‘Excuse me, can I see your passport? Are you here legally?’
Early on Wednesday patients, NHS workers and activists gathered outside the Department of Health and formed a not-so-orderly queue in front of a makeshift border checkpoint.
Dressed in hospital gowns, scrubs, and UKBA uniforms they blocked the entrance to Richmond House, and challenged people heading into work with the question: ‘Can I see your passport?’.
This week’s action was called by Docs Not Cops, a group committed to healthcare as a human right and dedicated to fighting the shift towards migrant charging in the National Health Service.
Changes brought in this month will see NHS trusts obliged to check patients’ passports up front, and if they are ineligible, deny treatment not deemed ‘immediately necessary’ unless it can be paid up-front and in full.
The policy turns doctors, nurses, midwives, and receptionists into immigration officers and border guards, and asks healthcare workers to think about their patients’ immigration statuses before thinking of how best to manage their condition.
The measure was announced in February in a document ironically named ‘Making a Fair Contribution’, alongside announcements of the government’s intentions to further extend charging into new areas of services. GPs will in future be made responsible for identifying ‘chargeable’ patients in primary care. Bringing charging into community services means access to mental health services, hospice care, and termination of pregnancy services will all be affected by the new law.
The same document also said that the Department of Health was considering introducing charging for primary care and Accident & Emergency for those it purports have a ‘temporary relationship with the UK’. Those with precarious, complicated, or no immigration status will be denied care they need and deterred from seeking it. Vulnerable people will be frightened.
Potentially lives will be lost. And being afraid of seeking healthcare for treatable conditions will result in people presenting much later, requiring emergency care, which is more costly and likely to have worse outcomes for the patient.
In 2015, an Albanian national with a suspected brain tumour was reported to immigration authorities by staff at the Royal Victoria Infirmary in Newcastle, after being treated for an aneurysm the previous year. It was shortly announced that “a medical decision was made” that the patient was “for travel and discharge to seek treatment in his own country”.
The latest changes build upon the already harmful effects of the government’s Immigration Act 2014, which has seen hundreds of refugee and migrant women, many with complicated asylum claims, made terrified of accessing antenatal care and threatened by the very hospitals they need to help them.
The government’s ‘health tourism’ narrative is being used to expand and tighten immigration control into public services. Health tourism accounts for a modest 0.03% of the annual NHS budget, at the Department’s own estimate. Freedom of Information requests (FOIs) sent last year by Docs Not Cops found that of hospital trusts that had dedicated overseas visitor teams in 156 Trusts contacted, over a third (34%) were spending more on these teams than they were recouping in fees.
These amendments will not make Jeremy Hunt the ‘efficiency savings’ he wants to see by 2018, but it is unclear whether they were actually intended to. They appear to be based on a nationalistic and capitalist ideology, not evidence.
As these policies take root, reports are already emerging of NHS staff racially profiling patients who are not white or who have ‘foreign-sounding’ names. It is not within the job description of any doctor, nurse, or midwife to ask questions more befitting of immigration officers.
The complex nature of the immigration process also means that many healthcare workers may be unclear as to who is, and who isn’t eligible, turning away people well within their rights to seek care. Doctors of the World have found this to be an extensive problem in the case of GP surgeries. They report having seen a homeless Eritrean asylum seeker who had been living in a bus shelter at one of their clinics, who had been turned away by her GP, despite it still currently being the case that everyone is entitled to register with a GP and receive primary care.
Docs Not Cops are devising strategies to empower NHS workers to refuse to comply with border policing in the NHS, including setting up a pledge that workers can sign to express their refusal to act as border guards and establishing a national network of groups. We are also encouraging patients to lobby their local GPs, CCGs (Clinical Commissioning Groups), and NHS Trusts. Anyone can contact their local MP to express their concern about the impact of the charges.
The National Health Service was built on the principle that we all deserve the right to healthcare. Almost 70 years after its inception we are here to demand that this basic tenet remains.