As the Calais “jungle” migrant camp closes today, high profile controversy over the UK’s external borders are only one side of the story.
Three years have passed since Theresa May, then home secretary, committed to creating a “hostile environment” for so-called “illegal” migrants in the UK. Since then the UK has reinforced and multiplied its inland borders, making border guards of teachers, landlords, and healthcare workers.
The hostile landscape created by May is not just making life uncomfortable for migrants within the UK, it is deterring vulnerable people from accessing vital services, and endangering lives.
Earlier this month St George’s University Hospitals Foundation Trust announced that it was piloting new proposals to require women in labour who presented at the trust, to present photo ID or proof of right to remain in the UK. The move is purportedly to reduce the abuse of the health system by ‘health tourists’, though there are anecdotal reports from round the country that similar schemes are operating and British-born black women are being asked to produce their passports before accesssing care.
The proposals are frankly absurd. Women in labour who don’t have their documents will, according to a document revealed in the Health Services Journal, “be referred to the trust's overseas patient team for specialist document screening, in liaison with the UK Border Agency and the Home Office” - presumably whilst being sent out to labour in the carpark.
These proposals are just the latest in a series of dangerous changes that are preventing ill people from accessing healthcare because they are afraid of the consequences.
The 2014 Immigration Act saw the introduction of the ‘migrant and visitor cost recovery programme’, which has dramatically increased the presence of the Home Office and immigration enforcement within the health service. For those not ‘ordinarily’ resident in the UK non-emergency healthcare is now billed at 150% of the cost to the NHS, meaning that having a baby in the NHS can cost the individual up to £9000, depending on the complications of the birth.
After giving birth in an East London hospital, Efe received a bill for £9000. ‘I took no notice of the letter. I just left it there,’ she told me, ‘I couldn’t pay.’ But the letters did not stop coming and soon they became threatening, informing Efe that failure to pay the bill would be used against her in her asylum claim.
It is women like Efe who are put in this position, often trafficked or irregular entrants, women who have overstayed visas or entered legally and fled abusive relationships, and women who are not allowed to work and have no form of income. Is it worth the expense of seeking this ‘cost recovery’, when the financial gains are likely to be so small? And if not for financial gain, what is the point of this punitive scheme if not to identify illegal immigrants at their most vulnerable. Efe is paying £50 a month towards her bill, a bill she will probably never pay off with money she doesn’t have to spare.
Officially the introduction of this programme was introduced for financial reasons. But initial evidence being collected by campaigners suggests that overseas visitors teams are not even making enough money from these schemes to cover their overheads, hardly surprising when you consider the group of people they are targeting. And with figures from the Health and Social Care Information Centre (HSCIC) showing that requests for patient data from the Home Office have recently tripled – from 725 in the first three months of 2014 to 2367 in the same period of 2016 – the suspicion is that although putatively aimed at ‘cost recovery’ the Home Office is increasingly using information gathered from hospitals to find and identify people of insecure immigration status.
Doctors of the World runs a clinic in Bethnal Green which sees many people who are terrified of accessing NHS services. Sarah, a doctor who ran the clinic last year, met a woman with sickle cell disease, a serious inherited blood disease, who had been paying for a previous bill by working illegally but due to tightening restrictions could no longer find work to support herself and two young children.
‘She wasn’t going to her specialist appointments and became dangerously sick, she wouldn’t even go to A&E even though she is fully entitled to emergency care.’ The risks of untreated sickle cell disease include stroke, blindness, and death.
These are dangerous and frankly racist policies. They demonstrate that our government is more committed to its modern day witch-hunt of weeding out people it deems ‘illegal’ than it is to saving the lives of those resident in the UK, regardless of the colour of their skin or their place of birth. We are in danger of following in the footsteps of our Atlantic cousins, who deport hundreds of migrants from their hospital beds every year, some as they lie in comas.
With the health service in turmoil, facing cuts, relentless privatization, and the imminent imposition of a discriminatory and hugely demoralising contract for junior doctors, this issue is in danger of being overlooked by the mainstream press. But we cannot let immigration officers hover around hospitals, we cannot allow politicians to make immigration informants of healthcare workers, and we cannot force vulnerable people to choose between their safety in the UK and their lives. That is not how universal healthcare works.