The UK is forcing health workers to be proxy border guards

Published 19th September 2017

UPDATE, 17 October 2017: Our open letter was sent to Jeremy Hunt on 9 October 2017. Since that date, a number of other bodies have also endorsed the letter, including Unison and the TUC. An updated letter with a full list of signatories can be found here.

The UK government is ratcheting up its strategy to inflict misery on undocumented migrants – and it’s forcing charities and community health organisations to help.

While the British government has long charged undocumented migrants for many types of non-emergency NHS hospital care, charges are now also being introduced for services provided by community health organisations. This includes community-interest companies and charities.

The new regulations will affect a wide range of health services, such as school nursing, community midwifery, community mental health services, termination of pregnancy services, advocacy services, and specialist services for homeless people and asylum seekers. GP surgeries are exempt.

From 23 October, all community health organisations in England that receive NHS funding will be legally required to check every patient’s immigration status to see whether they should pay for their care. If the patient is an undocumented migrant, they will have to pay in full before receiving any treatment.

Doctors of the World is calling for these heartless rules to be withdrawn, and for the impact of charges to be properly assessed.

“The human impact is likely to be huge. People who have experienced trauma and violence, such as victims of trafficking and exploitation, will no longer be able to access essential community services as they simply can’t afford them,” Lucy Jones, who runs our UK programmes, told The Independent this week.

“The government is effectively making a whole host of community health workers into proxy border guards – from school nurses to charity workers to trauma counsellors. It’s a huge burden on people who just want to do their jobs, not carry out the Home Office’s work.”

At our clinics across London, we treat vulnerable patients including asylum seekers, undocumented migrants, victims of trafficking and homeless people. Almost 9 in 10 of our patients live in poverty. We have no doubt that the new rules will deter many of the people we help from accessing services they need, and we’re particularly concerned about the impact on mental health services.

Abortion services, often provided in the community and by charities, are another big area of concern. Many women who are excluded from free NHS care, such as sex workers and trafficking victims who are undocumented, have limited access to contraception. They are also at increased risk of sexual violence.

Public health services commissioned through Local Authorities, which include drug and alcohol services, are also likely to be affected. Many community-based services prevent people needing specialist care or emergency treatment further down the line, both of which are more costly for the NHS.

The UK government has made multiple commitments to assess how extending NHS charges will impact vulnerable people, pregnant women and children, but this has not happened. There is little evidence regarding the anticipated financial saving for the NHS but it is likely to be around £200,000 a year – just 0.00016% of its total annual budget.

Community health services are often specifically commissioned to reach marginalised communities. There are estimated to be more than half a million undocumented migrants living in the UK, many of whom are highly vulnerable.

What can you do?

  • Read and sign our letter to Health Secretary Jeremy Hunt by 5pm on 6 October (the deadline for this has now passed)
  • Write to your MP
  • If you’re a healthcare professional, raise your concerns with your employer. Ask your employer what measures they’re taking to ensure the new regulations won’t prevent patients from accessing care or increase health inequalities. You could also raise these concerns with your union and royal college.
  • If you’re part of a charity or social enterprise which receives NHS funding, write to your MP raising your concern that this legal requirement will put an unworkable bureaucratic burden on your organisation and prevent you from providing essential services to those who need them.

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