Briefing predicts Health Disaster for Vulnerable Communities

Health groups and medical associations are up in arms about Home Office proposals to charge for NHS primary care, including treatment of communicable diseases, on the basis of immigration status.

Currently there is no charge for the treatment of certain communicable diseases, including Tetanus, Rubella, Tuberculosis and Measles. HIV testing and counselling are currently free. The new proposals will impose charges to bring primary care in line with similar changes in the hospital sector made in 2004.

The government claims the change will save money and discourage ‘illegal immigration’, but critics say it is likely to lead to higher costs and abandons basic NHS and human rights principles.

Representatives from health charity Medact warn of the danger of a public health disaster in the UK if universal primary care is withdrawn. “While TB is currently exempt from charging, without access to primary care there is likely to be a delay in detection with resulting poor outcomes for individuals and increased risk of infection for others”.

The government claims the proposed new regulations for primary care will reduce abuse of the NHS by “health tourists”; individuals who come to the UK with the sole purpose of accessing free NHS treatment. It also says that they will make life more difficult for migrants by ensuring ‘that living illegally becomes ever more uncomfortable and constrained until [failed asylum seekers] leave or are removed”.

Critics point out this is an abuse of human rights. “All asylum seekers, including those whose claims have been refused and the Home Office intends to remove from the UK, are still ‘within the jurisdiction’ and therefore beneficiaries of the rights set out in the panoply of interntional human rights treaties that the UK has adopted (Joint Committee Human Rights, 2007)”. There is no evidence to suggest that health tourism is the intention of those migrating to the UK; many are exercising their legal right to seek refuge from persecution.
It is also unlikely to save money. Individuals who lack access to primary care will experience deterioration in their health to such an extent that they present to hospital as an emergency, requiring more complex, and thus more expensive, treatment than they would have done had they presented earlier to a GP. Medical intervention may also be less effective at this late stage.

An estimated 86% of all UK health needs are met in primary care by GPs. It has been estimated that 90% of patients with the most common chronic diseases will never be referred to hospital and will be treated instead in the primary care setting (Pereira Gray D, 2006).

Crucially, lack of access to GP services will increase the likelihood of communicable diseases going undiagnosed and untreated. The proposed changes consequently threaten a public health disaster.

Among the groups affected will be failed asylum seekers awaiting deportation, failed asylum seekers who cannot safely travel home, victims of trafficking and undocumented migrants.

The proposals will hit some areas very hard. In Newham in East London, for example, 73 per 1000 residents are from an asylum-seeking background, with 13,000 new migrants registering with local GPs last year; their presence has not thrown services into crisis. The Newham PCT critique of the proposed changes, based on empirical evidence from a Health Impact Assessment of the proposals, suggests that excluding migrants from access to health care involves significant risks for the NHS and the health of the wider community[1]. Medact is calling for a full health and equality impact assessment to be undertaken before any further changes in NHS regulations.

The proposed regulations will bring primary care into line with hopistal care. In 2004 the Department of Health introduced legislation to the effect that groups considered to be not ‘lawfully resident’ in the UK were, no longer entitled to free hospital and maternity services, or HIV and AIDS treatment. This was shortly followed by a consultation that proposed to extend the regime to include primary care, including access to GP services. No response to this consultation has been published.

One example of the consequences of the 2004 changes in regulation is as follows:

“A man who has been diagnosed as suffering from pulmonary carcinoma presented at XXXXX seeking treatment. He was unsure of his immigration status, but the hospital contacted the Home Office for clarification and were told that he had two failed asylum claims.

He was refused treatment by the hospital and it was suggested he return to his own country to seek treatment. His GP has refused to a request to deem this immediate and necessary care, also suggesting he go home to seek care”.

The Department of Health Table of Entitlement to NHS Treatment (June, 2007) states that GPs have the discretion to register excluded groups as NHS patients.
It is both astounding and concerning that any health professional would refuse vital treatment to an individual on the basis of their immigration status. Such behaviour does not fit with the General Medical Council’s ‘Duties of a Doctor’, which include ‘protection and promotion of the health of patients and the public’. In the recent Michael Moore film ‘SiCKO’, the British Health System is praised for being inclusive and free at the point of delivery. The NHS was founded on fundamental principles - that health care should be free, available to all and of uniform quality no matter where people lived or what their background.

Migrants play a strong role in the work of the NHS as doctors, nurses and ancillary workers, and have done since its establishment in 1948. In a recent report by Compass [2], Wayne Farah suggests that this should be “presented as a model of the good which can be achieved through the presence of migrants in British Society, rather than a mechanism for excluding them from health benefits”.

Many, including the BMA, feel it inappropriate that health be used a lever of immigration policy. Resolutions passed at their Annual Representative Meetings have stated "this Meeting deplores the planned withdrawal of rights to medical care from asylum seekers whose applications have been refused" [2004] and "this Meeting believes that it is not appropriate for medical staff to act as proxy immigration officers in seeking to determine the immigration status of people presenting for care and treatment." [2005]

At the Medsin Autumn General Assembly in Southampton, student members responded to the Medact briefing with a resolution to "support members in all non violent protest against further restricting the rights of refugees to healthcare in this country".

Please consult the briefing published by health charity Medact [3] and visit the Medsin website for more information on ways to support the campaign[4]. An online petition can be found at


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