HISTORY OF THE DEFEND PRIMARY HEALTHCARE CAMPAIGN

Introduction

An ongoing Department of Health review threatens to restrict entitlement to primary healthcare for ‘Overseas Visitors’. This includes refused asylum seekers and undocumented migrants, some of the UK’s most vulnerable residents. The history of this is as follows. (entitlement to NHS primary care came under threat only a few years after the right to freely access most secondary care services was removed.)

  • In April 2004, regulations came into effect that, with a number of important exemptions, removed the right to free NHS hospital care from ‘overseas visitors’ (Statutory Instrument No 614)
  • This was closely followed by a government consultation ‘Proposals to Exclude Overseas Visitors from Eligibility for Free NHS Primary Care Services’. The responses to this were never published.
  • A cross-Government enforcement strategy document “Enforcing the Rules” (Home Office, 2007) suggests that the regulations governing access to primary care will be brought into line with existing secondary care regulations.
  • The language used in this document is particularly disturbing - suggesting that destitution be used as a lever of immigration policy: “To ensure that living illegally becomes ever more uncomfortable and constrained until they leave or are removed”
  • In April 2008, a judicial review found restricting access to NHS services for refused asylum seekers, as recommended by regulations over the preceding four years, to be illegal (see below).

We are campaigning against these proposals because...

  • Denial of care will lead to avoidable deaths and suffering
  • There is no evidence of significant levels of health tourism; this group are young, mostly healthy, and are little burden on services
  • Doctors are not immigration officers, our first duty is to our patients
  • Such a system would be difficult and expensive to administer
  • Primary care is cheap and prevents expensive A&E attendances

  • Unvaccinated children and missed diagnoses of infectious disease will lead to greater transmission of measles, TB and other diseases, which will harm us all. See Medact’s entitlement campaign to learn more about these issues. You can download their excellent briefing document here (pdf file). This was written before April's judicial review.

  • It is our opinion that policy should not be based on flimsy evidence of ‘health tourism’. Thus, we believe that responses to the 2004 consultation deserve public scrutiny in order to help inform constructive debate on the issue of charging foreign nationals for health services, especially given the stakes.

2004 Consultation and FOI Requests

  • We used the FOI Act to request access to the responses to the 2004 consultation. The DOH refused our request, on the grounds that they are still being used to guide policy through the ongoing review, 4 years after the consultation itself.

  • Despite a series of appeals, our request yielded only a list of 275 names. We used this to request copies of submissions from individual respondents. These 38 responses were collated to produce our own report on the public consultation. You can download the report here.

Failed Asylum Seekers and Ordinary Residence

  • In April 2008, a high court judgement resulted in changes to entitlement to free NHS healthcare for refused asylum seekers: those deemed ‘ordinarily resident’ in the UK, probably the majority, are now eligible for free NHS healthcare. However, this ruling does not affect undocumented migrants. (See Medact’s briefing on the April court case) The DOH has appealed the judgement. The appeal was heard in mid November 2008 and a new ruling is expected expected to be released towards the end of December.

  • The Department of Health have asserted that the judgement only applies to secondary or hospital care. We have sought independent legal advice and believe that it applies to primary care as well. The BMA has produced guidance on entitlement to primary and secondary care. DPH has also prepared a legal brief regarding GP contracts and entitlements to primary health care for those deemed ordinarily resident - you can download this from the main DPH page.

  • It seems unlikely that the DOH will report on the current review until the legal situation regarding secondary care is confirmed, further delaying the outcome of the review and holding many organisations in limbo, especially those that support refused asylum seekers.

Borders and Immigration Bill

  • Meanwhile, the Home Office seeks to simplify all existing immigration legislation in the revised Immigration and Citizenship Bill. The consultation process regarding the draft bill is underway. The bill will include, as yet unpublished, legislation on 'access to benefits and services'. One of the bill's stated aims is to ensure 'that migrants can only access benefits and services where they have ‘earned’ the right to them.'

  • We are concerned that legislation regarding changes in access to NHS services may be included in this so-called ‘immigration simplification bill’. We will be monitoring this closely. We feel it would be inappropriate for health policy to be set by the Home Office in this way. The Joint Committee on Human Rights are currently reviewing the compatibility of the draft bill with the UK's human rights commitments.

What do we believe?

  • Defend Primary Healthcare believes that destitution should not be used as a lever of immigration policy; and that all those who live in the UK should be entitled to free primary and secondary NHS care until the point that they leave or are removed.

What are we doing at the moment?

  • We are currently monitoring the legal situation. We are also raising awareness of these issues in anticipation of a future government consultation on access to NHS services and the likely need for public advocacy.

  • We work with Medact via the Entitlement Working Group to achieve a coordinated opposition to the proposals – see their website for more details.

  • See the campaign homepage for a list of actions - you can get involved whether you have 2 minutes, 2 hours, 2 weeks or are interested in joining the national campaign in the longer term.

Last updated on Saturday 22 November 2008 at 13:44.