New Clause 8
Health Bill [Lords]
2:30 pm
Sandra Gidley (Romsey, Liberal Democrat)
I beg to move, That the clause be read a Second time.
This new clause is similar to the amendment tabled by my noble Friend Baroness Tonge in the other place. It seeks to end the situation where refused asylum seekers, including children, the elderly, victims of torture and other seriously ill and extremely vulnerable people, can be denied secondary health care unless they can pay for it. There are many who regard this policy as inhumane. It puts asylum seekers’ lives at risk and is likely negatively to impact on public health in general. The policy is also very difficult for health care professionals to administer and enforce.
It may be worth providing some background to this. In 2004, as part of the National Health Service (Charges to Overseas Visitors)(Amendment) Regulations, the Government introduced charges for all refused asylum seekers to access hospital care except for emergencies. In practice that has meant that treatment in an A and E department is free but all other hospital and specialised medical care is chargeable; that strikes many as a blunt instrument. That includes patients on section 4 support, pregnant women, children, cancer patients, diabetics and those needing treatment for HIV/AIDS. Treatment for most communicable diseases, except HIV/AIDS, is an exception to this rule and can be provided free of charge; there seems to be an anomaly in not including HIV/AIDS. Given how difficult it has become for asylum seekers to access health care, it is questionable whether they will come forward for screening or treatment for diseases such as tuberculosis or mental health problems.
The rationale at the time for this policy seemed to centre on health tourism. That was something the media were concerned about at the time, but there has been relatively little evidence that it was a significant problem. The occasional person will come to the UK specifically to access health care, but there is no evidence that that is the prime motivation for most people entering this country. In 2009, the Royal College of General Practitioners concluded:
“There is no evidence that asylum seekers enter the country because they wish to benefit from free health care.”
It also stated that GPs have a
“duty of care to all people seeking healthcare”
and
“should not be expected to police access to healthcare and turn people away when they are at their most vulnerable.”
The Royal College of Psychiatrists has also observed:
“The psychological health of refugees and asylum seekers currently worsens on contact with the UK asylum system.”
During its scrutiny of the Bill, the Joint Committee on Human Rights noted:
“We remain as concerned as we were more than two years ago when we concluded our inquiry into the Treatment of Asylum Seekers that a highly vulnerable group of people in the UK...continue to be denied access to fundamental healthcare”.
In the first two years following the introduction of the regulations, the Refugee Council worked with dozens of refused asylum seekers who had been denied or charged for the health care they urgently needed. To give a snapshot of the sort of cases that have fallen foul of the regulations, 15 women and two girls were charged more than £2,000 for maternity care and in some cases were denied that care if they could not pay in advance. I would contend that the unborn children had a right to care in utero, but others decided differently. Ten people who needed operations for different medical conditions or treatment for injuries sustained in the UK were denied treatment, as were people with cancer. A gentleman with bowel cancer was admitted to A and E, but his operation was cancelled when he was unable to pay for it and he was told to come back when his condition deteriorated. There are many similar examples.
Refused asylum seekers face considerable obstacles to accessing care, including confusion about entitlements, GPs using their discretion whether or not to register or treat them, language barriers and so on. This all paints a very confused picture. Despite having been refused asylum in the UK, some of these people have horrendous stories. They sometimes have health problems linked to torture, poverty in their country of origin or even mental health problems caused by their detention. The numbers may be relatively small but the problems are quite specific. I alluded earlier to the problem women asylum seekers face; if they are pregnant, they do not get good anti-natal care.
There was a successful legal challenge to this policy in April 2008, but the ruling was overturned on appeal by the Government. The Court of Appeal handed down its judgment on 30 March, finding that failed asylum seekers cannot be considered ordinarily resident in the UK and are not exempt from charging, even if they have lived in the UK for a year. However, the court also found that existing guidance is unlawful as it is not sufficiently clear on what treatment should be considered urgent and immediately necessary.
In response, the Department of Health issued interim guidance on the 2 April 2009. That makes it clear that immediately necessary treatment, including maternity care, must never be withheld; urgent treatment for conditions such as cancer, which would deteriorate significantly if untreated, should not be withheld; trusts should not pursue charges beyond what is reasonable; and non-urgent treatment that can wait until the person returns home should not be started until payment has been made. By contrast, in Scotland, refused asylum seekers receive free health care until they return home, and in Wales, the Welsh Assembly have confirmed that they will not charge refused asylum seekers for access to secondary health care despite the outcome of the appeal.
The new interim guidance is welcome, but it does not address the fundamental concerns relating to the charging regime and the way guidance has been implemented since 2004. There has been a lot of confusion and the new clause is an attempt to clarify some problems from the past. The policy remains burdensome on health care professionals. They may have to assess when a patient is likely to return home, or whether waiting until that time would lead to an unacceptable deterioration in the patient’s condition. This can be difficult and time consuming. It is also inappropriate to make health care professionals consider a person’s immigration status when their duty of care should be their only concern. In addition, there are still likely to be differences of opinion between clinical and non-clinical staff as to which cases are immediately necessary or urgent, because hospitals will not be reimbursed for the treatment they give to refused asylum seekers.
We are moving into the argument about whether it is a good thing to charge for health care, but if people do not come forward there are public health risks, because they may not be screened for treatment or they may not receive inoculations. The policy is not consistent with the ethos of the NHS constitution, which we discussed at length earlier in the Committee.