Monday, 4 August 2008

Asylum seekers and the NHS

As ever, the rhetoric of the anti-immigrant lobby and the reality of the system we live under are utterly out of step. Thus, those accustomed to the usual platitudes that we are "too soft" on asylum seekers, that they are "drowned" in benefits, that they "bleed" our country "dry," and that they are "raping" the NHS might find themselves surprised by recent news.

Four years ago, this "soft" government that apparently "panders to every whim" of asylum seekers set forth proposals to restrict overseas visitors from getting primary NHS care for free. This includes refused asylum seekers, undocumented migrant workers, victims of trafficking, and recipients of Section IV Support, some of the most vulnerable people to come to this country. And, because they're so keen to make sure foreigners are "prioritised" and "treated like royalty" in the UK, when invited responses from the medical profession and experts on asylum and immigration issues came back largely opposing the new measures, they were suppressed.

It is only now, four years later, that these comments have come to light. Medsin's Global Health Advocacy project launched a campaign to defend the right to free primary healthcare for all, and have worked long and hard to contact all those who responded and find out what their opinions actually were. The submissions they received are very revealing. Overwhelmingly, they come out in opposition to denying anybody primary healthcare on both ethical and practical grounds:

"East Midlands Consortium for Asylum and Refugee Support - we have requested a copy of their submission. Meanwhile we note that in their annual report from 2003-4, they state (page 20)...

"Recently we sent a regional response to the Department of Health consultation on restricting overseas visitors (including failed asylum seekers) entitlement to free NHS Primary Healthcare. We argued that this was neither ethical nor practical to do in GP surgeries.


"Dr Jill Maben (Senior Research Fellow, Nursing Research Unit at King's College)...

"Cannot locate the documents I am afraid - sorry...My views are that access to healthcare is a human right. Here in the UK we may often take this for granted because of our largely very good healthcare provision with our 'free at the point of delivery' NHS system. However, whilst I am largey in favour of non EU citizens who travel to the UK for health provision paying for their treatment if they can afford it and on a case by case basis, I am not in favour of my government refusing the most vulnerable in our society (asylum seekers, failed asylum seekers and refugees) access to healthcare that they require. The NHS is a universal service for all based on clinical need, not ability to pay, yet we hear of failed asylum seekers being refused hospital treatment and being pursued by debt collectors if they have received emergency treatment (BMJ 06). Asylum seekers and Failed asylum seekers should be entitled to access to healthcare as this is a universal right under international law and embodies our recognition of common humanity. As these groups are also denied access to work, or the ability to earn money in any way, just how are they expected to pay?

"It will cause death and increased morbidity if such people are denied these basic rights and the impact would be felt further downstream, for example by emergency health services. If the government is unable to think of the health of the asylum seekers themselves, issues of public health for the whole UK population should be of concern. A lack of basic health information, health education and untreated HIV / Aids, TB, and other communicable diseases in an already stigmatised population may also result in the spread of such diseases to a wider population.

"I am wholly against this ill-thought through and pernicious proposal. It is shameful that the British government is seeking to act in this way, denying access to medical care is unlawful, inhumane and goes against what those if us in healthcare professions are seeking to achieve. Such a law would be largely unworkable too and is likely to have little effect on the number of asylum seekers treated by GPs, and practice nurses, it would merely force such doctors and nurses to carry out illegal actions to uphold their Hippocratic oath / code of conduct.


"David Sloane (City and Hackney Teaching Primary Care Trust)

"Of the top of my head I think the main reasons for objecting to the proposed legislation were:

"It is contrary both to basic human rights and to the spirit of the fight against inequalities in health which is clearly stated Govt policy

"It will frighten people off seeking help thus potentially causing ill health from potentially preventable stages of illness

"Antenatal care is a particular concern – if people do not come for it we know they are likely to get into trouble which the state will have to pick up and pay for

"Emergency care has traditionally been free to all – what is emergency care and what elective?

"There is no need to enact it because the NHS is not being abused by asylum seekers and refugees; they are not here to exploit our health care system

"There may be a case for legislating to prevent such exploitation by those from rich countries – eg bankers from the US

"Imposing the responsibility on GPs to police the system undermines the GP/Patient relationship which is likely to create a black market in healthcare

"There is an anomaly in the legislation which allows treatment for conditions presenting a public health hazard. However where do you draw the line? – e.g. we know that mental health is a major problem for R&AS – this could become a public health hazard if these people are not helped

"If we are concerned with public health then R&AS should be a focus for our concern not a target for penalty!

"Hope these rapid thoughts may be helpful."

Medsin's campaign briefing also provides specifics on the changes to the law and several revealing case studies that show the detrimental effects of the new regulations, Statutory Instrument 2004 No 614, on both individuals and on the nation as a whole. And the case against the new regulations is a damning one.

As well as being highly unethical, and in contradiction with both the Hippocratic Oath and the principle of universal health care that's free at the point of delivery, the new rules also highly impractical and nonsensical. For example, two of the types of primary care denied to foreign citizens is vaccination for things such as measles and whooping cough and medicine for the likes of diabetes and asthma. They have to wait until such diseases are in full swing before they can be treated. Besides the obvious fact that this essentially means that catching serious diseases in the UK becomes highly dependant upon your country of origin, it also falls flat as a money-saving initiative. It would cost the NHS just £9 to give a foreign national (or, indeed, anyone) an appointent with a nurse. It costs a paltry £110 for them to attend A&E. However, it costs the enormous sum of £1,387 for just one day in intensive care.

So, not only do the changes to the healthcare regulations deprive asylum seekers and other desperate people of necessary basic healthcare, and force them to forgo prevention so that they're more likely to need a cure, it does so at cost. Why? For the same reasons that such absurd and punitive measures are always brought in, of course; as an attempt to sate the baying hounds of the anti-immigration lobby and the right-wing media. To prove how "tough" they really are.

They needn't bother. No matter what measures the government brings in, no matter how harsh and Draconian they really are, there will always be those who make noises about "preferrential treatment" and being "too soft." The hounds can never be sated. No matter what is done - detention, points systems, denial of healthcare, or whatever else - they will keep fermenting the lies, demanding ever more brutal action, and pushing the ruling party towards totalitarian action. The reality will always go ignored, the facts will always go unheard, and the Tories, the BNP, MigrationWatch, the Daily Mail, and their peers will continue to present myth and hearsay as truth.

It is time we stopped pandering to the xenophobes and the nationalists and started fighting for justice and equality. And universal healthcare for all, free at the point of delivery, is as good a place as any to start.