Failed asylum seekers denied NHS hospital services

Failed asylum seekers have no right to hospital services except in an A&E department. Unable to pay for treatment, they are left ill and in pain in the hope that they will leave the country, says Amy Taylor

You are destitute, sleeping on a friend’s floor and trying to recover from major surgery for bowel cancer. After the operation you were billed for more than £1,000 which you have no way of paying. You need radiotherapy to destroy any remaining cancer cells but have been denied the treatment unless you pay in advance. A debt collection agency will soon be hounding you to settle your unpaid bill.

This is not a story from a third world country but a plight faced by significant numbers of children and adults in the UK today. The NHS may have been set up to provide health care for all based on need, not the ability to pay, but this does not apply to asylum seekers whose claims have failed.

The government introduced charging for hospital care for this group in April 2004. Ministers brought in the policy as a response to health tourism, saying that it was needed to protect NHS resources. But campaigners and medical professionals argue that asylum seekers come to the UK seeking refuge not health care and charging them for treatment is inhumane.

Exceptions are care provided in A&E departments and care for communicable diseases that might pose a public health risk. Emergency treatment elsewhere in the hospital will be carried out but asylum seekers will be billed afterwards. For all other procedures payment is required beforehand, making them out of reach to most.

Asylum seekers covered by the measures are those who could be deported at any time, or those who are unable to leave due to a physical impairment or there being no safe route of return. This group receive board and lodgings.

Nancy Kelley, head of international and UK policy at the Refugee Council and co-author of a report on denying health care to failed asylum seekers, is calling for the policy to be scrapped due to its devastating impact.(1)

“It’s a nonsense to ask people who have no access to money for payment for services. This is inhumane and it can’t be that we think it’s acceptable that people should suffer excruciating pain to enforce immigration control.”

The Refugee Council has worked with asylum seekers experiencing serious problems accessing health care under the measures and a smaller number who have been denied treatment for cancer, diabetes, HIV and Aids which they desperately need (see Case studies, below). Kelley says that, even where payment upfront is not required, the prospect of a large bill to follow the treatment deters many asylum seekers.

In its defence, a Department of Health spokesperson says that, where it is clear the patient has no means to pay and that it will not be cost-effective to pursue payment, the NHS trust can write off the fee. But the Refugee Council research found that many trusts strictly follow the measures and employ vigilant debt collection agencies. Where payment is required upfront the charity found it “extremely difficult” to persuade trusts to use their discretion and treat patients unable to pay in advance.

Yusef Azad, director of policy and campaigns at The National Aids Trust, says the letters hospitals send to asylum seekers fail to mention that the trust can write off the fee if the patient cannot afford it.

Initial testing for HIV and Aids and counselling is free for asylum seekers whose claims have failed but treatment services are chargeable. This prevents many asylum seekers from using them. According to Azad, this is dangerous for the asylum seekers themselves and for the public because somebody who is HIV positive and on antiretroviral drugs is less infectious than one who is not.

He argues that it is essential that asylum seekers with HIV or Aids receive treatment due to the severity of the illness. “When a [HIV positive] mother in this situation has to pay for drugs to stop her unborn child getting infected you wonder what sort of country we have become,” he says.

Many medical professionals have also expressed disdain for the policy. A British Medical Association spokesperson said the organisation had serious concerns about the health of asylum seekers whose claims have failed and that it was “totally unjustifiable” to require them to pay for care.

In the same way that section 9 of the Asylum and Immigration (Treatment of Claimants, etc) Act 2004 requires social workers to take into care the children of failed asylum seekers who refuse to go home, this policy requires health care staff to carry out an activity which they may feel is unethical.

Moyra Rushby, co-ordinator of the Network of Health Professionals Working with Refugees and Asylum Seekers, says it is unacceptable for the government to force overseas visitors managers – the hospital staff who usually have to decide whether treatment should be charged – to decide on a person’s right to treatment.

Kelley agrees it’s an unfair expectation. “The NHS is not a branch of the UK Immigration Services: It was set up to provide universal access to free health care to those in need and destitute failed asylum seekers are exactly that,” she says.

Confusion among health staff in implementing the regulations is a further barrier to treatment. Due to the severe health risks associated with pregnancy, maternity services, although chargeable, do not require payment upfront. But Kelley is aware of girls who have been told that unless they paid in advance they would not be provided with care (see Case studies,below).

Once an asylum seeker has been refused care or is unable to access it due to the bill, hospitals are under no requirement to follow up the outcome. “The unsaid hope is that they [the asylum seeker] will go away and somebody else will do it,” says Rushby.

And, unlike the situation in nations that charge for health care, because the NHS is free there is no parallel system of care provided by charities in the UK, leaving asylum seekers with nowhere else to go.

Kelley says that if the public were more aware of what was happening they would be horrified but Rushby is not so optimistic.

She says that if animals were being denied essential medical treatment rather than asylum seekers it would be a different story. “If it was a cat that was left to suffer there would be an absolute outcry.”

Case studies
E, a young woman from China, was turned away several times by an NHS trust, which told her that, unless she could pay them several thousand pounds upfront, it would not provide her with support through the birth of her baby. She gave birth at home, with no medical care, and then she and her baby had to be admitted to hospital with serious health problems relating to the birth. Once discharged the hospital sent E bills which frightened her so much she fled her home. The whereabouts of mother and child are unknown.

H is from Rwanda. When he went to the Refugee Council he was living on the street and destitute. He had bowel cancer and had worn a colostomy bag since an earlier operation. His health trust had refused to provide him care without advance payment and his GP was refusing to register him.

Source: Refugee Council report First Do No Harm

(1) First Do No Harm: Denying Health Care to People Whose Asylum Claims Have Failed