The ‘hostile environment’ is targeting the most vulnerable

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Covid-19 disproportionally affects BAME people and migrants, yet they have most to fear from seeking treatment, writes Jim Fagan

Since 2015 new health regulations have introduced charges for a growing number of patients wanting to access NHS services. Since then, NHS Trusts must identify and charge people deemed ineligible for free care. People who live outside the European Economic Area and Switzerland will require health insurance when they visit the UK, and those with no insurance will be charged at 150 percent of the NHS national tariff for any care they receive. An Immigration Health Surcharge has also been introduced. In October 2017, the regulations were expanded to introduce up-front charging and extended the range of services subject to charging to include some community and mental health services. Currently, all countries in the EU have reciprocal medical arrangements but these are likely to end with Brexit with unknown consequences.
The international organisation Doctors of the World found 20 percent of service users were affected by charging, and of these one-third were deterred from seeking care. This is of particular concern in the case of maternity care. Maternity Action found evidence of women frequently avoiding antenatal care for fear of being charged or having their information shared with the Home Office. Sally Daghlian, the head of Praxis, the charity that helped expose the Windrush scandal, said their service users were all living on the margins before Covid19, and the crisis has exacerbated their problems: “Everyone is meant to be entitled to GP care and A&E does not turn people away, but a bill may be sent for hospital treatment.
This terrifies migrants who have no money, and if the bill isn’t paid in quite a short time, this is reported to the Home Office and can affect their application to remain.” Research shows that during the pandemic immigrants, whose status is uncertain, are not seeking healthcare even for services to which they are entitled. According to the Medact charity some “57 percent of respondents confirmed that migrants had avoided seeking healthcare because of fears of being charged for NHS care, data sharing with the Home Office and other migration enforcement concerns.” Although testing and treatment for the coronavirus is exempt from charging it would still apply to the treatment of any “secondary illness”.
A study of former patients at Barts found half of the Covid-19 patients surveyed still had severe symptoms such as fatigue and breathing difficulties three months after they were discharged. And in the case of fatigue, some said their symptoms were getting worse. The pandemic has revealed the reality of structural racism and inequality in our society. The Office for National Statistics found the risk of death involving Covid-19 was twice as high for black men and 1.4 times higher for black women compared with white people. Men of Bangladeshi, Pakistani and Indian ethnic backgrounds were also found to be at a significantly higher risk of death. Passports There is resistance to the hostile environment from grassroots campaigns.
In east London, North East London Save our NHS linked up with Docs Not Cops and Migrants Organise, calling on Barts Health, the largest Trust in London, to suspend its involvement in the new regulations. Barts was piloting the new policy, asking women seeking maternity care in Newham for their passports and making up to one hundred referrals a week to the Home Office. Following a lobby of Barts’ annual general meeting, where a letter signed by 600 residents was presented, the Trust backed down on asking for ID and removed hostile environment posters.
However, Barts continues to check for eligibility and reports to the Home Office anyone who owes £500 for two months or more. Newham health activists revealed that between 2018-19, some 739 women were billed for maternity care by Barts. In fact, 290 were eligible for free care, strongly indicating that profiling based on a patient’s name or ethnic origin. In response to a statement from Barts that it was “inspired” by Black Lives Matter to “eliminate and racial inequality at Barts Health”, east London residents and health workers wrote to the Trust highlighting the contradiction of this stance while continuing to implement a racist charging policy.
Jim Fagan is a retired nurse and health activist.
For a copy of Migrants Access to Healthcare During the Coronavirus Crisis go to: medact.org/2020/resources/briefings/ patients-not-passports-migrants-access-tohealthcare-during-the-coronavirus-crisis