No Patient is Illegal: Fighting Borders in the NHS

by Erin Dexter

6 April 2017

Erin Dexter

This week, migrant activists protested changes to UK law, which will see healthcare workers co-opted as agents in the continuing assault on the rights and lives of UK migrants.

Yesterday, a group of protesters dressed as patients in hospital gowns, doctors in scrubs, and border guards blocked the path of those heading into work at the Department of Health in Whitehall. Queuing before a makeshift checkpoint, they stood and shouted in solidarity with migrants to protest changes to the law coming into effect this week.

As of April 2017, the government will implement passport checks in hospitals, and deny care to those who cannot pay for treatment. These are changes that will deeply affect and endanger the lives of thousands in need of healthcare in the UK.

Joined by other migrants’ rights and activist groups, Docs Not Cops called the action in response to amendments to UK law that will make the country’s health system one of the least navigable and most restricted in Europe for undocumented migrants. Made up of activists, NHS workers, and patients, Docs Not Cops formed following the 2014 UK Immigration Act, and are committed to fighting back against xenophobic and racist laws, such as the introduction of the Visitor and Migrant Cost Recovery Scheme. The act laid out the government’s intention to recover the cost of healthcare for those not permanently settled in the UK at 150% its cost to the health service. This policy has already been responsible for deterring vulnerable migrant women from accessing antenatal care, and for harassing and threatening women into ensuring they bring payment methods to their next appointment.

Patients not Passports.

These changes to migrant charging are quietly slipping into law this week without parliamentary debate. Their enactment comes in response to measures announced in February this year in the form of  a Department of Health document, sinisterly titled ‘Making a fair contribution‘. The document outlined how the government intends to further obstruct and restrict access to people who need it – the justification behind it being that these measures will affect only those who have a “temporary relationship with the UK”.

Despite the serious objections and grave concerns expressed by migrants rights groups and charities, starting from April, NHS Trusts are legally obliged to charge hospital patients for upfront care that is deemed not “immediately necessary”, and to deny care that is not paid in full up-front. It also asks that relevant NHS bodies identify the “chargeable status” of overseas patients and notify the trust accordingly. This means asking doctors, nurses, and midwives to ask to see passports before treating their patients. It asks people trained to provide cure, care, and comfort to withdraw or refuse treatment because they cannot provide a document, or were born overseas. In reality, this means that migrant charging affects the most vulnerable; undocumented migrants, refused asylum seekers, and those affected by homelessness.

Additionally, vetting and charging migrants will be extended into the community and to non-NHS providers of NHS-funded care. This will affect and restrict access to mental health services, hospice care, and services providing pregnancy terminations, amongst others. The Department of Health also wants GP surgeries to identify chargeable patients before they go on to receive treatment in hospital, and has indicated it would soon like to see Accident & Emergency, as well as primary care, become chargeable services too.

The government’s exemptions to charging include victims of sexual and domestic abuse, female genital mutilation, torture, and human trafficking. To anyone who has worked in services from health to social care, this is a blatant and pathetic gesture of acknowledgment of the vulnerable individuals that will be affected by the law. Unsurprisingly, it often takes more than an initial encounter for survivors to recount their experiences of abuse.

Let doctors be doctors. 

Last year, Docs Not Cops sent Freedom of Information requests to 156 hospital trusts across the UK. They revealed that, despite the intention to save £500 million by 2016 by recouping the costs of ‘health tourism’, the revenue recouped by overseas charging teams is pitiful. Taking finances in the 2015 calendar year, of the 156 trusts contacted, 70% confirmed that they had sent invoices to patients. Of these trusts, 34% had spent more on the team they employed to recoup costs from overseas visitors than they managed to recoup. There is no plan for this month’s extensions to migrant charging, but they are likely to be costly.

Anti-migrant narratives have proven sickeningly successful in convincing the public that this is an acceptable way of making savings in the NHS. Despite only accounting for an estimated 0.03% of the annual NHS budget, politicians continue to pedal the lie that people are coming from overseas to bleed the faltering heart of socialist Britain dry.

The logic is flawed, but the motivation for this attack on universal healthcare is more than fiscal. The introduction of migrant charging is underpinned by the same racist ideology that wants landlords to police their tenants, teachers to police their students, and police to turn victims of crime into the Home Office. If you spend any time on a hospital ward you soon realise that it is not the white people English names that are asked to produce passports, to prove they have a right to be there.

The government wants healthcare workers to comply with its valorisation of (white) bodies that are allowed to be here over (brown and black) bodies that are not. This is a targeted assault on the lives of migrants, couched in faux-worthy rhetoric of creating a sustainable NHS for everyone (who is British). The NHS has become another border against which we must struggle, and the fight is only beginning. People are organising locally with their GPs and taking part in patient forums.

Groups such as Docs Not Cops will continue to campaign for free and universal healthcare for all; for doctors to remain doctors. No patient is illegal, and we cannot let Theresa May’s hostile environment claim one more life, be it in the channel tunnel, a detention centre, or outside an NHS hospital.



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