We are all familiar with the phenomena of ‘health tourism’; the former Labour government’s notion that planes laden with sick foreigners are constantly landing on our shores. An invading army of the seriously ill, collapsing off the plane into a land of free dialysis units, first world cancer treatment and free (yes, free!) medical care. But is this really the truth and how do we separate fact from myth? In a time of jittery economic reform and looming upheaval in our National Health Service, should claims like those of ‘health tourism’ be immune to scrutiny and objective reasoning? For those migrants that are in the UK under the current Coalition government, where exactly do they stand with regards to access to health care?
There remain clear differences between access to primary (medical services received in your local community, usually through your GP) and secondary (hospital treatment and ongoing care) health care. Under UK law all asylum seekers, those granted Discretionary Leave to Remain or Humanitarian Protection, are entitled to free primary and secondary health care. Failed asylum seekers, undocumented migrants and irregular entrants to the UK are eligible for primary health care at the discretion of the GP, regardless of immigration status. Provided a GP Surgery has space on its books for new patients, a GP has the discretion to register any new patient, regardless of immigration status and provided they do not discriminate. Therefore a refusal to register or treat a new patient on the grounds of their immigration status or documentation is a clear violation of Article 14 (Ban on Discrimination) of the UK Human Rights Act, 1998. In refusing to offer health services or by offering lower standards of care, based on the immigration status or nationality of a new patient, GP surgeries are at risk of also violating the Race Relations Act 1976. Due to poor guidance from Primary Care Trusts and under financial pressure, many GP practices across the country are wrongfully demanding proof of immigration status when registering new patients. Other barriers that exist in restricting migrants’ access to health care in the UK include language barriers, lack of knowledge of the NHS, institutional racism, and the lack of cultural competence of NHS systems and staff.
It is difficult to quantify undocumented migrants, but current estimates put the figure around 725,000, just over 1% of the population. Of the total NHS budget of £120 billion, undocumented workers would consume around 1%, or just over £1 billion pounds a year. Sounds like a lot of money, especially in “the age of austerity”. But this only tells one side of the story. To give one example, in 2008 patients across the UK failed to turn up for over six million hospital appointments, 911,000 GP consultations and 264,000 practice nurse appointments, a combined cost of nearly £1 billion pounds. You be surprised how much more money was available if we actually all turned up!
The real issue with regards to migrant health in the UK however, is in understanding the benefits of treating people early through effective and available primary health care. These benefits are both real and needed by the NHS, which is already struggling to cut £20 billion by 2014, as demanded by the Coalition government. Whatever the cost of treating undocumented migrants, prevention remains a far sounder economic approach than cure. By denying people access to simpler primary care we let the problem fester. Migrants are forced to bear their pain or they drop dead. And where do they drop? In their homes or in the street - to be whisked away and cared for by the NHS Ambulance and Accident and Emergency wards. Poor access to basic health care leads to patients finally presenting themselves to medical services in much later stages of illness, such as cancer, which then require more expensive and often less effective treatments. The cost of treating a patient in an intensive care ward far exceeds that of preventative medicine. At current estimates, a visit to a GP costs one third of the price of a trip to A&E and for a sufferer of HIV-related pneumonia, the price of two years antiretroviral treatment is the same as merely one night in intensive care. This is the financial legacy of a health care system based on exclusion and inequality.
The Coalition government released their master plan for the NHS in the form of the White Paper last July, effectively ending the current centralised structure and turning one million employees into independent “social enterprises” called foundation trusts. In handing such large financial control over to these smaller foundations, what effect will this have on the existing inequalities with regards to migrant health care in the UK? By forcing primary health care to function within a framework of increased commercialisation, GPs and local authorities will struggle to meet the needs of local people, individuals and families, let alone fulfil their duty to provide a service to migrants based on equality and non-discrimination. The abolition of PCTs will no longer give GPs the financial support they need and will result in an increased number of decisions being taken in the interests of the health care stakeholders, and not the patients. As the independent pressure group The NHS Support Federation states, “The taxpayer will still be funding health care, but there will be no unified health service”.
When it comes to making policy decisions on health care and cuts to services, vulnerable members of our society such as migrants are usually the first the feel the pinch. For migrants to be a victim of Conservative policy is neither correct, nor new. As Nye Bevan explained when he created the NHS, “One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill informed and some of it deliberately mischievous… The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine”.
There is at least some goods news though, and last week The European Parliament adopted a resolution entitled Reducing Health Inequalities in the EU (INI/2010/2089) calling upon all member states to reduce health inequalities within their borders. In it, The European Parliament stresses that, "equitable access to health care is secured, not only in practice but also in law, for undocumented migrants in many EU countries" and also urges all EU member states, "to ensure that the most vulnerable groups, including undocumented migrants, are entitled to and are provided equitable access to health care". While not binding, this represents the first time the European Parliament is clearly addressing the fundamental right to health of undocumented migrants.
Returning to the invading army of terminally ill, it took the Labour government several years before finally quietly admitting in a 2007 House of Lords/House of Commons Joint Committee on Human Rights that there was no evidence to suggest reports of the scale and cost of ‘health tourism’ were true. Human rights organisations such as Doctors of the World UK were instrumental in holding the government to account and continue to campaign against barriers to health care across the world. Sadly myths like these prevail in certain parts of the media, and health care provision for migrants remains at risk from a lack of understanding of both the facts and legislation. As Human Rights advocates, we need to build a greater understanding of both current and proposed health legislation. We should all be active in support of campaigns to ensure that the principles of our NHS such as universal access, including for migrants, do not become a victim of naïve policy decisions.
For further information:
Patrick Duce has worked closely with Doctors of the World UK over the past year as a Case Support Worker and also trains new volunteers in Access to Health care Legislation and Advocacy Skills. He is also a full-time MA student and a Metropolitan Police Authority Independent Custody Visitor, a community volunteer role ensuring that all rights are adhered to in pre-charge detention facilities throughout London. He can be contacted at Patrick.Duce@postgrad.sas.ac.uk
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