At the United Nations in New York today (23 September), the UK will affirm its support for universal health coverage around the world.
One reason the UK is at the forefront of championing this core principle of the World Health Organization (WHO) is that – as an example of universal health coverage - the NHS was established to ensure everyone could access health services, regardless of their ability to pay.
But the sad truth is the UK can no longer claim to provide healthcare for all. Over recent years successive governments have expanded efforts to restrict access to the NHS. Next month marks the second anniversary of the introduction of upfront charges for NHS care for many migrants – a policy that is demonstrably causing harm to patients. Just last week it was reported that a 39-year-old woman had died, after having been wrongly denied treatment for breast cancer.
The UN has enshrined health as a fundamental right of every person. The meeting of global leaders today is calling for “pursuing equity in access to quality health services”, a pledge supported by the UK. In July this year, the then International Development secretary Rory Stewart said that the NHS had “pioneered” universal health coverage, with health being “a foundation for development; it enables people to go to school, go to work, and contribute to the economy.” The NHS constitution underscores a comprehensive service available to all, based on clinical need. But these principles are being undermined every day in hospitals across England. Racist and xenophobic border control policies lead to patients being denied care and deter sick people from seeking timely treatment, fearful of being charged and being reported to immigration authorities.
Politicians seek to lay the blame for years of chronic underfunding of the NHS at the feet of migrants, despite evidence consistently showing that migrants are generally healthier than their UK-born counterparts.
The UK government has been pursuing policies that actively undermine the human right to health in this country. For the past two years, if you do not have the documents to prove legal residence in the UK, you can be charged up to 150% of the cost of your treatment – upfront. If you can’t afford to pay, hospitals can refuse to treat you unless it is urgent.
The NHS is also being asked to share information about patients with the Home Office. Patients with a debt of more than £500 can be reported to the Home Office, which may then refuse their applications to stay in the UK. Fear of these policies puts off many patients from seeking care, so they may only finally see a doctor when their condition has become much more serious and harder to treat. This leads to poorer health outcomes, and has much wider social and psychological ramifications, causing already marginalised people to worry about their entitlement to healthcare, and to fear receiving huge bills and being pursued by debt collectors. Although the UK prides itself on the universality of the NHS in the UK, research shows that migrants actually perceive accessing healthcare in the UK to be difficult, with fear of being reported to the authorities are higher than in other European countries.
These policies not only deter the people they target from seeking treatment, but also have serious public health consequences for the whole population. Leading medical bodies such as the British Medical Association and Royal College of Physicians have called for the policies to be suspended for this very reason.
The culture of restriction and denial that NHS charging has created also means many migrants face difficulties in accessing the services that they are freely entitled to, such as GP practices wrongly refusing to register them. Charity Doctors of the World reported last year that 1 in 5 of their attempts to register patients with a GP were wrongly refused. There are numerous reports from patients and NHS staff of people being racially profiled when asked to prove their eligibility for NHS treatment. Such practices are directly opposed to the WHO’s longstanding belief that we all have a fundamental right to the highest attainable health “without distinction of race, religion, political belief, economic or social condition”. NHS charging also erodes the integrity of the relationship between patients and healthcare workers which is vital to effective healthcare.
The hypocrisy of the UK government is all the more striking given that the NHS actively recruits staff from all over the world. Far from putting a strain on NHS services, non-British workers today make up 13.1% of NHS staff. While the NHS benefits, the situation contributes to a drain of qualified healthcare workers from their home countries. It seems absurd for the government to promote the need for other countries to maintain their own sustainable health systems while taking advantage of staff whose training it did not have to pay for, to prop up an underfunded NHS system. For example, Nigeria is both the 7th most common nationality of NHS staff and the biggest recipient of the UK’s bilateral aid spending on health.
It is important to note that even a health service that is universally accessible is not necessarily equally accessible to all. Recent research has shown that black women in the UK are five times more likely to die as a result of complications relating to pregnancy and childbirth than white women. Migrant women specifically also experience higher rates of pregnancy complications and maternal death, making them an especially vulnerable group for whom early and effective antenatal care is vital.
As healthcare workers and patients, we call for the UK to restore universal health coverage at home before it has the audacity to lecture other countries - the majority of whom have far fewer resources than ours.
Join us in signing our letter to the Health Secretary and demand an end to charging for NHS care.