Proposals to exclude overseas visitors from eligibility to free NHS primary medical services: A consultation

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"there is much that we simply do not know. We don’t know how many people in the UK fall - intentionally or not - into the groups that would be most affected by the proposed changes to primary care; nor do we know how many have already been refused secondary care and what has happened to this group. Perhaps more importantly it is not clear how we will provide alternative care for those who will be excluded from both secondary and primary care. It is perhaps not unreasonable to suggest that the Government answers these questions before taking such a drastic measure."

You can read the rest of this Medact briefing here

In 2004, the Department of Health launched Proposals to exclude overseas visitors from eligibility to free NHS primary medical services: A consultation. A response to this consultation was never published and the Department of Health have refused to release the submissions to the enquiry. We are currently going through the appeals process with the intention of bringing this information into the public domain.

The department did, however, send us a list of all the individuals and organisations that submitted responses to the consultation.

We are now contacting these individuals and organisations and collecting submissions as we feel that this will enrich the debate about access to primary care. We will keep a record of our progress below...

Note that email addresses have been removed from documents to protect confidentiality and prevent spam. If you would like to contact any of the authors, please email access@medsin.org and we may able to help.

Organisations

  • Age Concern - submission available from the box, top right

  • African HIV Policy Network - submission can be downloaded from the box, top right

  • Asylum Aid - submission can be downloaded from the box on the right

  • Barnsley Primary Care Trust - we have been in contact. We have the comments of one employee, Lesley Hedges, a public health specialist (see 'Barnsley PCT - comments from Lesley Hedges') and are awaiting the response from the PCT.

  • The Breastfeeding Network - Sent us their submission which is available from the box, top right.

  • Christian Medical Fellowship - submission can be downloaded from the box on the right or accessed via the CMF website.

  • Churches' Commission for Racial Justice - submission available from the box, top right

  • Doncaster LMC - have refused to release their three submissions...

We are very sorry that we are unable to assist you on this occasion as the submissions were in confidence and therefore we are unable to supply you with details.

  • East Midlands Consortium for Asylum and Refugee Support - we have requested a copy of their submission. Meanwhile we note that in their annual report from 2003-4, they state (page 20)...

Recently we sent a regional response to the Department of Health consultation on restricting overseas visitors (including failed asylum seekers) entitlement to free NHS Primary Healthcare. We argued that this was neither ethical nor practical to do in GP surgeries.

  • The Haven - submission can be downloaded from the box

  • Immigration Law Practitioners Association - submission available from the box at the top of the page

  • Joint Council for the Welfare of Immigrants - submission can be downloaded from the box, top right

  • Kensington & Chelsea Social Council - have told us that they made no submission to this consultation

We did not submit a response to this

  • Kent LMC - submission available, top right

  • Lambeth Primary Care Trust, Refugee Health Team - are awaiting permission to place this submission online

  • Lewisham PCT - submission available from the box, top right (the covering letter plus the submission have been amalgamated into one document)

  • Mayor of London - we have obtained a copy of this submission which can be downloaded from the box, top right

  • Médecins du Monde - submissions available from the box at the top of the page

  • Médecins sans Frontières - submission available from the box, top right

  • Migration Watch - you can read their submission here

  • Morecambe Bay PCT - submission available from the box, top right

  • National AIDS Trust - submission can be downloaded from the box at the top of the page

  • Newark and Sherwood Primary Care Trust - available from the box, top right

  • Refugee Action - submission available from box, top right

  • Refugee and Asylum Seekers Health Action Group - submission available from box, top right

  • Refugee Council - subission available from box, top right

  • Royal Society for the Promotion of Health - submission available from box, top right

  • South Birmingham PCT - have requested that we do not place their submission online as it no longer reflects trust policy

  • Suffolk Practitioners Service Unit - submission available from box, top right

  • Terrence Higgins Trust - submission available from the box at the top of the page

  • The Whitehouse Practice, Huddersfield - submission available, top right

Individuals

  • Silke Bannuscher (General Practitioner) - submission can be downloaded from the box, top right

  • Woody Caan (Professor of Public Health, Anglia Polytechnic University) - no longer has a copy of his submission to the consultation but has sent us 2 letters which he sent to BMJ online and as well as an article which reflect his views. These can be downloaded from the box on the top right hand corner of this webpage.

  • Carol Cheal (General Practitioner) - can be downloaded from the box, top right.

  • Christina Cock (General Practitioner) - submission available from the box, top right

  • Brian Fine (General Practitioner) - submissions available from the box at the top of the page

  • Peter Le Feuvre (General Practitioner) - no longer has a copy of his submission

To be honest I can't remember what I submitted and I certainly did not keep a copy. It would have been around the issue of public health risks of failing to treat destitute asylum seekers, difficulty in knowing exactly who is a failed asylum seeker and who is not, and human rights. Nothing has materially changed since 2004 and we are no nearer to knowing what the DoH will decide.

  • Dr Jill Maben (Senior Research Fellow, Nursing Research Unit at King's College)...

Cannot locate the documents I am afraid - sorry...My views are that access to healthcare is a human right. Here in the UK we may often take this for granted because of our largely very good healthcare provision with our 'free at the point of delivery' NHS system. However, whilst I am largey in favour of non EU citizens who travel to the UK for health provision paying for their treatment if they can afford it and on a case by case basis, I am not in favour of my government refusing the most vulnerable in our society (asylum seekers, failed asylum seekers and refugees) access to healthcare that they require. The NHS is a universal service for all based on clinical need, not ability to pay, yet we hear of failed asylum seekers being refused hospital treatment and being pursued by debt collectors if they have received emergency treatment (BMJ 06). Asylum seekers and Failed asylum seekers should be entitled to access to healthcare as this is a universal right under international law and embodies our recognition of common humanity. As these groups are also denied access to work, or the ability to earn money in any way, just how are they expected to pay?

It will cause death and increased morbidity if such people are denied these basic rights and the impact would be felt further downstream, for example by emergency health services. If the government is unable to think of the health of the asylum seekers themselves, issues of public health for the whole UK population should be of concern. A lack of basic health information, health education and untreated HIV / Aids, TB, and other communicable diseases in an already stigmatised population may also result in the spread of such diseases to a wider population.

I am wholly against this ill-thought through and pernicious proposal. It is shameful that the British government is seeking to act in this way, denying access to medical care is unlawful, inhumane and goes against what those if us in healthcare professions are seeking to achieve. Such a law would be largely unworkable too and is likely to have little effect on the number of asylum seekers treated by GPs, and practice nurses, it would merely force such doctors and nurses to carry out illegal actions to uphold their Hippocratic oath / code of conduct.

  • Phillip Mathews (General Practitioner) - submission available from the box at the top of the page

  • Stanley Platt (Advisor on Immigration and Asylum, the Methodist Church) - available from the box top right

  • Wendy Ross (General Practitioner) - submission can be downloaded from the box, top right

  • Adam Sandell (General Practitioner) - submission available, box top right

  • David Sloane (City and Hackney Teaching Primary Care Trust)

Of the top of my head I think the main reasons for objecting to the proposed legislation were:

It is contrary both to basic human rights and to the spirit of the fight against inequalities in health which is clearly stated Govt policy

It will frighten people off seeking help thus potentially causing ill health from potentially preventable stages of illness

Antenatal care is a particular concern – if people do not come for it we know they are likely to get into trouble which the state will have to pick up and pay for

Emergency care has traditionally been free to all – what is emergency care and what elective?

There is no need to enact it because the NHS is not being abused by asylum seekers and refugees; they are not here to exploit our health care system

There may be a case for legislating to prevent such exploitation by those from rich countries – eg bankers from the US

Imposing the responsibility on GPs to police the system undermines the GP/Patient relationship which is likely to create a black market in healthcare

There is an anomaly in the legislation which allows treatment for conditions presenting a public health hazard. However where do you draw the line? – e.g. we know that mental health is a major problem for R&AS – this could become a public health hazard if these people are not helped

If we are concerned with public health then R&AS should be a focus for our concern not a target for penalty!

Hope these rapid thoughts may be helpful

  • Dawn Solomon (Newcastle PCT) - submission can be downloaded from the box, top right

  • Anthony Sudell (formerly of Cumbria and Lancashire Stategic Health Authority)

I submitted comments when I was in the employment of Cumbria and Lancashire Strategic Health Authority. When I changed my employment I was selective in the documents that I retained, and I do not believe that I have retained this particular one. I do not recall making reference to refugees.

  • Helen Sykes (General Practitioner) - submission can be downloaded from the box, top right

  • Kevin Vaughan (General Practitioner) - submission available from the box, top right

  • Paul Westcar (General Practitioner)

I've looked in my files & cannot find my submission. As you know, there is a lack of clarity in the guidance and the DOH, if pressed, tends to say it is up to the GP/Practice resulting in inconsistencies across the nhs. My submission related to temporary visitors I believe. Refugees given leave to remain in the uk would fall into a different category as they are regarded as "ordinarily resident".

  • Paul Williams (General Practitioner) - Submission can be downloaded from the box top right.

Last updated on Tuesday 05 August 2008 at 21:55.