Demos: Migrant health access fears put vulnerable people at risk

A new report by the think-tank Demos, supported by Doctors of the World, argues that encouraging earlier detection of health conditions amongst migrant communities would reduce NHS spending on treatment and reduce the wider public health risk by catching transmittable diseases early.

The report responds to concerns about Government proposals for extra NHS charges for migrants that could deter even more vulnerable people from accessing the healthcare they need. Previous Demos research also found a significant number of the 850,000 migrants who cannot speak English struggle to access public services.

“You don’t have to approach this issue ideologically to see the wider risks of discouraging migrants from accessing healthcare,” says Max Wind-Cowie, Demos associate and co-author of the report. “The potential costs to the system of delayed treatment and risks to public health of missed opportunities for diagnosis speak for themselves.”

The report urges the Government to set up ‘all-in-one’ centres combining GPs with advisors to encourage migrants to seek health treatment despite concerns over their immigration status. The centres would bring together frontline NHS staff with expert advisors from support agencies, who would confidentially be able to inform patients what they are eligible for, where they can access care and what charges they might incur.

The research, published on Monday, builds on evidence from a Doctors of the World survey of 1,000 migrants which found 90 per cent have not registered with a General Practitioner even though they were eligible to do so. Twenty per cent of those who didn’t register said they were deterred from seeking care for fear of the immigration control consequences.

“Volunteer doctors at our London clinic see a steady stream of vulnerable migrants who – despite being entitled to it – are denied access to NHS care or are too afraid to try,” says Leigh Daynes, Executive Director of Doctors of the World UK. “This includes people with serious illnesses such as cancer, parents with small children and heavily pregnant women.

“And the patients we see are not health tourists, they live here – on average for more than four years before seeking a doctor’s help.”

He added:

“Protecting the NHS from alleged misuse must not compromise a doctor’s duty to treat the patient in front of them, regardless of income or status.

The report goes on to say that if migrants are put off from accessing healthcare the NHS will struggle to build up an accurate data profile of emerging trends in healthcare needs.

The report also recommends:

• Blanket exemptions for children in NHS eligibility criteria, both for ethical reasons and to also catch conditions early enough to prevent serious, expensive treatment.
• One-way information sharing that allows health professionals to access information held by the Home Office, without permitting the reverse – thus reassuring any migrants that seeking treatment will not lead to questions over residency.
• The Government carries out rolling impact assessment of the changes to understand the effect on frontline medical staff and review additional data obtained through the centres to more accurately plan the assignment of healthcare resources in future.
• The NHS implements a campaign to educate administrative staff about the charging system and people’s entitlements.

The report, Do No Harm, by Max Wind-Cowie and Claudia Wood is published by Demos on Monday 20 October 2014. The full report can be downloaded here, after 00.01 on Monday 20 October: www.demos.co.uk/publications/donoharm.

British migrant figures according to The Migration Observatory at the University of Oxford.

Mary’s story

Mary (name changed), arrived in the UK eight years ago from Uganda and hadn’t thought to register with a GP as she had always been in good health. Then she fell very ill. ‘It came on suddenly and I started sweating,’ she recalls. ‘My breathing was bad and I couldn’t speak’. Despite being extremely ill she was unable to register with a GP because of her immigration status and DOTW staff tried for months to get her registered, without success, eventually finding her a doctor in Barnet. The doctor diagnosed her with tuberculosis and she got the medication she needed, which she no longer needs to take.