Sitting in a plush restaurant over the summer I couldn’t help eavesdropping on the conversation between the couple next to me.
The woman was irately complaining: “They should shut the hospital door to these foreigners draining money from our cash-strapped NHS.”
There was nothing particularly unusual to me about this comment. It wasn’t the first time I’d heard the opinion that healthcare should be refused on the grounds of nationality, but it was the first time I realised that I didn’t know anything whatsoever about the NHS’ policy on these ‘foreigners.’
As a medical student with a particular interest in global health, I was slightly ashamed. I decided to geek-it-up and research the subject a little.
Scanning through waves of tedious government policies I came across the ‘Charges to Overseas Visitors’ amendment of 2004. This regulation obliges hospitals and doctors to charge for most hospital care for refused asylum seekers and undocumented migrants on the NHS.
The hollow request made by the woman next to me couldn’t actually be a description of our health policy, could it?
Indeed, it seems that the realisation of the woman’s wishes is helping to further marginalize one of the most vulnerable groups in society. Charging for NHS healthcare shuts the door to the refused asylum seeker.
The amendment was predicated on the prevention of ‘health tourism.’ At present there is no evidence regarding the extent of such ‘tourism’ on the NHS. Grouping a vulnerable demographic such as asylum seekers with relatively well-off people who come from abroad to use the NHS seems a severe misjudgement. So what did the government base its regulations on? Was it anecdotal comments like the one from the woman in the restaurant?
A 2007 Home Office report, aptly titled ‘Enforcing the Rules,’ suggests a different motivation for the changes: “To ensure that living illegally becomes ever more uncomfortable and constrained until they [the illegal immigrant or refused asylum seeker] leave or are removed.”
Restrictions on healthcare are being used as a punitive political tool rather than in an attempt to curb pressure on NHS finances, compromising the main aim of medical professionals, namely to “make the patient their number one concern”.
The effect on the patients was highlighted by case studies in the Refugee Council’s report ‘First Do No Harm’ (2006), which described cases in which women were denied maternity care if they could not pay £2000 up front. Fifteen women and two girls were charged more than £2,000 for maternity care, and in some cases were denied that care if they could not pay in advance, jeopardising the health of both mother and baby.
One man with bowel cancer was admitted to A&E, but had an operation cancelled when they realised he could not pay for it. He was told to come back “when his condition deteriorates.” Not only was this a potentially life-threatening dismissal, it is economically ineffective - the surgical expenditure will increase if a necessary operation is delayed and complications occur due the progression of the disease.
In 2008 West Middlesex NHS, disgraced by the way the NHS was obligated to treat certain patients, challenged the state to allow it to provide treatment to a refused asylum seeker. West Middlesex NHS won the right to treat the patient who was suffering from chronic liver disease. However, their victory was to prove short-lived. In 2009, the ruling was over-turned.
Amidst this turmoil in healthcare politics in England, the Welsh Assembly Government decided to amend the regulation of 2004. Edwina Hart stated that the mark of a civilised government was the way it treated the sick and the dying.
The same move was not made in England. After the successful government appeal in 2009, Secretary of State Alan Johnson conceded that previous guidelines were somewhat lacking in clarity.
Following this admission new guidelines have been written for England, but these do not change the basic aim of the original 2004 ‘Charges to Overseas Visitors’ amendment: most hospital services still charge refused asylum seekers. Confusion about who is eligible for treatment still lingers amongst medical staff.
Due to the valued nature of the NHS, the issue remains controversial. Headlines such as ‘Free Treatment on the NHS for Thousands of Asylum Rejects’ are splashed angrily over the Daily Mail (November 2, 2009). Stories like this tend to focus on the financial implications of the NHS treating refused asylum seekers, about which there is currently very little information. Such reports detract attention from the central issue of human rights abuse perpetrated by our government.
Under the International Covenant on Economic, Social and Cultural Rights, the UK recognises “the rights of everyone to the enjoyment of the highest attainable standard of physical and mental health.”
The Universal Declaration of Human Rights recognises the right to health free from “discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.” In light of this, charging refused asylum seekers for healthcare is a violation of human rights.
Alex Elliott-Green
25/01/2010
