NHS data-sharing U-turn is welcome – but more to do to scrap the ‘hostile environment’

Recent attention to the Windrush scandal has focused attention on the many ways migrants are deterred from accessing healthcare. This Saturday, join NHS workers protesting that they are not border guards.

Peter Pannier
11 May 2018

Image: Medact

The government has this week announced it will be suspending “with immediate effect” the controversial memorandum of understanding (MOU) under which NHS Digital shared NHS patients’ details with the Home Office.

It’s a significant victory for the #StopSharing campaign by Doctors of the World, the National AIDs Trust, and a host of others - including Docs Not Cops. Campaigners have been insisting that patients should not fear immigration enforcement when seeking NHS treatment. The policy – part of the ‘hostile environment’ - has stirred considerable controversy, with a legal challenge from Migrants’ Rights Network legal challenge due to be heard next month. MPs on the Commons Health Committee also voiced considerable concern after hearing a range of powerful testimony – including from Voices of Domestic Workers, who highlighted a case of a domestic worker who had died of pneumonia 'too frightened' to access healthcare.

While suspension of this damaging data-sharing provides a rare moment to celebrate, and appreciate the impact campaigning can have, there are caveats and a good deal of context to bear in mind. Firstly, it is essential to emphasise that - thanks to regulations introduced through secondary legislation by Jeremy Hunt in October 2017 - patients will still be required to prove immigration status to access most hospital care. Such a requirement stops people receiving treatment, criminalises patients and makes healthcare workers complicit in racist policy. Further, the NHS is but one arena in which the government’s hostile environment operates - banks will still freeze your account if you're unlucky enough to end up on a Home Office wanted list, and Landlords are still required to check your passport if you're renting from them. The Prevent duty still places students – and patients – under suspicion, as highlighted by the Joint Council for the Welfare of Immigrants, No Borders In Banks, and Unis Not Borders amongst others.

Another caveat is that the announcement on NHS data sharing came during a debate on the Data Protection Bill – however during the wider debate on the bill, an amendment which would have definitively scrapped the exemption that allows data protection rules to be broken for immigration purposes was defeated by 18 votes. And the suspension was also announced with a suggestion that in future the Home Office would still be “able to use the data-sharing mechanism to trace people who are being considered for deportation from Britain because they have committed a serious crime”. As Liberty and the National Aids Trust have already noted, the definition of “serious crime” here is vague to say the least.

Corey Stoughton, advocacy director at Liberty said: “The government now admits it has been needlessly exploiting NHS patient data on a mass scale for minor immigration enforcement matters. They have undermined the confidentiality and trust at the heart of our healthcare system in the name of pursuing their hostile environment. We welcome the agreement to overhaul its practices and immediately curtail some data-sharing – but its language is worryingly vague. We need a cast-iron commitment that people will no longer have to fear immigration enforcement when seeking urgent medical care.”

Any discussion of crime must acknowledge that those who are not white are more likely to be stopped, detained, prosecuted, and receive harsher sentences. Immediately it is clear that not everyone will be safe from data sharing - and instead of protecting people, and ensuring no-one is deterred from seeking treatment, the discussion is once again dragged toward distinctions between ‘good migrants’ and ‘bad migrants’, ‘deserving’ and ‘undeserving’ people.

As with much of the recent (and long overdue) media and political attention to the government’s ‘hostile environment’, people who can be deemed 'illegal' are once again dehumanised even by politicians opposing government policy. Labour’s Shadow Secretary of State for International Trade, and for Climate Change, Barry Gardiner recently told the BBC’s Daily Politics "we have to make sure that those people who are in this country illegally are removed from this country... I'm very happy to see a target of the number of those people that we want to remove". When the BBC’s Nick Robinson asked the Shadow Foreign Secretary Emily Thornberry on the Marr Show “Are you saying that you don’t want to see checks when people arrive in hospital for treatment that might cost tens of thousands of pounds – you don’t want to see whether they’re in fact illegal immigrants?”, Emily Thornberry replied “I don’t have a problem with checks being made”. It was disappointing that Thornberry made no attempt to query the premise of the question (where Robinson also suggested illegal migrants "take" jobs and houses from legal residents) or defend the principle that all should be able to access healthcare as a human right. It would have been easy for Thornberry to mention the public health risks entailed when denying people treatment – as Public Health England have done.

This stance must change - as Luke de Noronha argues, “There are no sharp divisions between ‘legal migrants’ and citizens over here, working hard, paying taxes and playing by the rules, and the ‘illegal immigrants’ over there, sneaking around, stealing jobs and deceiving ordinary Brits. In fact, the law changes around people; illegality is produced in ways which create divisions within our families, communities and classrooms. We can only develop a stronger critique of the UK’s cruel immigration system if we see Windrush migrants and ‘illegal immigrants’ as kin, rather than as good and bad migrants to be isolated from one another.” No one should be made to feel undeserving of care.

More positively, it is welcome that, responding to the suspension of data-sharing, Shadow Health Secretary Jonathan Ashworth noted yesterday “Theresa May has ignored warnings that the regulations on ID checks at hospitals are also damaging patient care” and added that "The Government must now suspend these regulations while a full review is carried out.”

Having been making this case for months - indeed years - we are pleased to hear a senior opposition politician say:

“This policy was yet another example of Theresa May’s heartless ‘hostile environment’ which is clearly undermining patient care. This U-turn is a victory for Labour MPs like Paul Williams and Luciana Berger, as well as the Health Select Committee. But the Government needs to go further. Today’s U-turn should only be the start. To protect the best interests of patients the Government must end Theresa May’s hostile environment entirely.”

This is a welcome first step - Labour must now commit to scrap these regulations in their entirety, as we've argued on LabourList, and ahead of their 2017 conference on OurNHS openDemocracy.

Of course, responsibility lies with Jeremy Hunt. That’s why this Saturday 12th May we’re organising a twitter storm for International Nurses Day. This year the International Council of Nurses have chosen “Nurses A Voice to Lead – Health is a Human Right” as their theme. We agree with them that "healthcare should be accessible to all". The government’s ‘hostile environment’ policies go against this principle - making it more and more difficult for people to access the NHS services they need. It is now mandatory for NHS trusts to check people’s immigration status before providing secondary care and to charge upfront for treatment where people are unable to prove their eligibility. And additionally, the Immigration Health Surcharge is set to be doubled, despite pricing people out of visa applications at the rates introduced in 2014.

Already these policies are leading to discrimination and racial profiling, to people being too scared to access the care they need, and are turning healthcare workers into border guards.

As health workers we are standing up for our patients and advocating for free, universal, non-judgemental healthcare. Ahead of International Nurses Day, a member who is a nurse has written of seeing the fallout of these policies every day in A&E. Join Docs Not Cops in celebrating International Nurses day this Saturday (12 May) by telling Jeremy Hunt it’s time to end prohibitive healthcare charges for migrants, scrap ID checks in hospitals and community care, and time to kick the ‘hostile environment’ out of the NHS. Please tweet a selfie of you and your colleagues (ideally in uniform - but you don’t have to identify anyone) holding a sign saying “We treat patients not passports. I’m a Nurse not a border guard”. For more information go to: docsnotcops.co.uk/nursenotaborderguard

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