Labour must end May’s ‘hostile environment’ for migrants in the NHS

The Labour Party’s 2017 Conference begins this weekend. Docs Not Cops highlight opportunities for attendees interested in migrant access to the NHS to intervene. 

Docs Not Cops
23 September 2017
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Image: Flickr/SMA

Jeremy Corbyn has attracted support in his leadership and general election battles due in part to his firm position against privatisation in general – including NHS privatisation - and also due his history of support for migrants and anti-racist organising.

Yet Labour’s health policy platform is currently limited – as pointed out in this excellent recent article by Allyson Pollock. And the party appears to have no formal policy and little to say in public about the “hostile environment” the government has been creating for migrants.

The Party’s conference this weekend offers members, delegates, and those outside the party, opportunities to improve this situation.

The government is trying to blame the severe and growing NHS funding crisis on migrants, but this is a distraction. The numbers don’t add up: ‘deliberate health tourism’ costs, at most, £300 million a year – just 0.3% of the overall NHS budget. The costs that can be recouped by charging people for their care are a drop in the ocean for the NHS, but potentially ruinous for patients now being landed with multi-thousand pound bills – or being put off accessing healthcare altogether.  

The Socialist Health Association has put forward a motion to conference – supported by at least a dozen constituency parties – that calls for the party torestore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17)”. What this means is that the Labour party’s aim should be to return to a publically funded NHS that doesn’t charge patients. While immigration checks and charges are not mentioned specifically, the references to “comprehensive” and “universal” care, and clear emphasis on an “NHS without user charges” are welcome.

The SHA motion also references the NHS Reinstatement Bill. Docs Not Cops also supports this Bill – developed by Professor Pollock in close association with NHS campaigners - in part because the central function of the Bill would be to restore a publicly owned, managed and accountable NHS. The Reinstatement Bill would end the wasteful and damaging competition between parts of the NHS that has been introduced in order to enable private companies to extract profits. 

Crucially, Docs Not Cops also supports the aim of the bill to ensure healthcare is available on the basis of need, not ability to pay or migration status. The bill contains a commitment we feel is essential - to “abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services”.

For any of this to be discussed at conference, the NHS will have to be selected as an area of discussion in the ‘priorities ballot’ on Sunday morning. And for the NHS Reinstatement Bill to be discussed/voted on, it would need to survive the process of ‘compositing’ NHS motions. CLP delegates can attend the compositing meeting on Sunday evening to debate motion composition with the relevant NEC Policy Commission co-convenor and shadow Minister (as Momentum’s guide to the conference explains). 

Corbyn himself is registered as a supporter of the NHS Reinstatement Bill. In Diane Abbott’s 2016 Speech to Conference the then Shadow Health Secretary claimed the party would be “returning our NHS to what it was originally conceived as: a publicly-owned, publicly-funded, publicly-accountable universal service, as outlined in the NHS Reinstatement Bill”. But this has not yet been adopted as party policy, and it didn’t feature in Labour’s 2017 Manifesto. So it’s crucial these issues are discussed at conference.

On EU Freedom of Movement, there has been more questioning of Corbyn’s recent rhetoric. Labour’s immigration policy in the context of Brexit has been the subject of criticism more generally, but Corbyn has at least raised the issue of NHS access requirements based on citizenship or immigration status at Prime Ministers’ Questions. In November 2016 he challenged Theresa May: "Rather than distracting people with divisive and impractical policies, could you provide the NHS and social care with the money that it needs to care for the people who need the support? [...] Instead of looking for excuses and scapegoats, shouldn’t the prime minister be ensuring health and social care is properly secure and properly funded?” 

Such statements are obviously welcome – particularly compared to the likely approach of alternative leaders. But the Labour manifesto and recent campaigning has been silent on the issue. Indeed, Labour appears to have no formal policy and little to say in public about the range of “hostile environment” policies the government has been creating for migrants – whether in the NHS or education, housing, or with regard to access to bank accounts and driving licenses. We urge those attending Labour conference to take the opportunities – informal if not in terms of conference proceedings – to ensure that opposition to “hostile environment” policies (immigration checks, data sharing, and/or charges) are included in discussions.

Chances to get involved both inside and outside conference

Movement for Justice (MfJ) have organised an “Immigrant rights, anti-racist march and rally at Labour Party Conference” – making the demand to “Reverse the hostile environment of racism in Britain” on Sunday 24th. The newly formed Brighton Docs Not Cops group will be joining this march (11am Brighton train station, Midday rally at conference).

Sussex Defend Our NHS have organised an NHS march and rally “It's a Matter of Life or Death!”, featuring Shadow Chancellor John McDonnell, Allyson Pollock and Dr Alex Scott-Samuel from the SHA (11am The Level, 12.30pm rally at conference, Sunday 24th.

At The World Transformed festival which takes place alongside Labour Conference but which is open to others there is a “People Not Profit: Reclaiming the NHS” event from 11.am-12.45pm on Monday 25th. Emphasising that “there is still a long way to go for the entire party to back” “a comprehensive, universal, publicly-provided NHS”, the workshop will “explore building a network of NHS activists in Labour that works with unions and health campaigns”.

Stronger policy is desperately and urgently needed.

The Conservative’s 2016 Queen’s Speech promised an "NHS (Overseas Visitors Charging) Bill". The Department of Health’s new “overseas visitor charging“ regulations (pdf) are about to come into force next month, forcing school nurses, health visitors and community mental health teams to charge patients up front if they are not entitled to free NHS treatment.

The impact of the 2014 Immigration Act is already being felt. Twenty hospitals are currently running pilots of passport checks and upfront charges for all patients accessing NHS services. Those deemed ineligible for free treatment will be charged 150% of the usual NHS rate for their care. Recently London North West Healthcare - one of the trusts - sent a letter demanding eligibility documents from an eight-day-old baby.

Barking, Havering and Redbridge University Hospitals NHS Trust (BHR) – another of those on the pilot – claims that ‘maternity services, or treatment which the doctor or nurse thinks is immediately necessary or urgent, will never be withheld.’ But it has also sent at least one pregnant women a letter threatening that future appointments may be cancelled if she cannot pay a deposit for treatment. BHR states that patients will be asked to pay a deposit before treatment starts, and will be billed afterwards (£6,500 for maternity care). 

At St George’s Hospital in Tooting, they’ve just concluded an evaluation of the first part of their pilot into ID requirements for patients in maternity care. The report found ‘no obvious issue with eligibility in obstetrics’, and the new policy led to just 1% of patients being charged for care (18 out of 1,660) over the course of the pilot – revealing the basis of the policy on a politics of scapegoating. These 18 people are now the targets of the hospital’s debt collection agency - we don’t know anything about them, their jobs, or their families. We don’t know anything about their complicated immigration or asylum statuses – or how they can possibly pay these bills, £45,000 in total. We do know that their details may be passed on to the Home Office a practice that has been going on for years but has just this year been set out in a Memorandum of Understanding.

The St Georges evaluation claims that no patient was denied treatment due to ‘charging issues’ (3.9) but policies like this have their main effect before passports are demanded at the hospital: they deter people from accessing care in the first place. Maternity Action regularly hears from women who have received large bills from the NHS and are distressed because they cannot pay them. It has been shown by Doctors of the World, among others, that pregnant women with irregular immigration status are avoiding seeking NHS antenatal care, out of fear that they will be deported or face unpayable medical bills. In doing so, they are being put at serious risk.

Not only does this raise difficult medical ethics issues for the overstretched NHS staff who are supposed to carry out these checks; it will destroy the relationship of trust between NHS staff and patients. NHS workers shouldn’t be forced to police the people they’re treating. It is costly and time-consuming. We know the way to ensure the NHS funding crisis ends is by ending PFI contracts and the billions wasted on running the NHS as a market. We believe that a party that is “for the many not the few” should take into consideration the impact of these moves on access to healthcare and marginalised communities. We ask Labour members and supporters to put pressure on the party to ensure the right to healthcare on the basis of need is not trampled on, and that migrant rights are at the forefront of the conference. And that they consider joining us at our #PatientsNotPassports event next Saturday 30th September when Docs Not Cops along with a coalition of anti-racism and pro-migrant organisations will gather at a London location to protest the introduction of immigration checks and upfront charging for all NHS patients and to share stories highlighting the human impact of these changes. 

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