS. “They are turning healthcare workers into border guards in an attempt to distract from underfunding of NHS services. It is a further stress on staff,” at a time when stress among Bristol’s NHS workers has soared.

Many NHS workers oppose the charges because it goes against the fundamentals of their commitment to treating patients equally. Across the political spectrum, people have been getting organised and fighting back.

Docs not Cops are a national campaign led by healthcare workers, who have taken action including blocking the Department of Health with a makeshift immigration checkpoint, and successful social media campaigns such as #patientsnotpassports.

In Bristol, the Care Workers Network are an independent union that act in solidarity with workers who want to challenge and defy these policies. There are also legal challenges, and an open letter signed by hundreds of health professionals, which has forced an ongoing Department of Health review into the impact of the changes on “vulnerable groups”. Groups across the UK are calling for the regulations to be scrapped.

As the outrage surrounding the treatment of the Windrush generation wanes, campaigners are working to ensure public scrutiny stays fixed on the scorched earth ‘hostile environment’ approach of the government despite its effects on the NHS itself.

As journalist Gary Younge said, “No claim about the strain that immigrants place on the NHS can be taken seriously without a concomitant appreciation of the strain it would be under were it not for the immigrants working in it.”

*Names have been changed to protect the individuals featured in this piece.

Find out more here: 

Docs Not Cops

Doctors of the World

Joint Council for the Welfare of Immigrants

Read more on: health, immigration enforcement...

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