Monday, August 11, 2008

"GPs demand right to treat refugees"

I have written before upon the rights of non-UK citizens residents to medical treatment under the free UK National Health Service. The GPs (primary care) do not want to police immigration status.

Although a full UK Citizen, you are not entitled to free NHS treatment, whether primary or secondary, unless you have been "ordinarily resident" in the UK for six months. Exception - Accident and Emergency. If A&E pass you (non-UK "ordinarily resident") on to secondary care, the local Primary Care Trust where you were admitted can charge you for secondary care treatment.

Kezia's first visit to the UK was to A&E from which five hours later she passed to secondary care.

So, as I have stated before, we are lucky that the bean-counter at our local PCT did not understand the complex regulations or is extremely sympathetic.

In 2004 the Department of Health (DoH) began a review and consultation of free NHS treatment of "failed" asylum seekers. One may be a "failed" asylum seeker but remain in the UK for several reasons ...

- you are appealing.

- the situation in your country of origin has radically changed (vis Zimbabwe or last week's coups in Mauritania and Guinea-Bissau)

etc etc ...

... you will not be immediately put on a plane.

"In April 2004, ‘Statutory Instrument 614’ was enacted by the Department of Health1. This meant that those classed as ‘not lawfully resident' in the UK, including vulnerable migrant groups such as victims of trafficking and other undocumented migrants, were no longer, with a number of important exemptions, eligible for free NHS hospital care. Until April 2008, asylum seekers whose claims had been refused were also being denied hospital care.

However, a judicial review by Mr Justice Mitting found this group to be ordinarily resident and thus eligible for free NHS care. The Government has appealed this decision, with the hearing scheduled for mid-November. However, for now, failed asylum seekers should be able to access these services.

The 2004 changes in access to secondary care were soon followed by a consultation examining proposals to extend the new rules to limit access to primary care. The stated intention of the proposed regulations was to reduce ‘health tourism’ - overseas visitors arriving in the UK with the sole purpose of exploiting NHS services. The results of this consultation were never released.

In March 2007, a Home Office paper ‘Enforcing the Rules’ was released. It examined access to public services by ‘overseas visitors’. The document stated 'Illegal migrants are unlikely to place a great strain on the NHS as most are thought to be young and therefore relatively healthy' (page 13). However, it suggested the denial of services could be used to deter undocumented migrants from entering the country and to encourage refused asylum seekers to leave.

The issue of charging foreign nationals for care is currently being revisited by the Government. A review of their findings is expected soon. It is expected that this will lead to changes in the regulations governing entitlement to NHS primary healthcare services."

The Global Health Advocacy Project and Medsin are leading the campaign against the government's November judicial appeal.

The Global Health Advocacy Project and Medsin requested through the provisions of the Freedom of Information Act access to the responses of the 2004 consultation. They were not granted access to the responses, but were given a list of those who responded.

The Global Health Advocacy Project and Medsin have since approached those who responded to the original consultation to allow them to see their responses. I am disappointed to see that notable cancer and leukaeimia organisations were not included in the original consultation exercise: Leukaemia Research Foundation, CLIC Sergeant, ACLT, Antony Nolan Trust, Macmillan etc etc.

However, amongst those who responded to the Global Health Advocacy Project, notable concerns raised were as follows:

1. Seventy five percent of submissions from healthcare providers expressed concern that denying care would place them in breach of professional codes of conduct. Many were concerned that questioning patients about their immigration status could damage the doctor patient relationship.

2. Sixty eight percent of submissions expressed concerns regarding the public health impact of the proposals, particularly the risk that the delayed detection and treatment of infectious diseases would constitute a risk to public health.

3. It was stressed that certain groups were particularly vulnerable and concerns were raised about the potential impact of the proposals on children and pregnant women. The majority of respondents felt refused asylum seekers, settled in the UK, were not 'overseas visitors', rather they were a vulnerable group who should not fall within the scope of the proposals.

4. Eighty seven percent raised concerns about the workability of the proposals. These included the challenge of requiring front-line healthcare workers or NHS administrators to determine immigration status.

5. Fifty five percent of respondents were concerned about the cost effectiveness of the proposals. Many felt that administrative costs incurred, as well as the costs associated with an inevitable increase in the uptake of expensive emergency services, would exceed any savings made in primary care. Some highlighted the Government's failure to undertake a cost-benefit analysis of the proposals.

6. A number of respondents thought the implementation of these proposals would lead to discrimination, social marginalisation and damage to the public perception of migrant communities. Some called for a full race impact assessment prior to any implementation of the proposals.

7. Twenty nine percent of submissions expressed concerns that the proposals would violate several international human rights agreements and therefore be open to legal challenge.

8. Whilst five submissions were broadly supportive of the proposals, seeing the current situation as lacking clarity, these submissions all contained concerns. One of these respondents contacted us to inform us that their organisation no longer held the views expressed in their submission; another submission called for vulnerable migrant groups to be excluded from the proposals. Others were concerned about the practicality of the proposals.

Whilst we acknowledge our sample may be biased, the concerns raised are valid and important. It is vital that the Department of Health address these points before moving ahead with further policy change. We call upon them to release the remaining two hundred and thirty six submissions in order that these valuable expert opinions are available to inform public debate and policy.

Our full conclusions and recommendations can be found towards the end of the document. Our recommendations include:

1. We suggest denial of healthcare should not be used as a means of enforcing immigration policy.

2. We recommend the Government reconsider leaving any community unable to access primary care as this could undermine efforts to tackle infectious diseases.

3. We recommend refused asylum seekers fall outside the remit of these proposals.

4. Front line healthcare workers and administrative staff have insufficient knowledge
of the asylum process to implement these proposals.

5. Government must recognise that administering a charging regime would place a significant burden on front line NHS services.

6. We recommend the Government undertake a full cost benefit analysis of both proposed and existing NHS charging regulations.

The Department of Health has been under increasing pressure from the Home Office (responsible for the state budget and immigration) to cut - and want to leave some of the most vulnerable members of UK society without basic healthcare. The DoH has never published the findings of this consultation.

I would not oblige our readers to go though the whole 60+ pages of the Global Health Advocacy Project and Medsin report but please read this article from last Sunday's Observer (sibling edition of The Guardian). I cannot put the medical profession's opinion more succinctly than this article, but If you cannot be bothered to go read either the whole report or even the Observer article, there are two major objections from the medical profession. And please sign the petition here.

1. It is unethical. It goes against the General Medical Council's (state medical regulatory body for doctors) Code of Ethics and ip so the "Hippocratic Oath".

2. If GPs are not allowed to treat, vaccinate etc, then non-deported rejected asylum seekers will spread the risk of preventable disease to the entire population.

The only exception under government and NHS rules are if the patient turns up at A & E ... I am happy we took Kezia to A & E ...

There are few countries in the world (excepting the EU) for which a visa to enter the UK is not required. Is it not too much to ask that with each visa application to enter the UK, the local UK Embassy requests a health certificate from an embassy-approved physician ?

‘Our members believe that denying proper medical care will seriously impede some clients from exercising their rights to enjoy a reasonable family or private life. Denial of treatment to one family member, for example the husband of a British-born wife and father of British children, who is applying for leave to remain with his family, will impact on others. They also doubt whether a court would find it proportionate to deny treatment which for instance would enable a child to walk with assistance in order to attend school and be part of thec ommunity when he or she had been born in this country and had played no part in his or her parent’s illegal entry to the UK.

Immigration Law Practitioners Association

Is Kezia a Health Tourist?

"Freedom of Information...can be inconvenient, at times frustrating and indeed embarrassing for governments. But Freedom of Information is the right course because government belongs to the people, not the politicians [...] Public information does not belong to Government, it belongs to the public on whose behalf government is conducted.

Wherever possible that should be the guiding principle behind the implementation of our Freedom of Information Act."

Gordon Brown, 27 October 2007

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