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Doctors are caregivers, not border guards

Migration
Health
England
NHS nurse giving injection

NHS Employers under a Creative Commons Licence

Roshan* came to Britain seeking refuge from the civil war in Sri Lanka that claimed tens of thousands of lives. But since leaving the former war zone nine years ago, he has faced a whole new set of challenges.

When he tried to see a doctor at his local general practice about recurring health issues, including asthma and stomach problems, the receptionists turned him away because he couldn’t produce a bank statement. At another practice, they turned him away for not having photo identification. Staff were dismissive and rude when they learned of his undocumented status.

‘Every GP I went to asked for so many IDs, statements, bank details,’ he says. ‘How do I get a bank account without good ID?’

As his symptoms worsened and he grew more worried about not having medical care, he began to suffer headaches.

A study published this week confirms that Roshan is not alone. Researchers from the London School of Hygiene and Tropical Medicine spoke with undocumented migrants in London and found they face multiple barriers, including misinformation and rejection from GP services they are entitled to.

Undocumented migrants are ‘very confused about their healthcare entitlements and usually wait years before trying to access care,’ study co-author Shoba Poduval says. ‘When they finally do, they sometimes face hostility from practice staff.’

Implementation of the 2014 Immigration Act looms as another hurdle between vulnerable migrant populations and healthcare. From April 2015, migrants who do not qualify for free treatment must pay 150 per cent of their hospital costs, and the government is considering charging for more services, including Accident & Emergency (A&E).

In addition, an IT link has been set up between the NHS and the Home Office to check entitlements. Patients will also be asked whether they have a European Health Insurance Card at both GP surgeries and A&E.

‘The government plans to use primary care as an access point for recording the immigration status of migrants,’ Poduval says. ‘This places huge administrative burdens on already overworked frontline staff and requires expensive IT and admin systems.’

Some migrants interviewed for the study were so frightened of deportation they declined to approach a GP surgery at all, instead presenting much later at already over-burdened A&E departments. This has significant implications in terms of both increased costs and endangering public health.

‘Without early medical attention, illnesses spread and become harder and more expensive to treat,’ says Lucy Jones, study co-author. ‘By creating hostility around access to healthcare for those who need it, we are not just hurting individuals but the health of the whole of society.’

The study calls for support, rather than isolation, of the vulnerable migrant population, including training for health workers about the rights of migrants and more careful consideration by policymakers of the long-term costs of new limitations.

‘From the amount of sick and vulnerable people we see turned away from GP surgeries every day we know there’s already confusion about identity checks among frontline healthcare staff and proposed new rules will only add to that,’ says Leigh Daynes, Executive Director of health charity Doctors of the World UK. ‘Primary care must be accessible to everyone.’

Migrants often face a laundry-list of obstacles: discrimination, language and cultural barriers, lack of familiarity with public transportation options, irregular housing, increased chance of poverty, a small or non-existent network of supporters, no feeling of belonging, constant fear of deteriorating health status and stress about deportation.

It is estimated that more than 618,000 undocumented residents live in Britain, 120,000 of them children.

‘There must be a way to manage migration whilst ensuring equitable, sustainable access to healthcare for everyone living here,’ says Daynes. ‘Protecting the NHS from alleged misuse must not compromise a doctor’s duty to treat the patient in front of them. Doctors are caregivers, not border guards.’

*name changed

Follow Chelsea on Twitter: @ChelseaRadler

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