By Daniel Robertson

(Source: keepournhspublic.com)

Last month, on October 23rd, new regulations came into force, with little fanfare, making it an obligation for providers of NHS healthcare in England to check whether patients may be charged for that care, and demand payment up-front before treatment is given. In addition to secondary care in hospitals, those deemed not ‘ordinarily resident’ may now be charged for mental health services, drug and alcohol services and midwifery in the community.

These changes are billed by the government as a crackdown on health tourism that will generate savings for the NHS. The reality is that the charges will target some of the poorest and most vulnerable people in the UK — people who simply cannot afford to pay. The Department of Health has erected obstacles to healthcare for groups who are supposed to be exempt, and is deterring many from seeking health care in the first place. The impact of this discriminatory policy on public health could be huge.

I work for a charity that provides advocacy and support to asylum seekers and refugees — two groups supposed to be exempt from the charges. Since the new charging regime came into force, I have already had to advocate for asylum seekers refused care because they couldn’t pay for it, or charged for care they had already received. A Kurdish asylum seeker who was referred to the local hospital for a scan for breast cancer was sent back to her GP because she couldn’t pay up-front for it, even though asylum seekers are officially exempt from the charges.

Similarly, a pregnant asylum seeker from Iraq was charged for all of her prenatal scans. The Overseas Visitors office had decided she would only be exempt once she was issued with a Home Office Asylum Registration card (ARC), even though this may take several months from when an asylum claim is first lodged. Is it any wonder that pregnant asylum seeking women are being deterred from seeking care?

A Zimbabwean client undergoing treatment for a cancer that developed since she arrived in UK was granted exceptional leave to remain because of this condition — yet she cannot receive treatment until it is ‘immediately necessary’ and, in the meantime, will have to pay tens of thousands of pounds for it. Her status document indicates that she has no recourse to public funds, which means that when she is sick after chemotherapy and unable to work she will not be able to claim any benefits to help her survive, let alone pay off massive health bills.

“I am really worried about what will happen to me when I go back to the hospital again,” she told me. “For now I can work, I have a job, but when I’m down again there will be nothing for me.” She risks eviction and being returned to a country where healthcare is inadequate and inaccessible, and where she has no surviving family members.

In recent months, our clients have also suddenly started receiving bills for hospital care dating back as long ago as 2013. They were not charged at the time, and were not even aware that they would be charged. However, as the letters prominently state, the details of unpaid debts over £1,000 — and bear in mind that these patients are being charged at 150% the actual cost of treatment — will be passed on to the Home Office, and can be used to deny future requests for immigration status.

A mother who gave birth to her child after the Home Office refused her asylum claim in 2014 has just received a bill for her maternity care from the hospital. Since she gave birth she has been granted leave to remain but that expires next year. She now has a bill of several thousand pounds to pay off before she must apply for further leave. “I thought that when the Home Office gave me leave to remain I was safe here,” she told me, “but now… I don’t know.”

Another change that has occurred since 23^rd Oct is to the GMS1 form, the standard form for GP registration in England. Although GP registration is supposed to be open to everyone, regardless of immigration status, and despite the fact that GP services are supposed to be exempt from the new charges, migrants have to tick a box and sign a declaration to state whether they think they are chargeable or not. This information will then be recorded on their health record and may be checked against Home Office records. Some GPs are resisting this intrusive questioning by crossing out the section on their registration forms.

The effect of these changes on the behaviour of migrant communities is likely to be profound. Once stories like those above start circulating within a community, people will have the impression that they shouldn’t seek out healthcare in the first place, in case they incur debts they cannot pay or, worse, get into trouble with the Home Office. It won’t matter whether the treatment for their hepatitis is exempt from charging or that, if they provided their ARC, the bills would go away; they will stay untreated, possibly passing the disease on to others, rather than jeopardise their immigration application.

These are not isolated cases. In April of this year, Doctors of the World warned that thousands of asylum seekers had wrongly been denied treatment at hospitals and GP surgeries. The organisation ended up having to take legal action in order to secure treatment for a man suffering from a heart condition, and another suffering from renal cancer. According to campaign group Docs Not Cops,  this new charging regime has led to “racialised outcomes”, with certain patients under greater scrutiny because of their appearance, speech or having a foreign-sounding name.

In light of these concerns, an open letter signed by a large number of advocacy groups, medical professionals and even a former chief executive of the NHS, was sent to the Health Secretary, Jeremy Hunt, in October, demanding that the regulations are withdrawn. The letter cited concerns over racial discrimination and health inequalities, as well as increased patient waiting times, the risk of withholding lifesaving care and net costs to the NHS, as reasons to dump the regulations. Docs Not Cops also organised mass complaints against the regulations on the day they came into force.

However, the Conservative Government is keen to press on with the measures, whatever the cost, because they are an essential part of Theresa May’s ‘hostile environment’ for undocumented migrants. It’s not just healthcare but housing, bank accounts and even driving licenses that are to be denied to those deemed to be the wrong kind of migrants.

It seems that no amount of individual or societal suffering is too great to deter certain politicians from trying to look tough on immigration. Those who understand the injustice of denying migrants rights need to make alternative arguments to those deployed by the anti-immigrant lobby, forcefully and throughout society, if we want to see equal rights for all.