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.)

  1. 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)
  2. 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.
  3. 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.
  4. 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”
  5. A high court ruling in April 2008 found that denying refused asylum seekers free NHS secondary care was unlawful. This ruling has subsequently been overturned by Department of Health appeal, meaning that a large section of our community once again is denied access to important treatment.
  6. The case is now being considered for appeal in the House of Lords. Please find information regarding ongoing developments in 'Campaign Updates'.
  7. The Government have announced a further consultation on current charging proposals that will take place in the Autumn. We will have more information in coming weeks.

We are campaigning against charging vulnerable migrants for health services because 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.

  • For 16 months 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.

  • In January 2009 we were granted access to the majority of the responses following involvement by the Information Commissioners Office. We published a second report 'Four Years Later' analysing these responses and again refuting a number of assertions previously made by the Department regarding the level of support for the primary care charging proposals. We are currently using this to advocate against charging for primary or secondary care, given the lack of evidence that surrounds such policies. Please see campaign updates for details.

Failed Asylum Seekers and Ordinary Residence - THIS JUDGEMENT WAS OVERTURNED IN MARCH 2009. 'ORDINARY RESIDENT' NO LONGER APPLIES TO REFUSED ASYLUM SEEKERS.

  • 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.

  • The case is now being considered for appeal in the House of Lords. It is important that as much evidence as possible is available of the harm that individuals are suffering in order to challenge public law. We await further news.

Current and Future Legislation

  • We are also keeping track of possible changes to healthcare rights for asylum seekers through government legislation in both health and immigration.
  • The new Borders, Citizenship and Immigration Bill received royal assent in July 2009. Further changes to immigration law will be considered in a process of immigration 'simplification'
  • A full draft Simplification Bill and immigration rules framework will be published in late 2009. We are concerned that this may include changes in access to NHS services and will monitor the situation closely.

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.

  • Please see the 'Updates' page for more up to date information and current events and actions that you can get involved in.

Last updated on Tuesday 25 August 2009 at 18:02.