Views from the London School of Hygiene & Tropical Medicine

UK doctors are care givers, not border guards

2015-02-25 Chelsea blog 2Edited from an article by Chelsea Radler published by Doctors of the World: Research from the London School of Hygiene & Tropical Medicine at Doctors of the World’s London clinic, published this week, shows that undocumented migrants face multiple barriers, including misinformation and rejection from GP services.

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

For example Roshan (not his real name) came to the UK seeking refuge from the civil war in Sri Lanka nine years ago, but when he tried to see a GP 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.

Implementation of the 2014 Immigration Act looms as another hurdle between vulnerable migrant populations and healthcare. From April 2015, chargeable migrants must pay 150% 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 and patients will also be asked whether they have a European Health Insurance Card (EHIC) 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. The study findings are published in the International Journal of Health Services (view pdf pre-print).

“Without early medical attention, illnesses spread and become harder and more expensive to treat,” says Lucy Jones, from Doctors of the World. “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.

More than 600,000 undocumented residents are estimated to live in the UK, 120,000 of them children. These 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.

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

Photo: clinical consultation, courtesy of Doctors of the World UK.

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