Will the gates open?

They say it will help in the war against terror. But it will also
be used to access public services – and a card designed with the
prevention of terrorism in mind is not necessarily tailored to
those in need of health care or social care. Indeed, the planned
identity card scheme could create barriers that prevent some of the
most vulnerable people, such as those with physical or mental
health problems, homeless people and asylum seekers, from getting
the services they need.

Controversy has long surrounded any suggestion of ID cards for the
UK. Successive governments have mooted the idea and then, following
strong public resistance, shelved it.

Now, however, a draft bill has been introduced and the Home Office
Select Committee recently reported in favour of ID cards being
brought in as a measure to counter terrorism. The process is still
at its consultancy stage, but it is envisaged it will become
compulsory for everyone to register for, though not to carry, an ID
card.

The cards will also be required to access public services. And it
is this aspect that has provoked serious concerns – that the system
might lead to people without a card being denied the services they
need.

It is estimated a card will cost about £35, or £75 for a
combined passport/ID or driving licence/ID. It is envisaged there
will be provision to help people on a low income pay for it, and
the first card issued to 16- year-olds will be free. By about 2012
it will become a civil offence not to register and not to update
your card with new information, such as a change of address, for
which the penalty is likely to be a fine.

Those at risk are perhaps the most likely to be without a card,
such as those with mental health problems, older people, homeless
people, or asylum seekers. People who are most likely to lose their
cards, or who change their address most frequently, are the ones
least able to afford to replace them, making themselves ineligible
for the services they need.

The British Medical Association is concerned that some people might
be excluded from health care. Vivienne Nathanson, head of science
and ethics at the BMA, says: “We are worried about vulnerable
patients falling through the net and not getting treatment.
Socially excluded groups are among the least likely to access
public services, and the need to register for and hold an ID card
in order to access vital services could act as an additional
disincentive.”

A card will not need to be shown for emergency medical treatment.
However, treatment that falls into this category has yet to be
defined, and anyway this approach could ultimately prove expensive
for the health service. “Not treating patients for non-emergency
conditions may end up costing the NHS far more in the long run,”
says Nathanson. “For example, it is much more expensive to treat a
patient with periodic diabetic comas than to provide maintenance
doses of insulin.”

The costs are not just financial but also involve staff time and
efficiency costs – treatment could be delayed while eligibility is
being proved.

There are no plans to give asylum seekers ID cards; they will
continue to use the application registration cards (ARCs) they are
currently issued with, which carry basic information about the
holder. According to Bharti Patel, head of policy at the Refugee
Council, ARCs have proved useful for people to identify themselves,
their status and language and their eligibility for services.

However, although the legal position on entitlement to services is
quite clear, not everyone understands it fully and there have been
cases of people being denied a place on GP lists because their
status has been misinterpreted.

“Furthermore,” Patel says, “If ID cards become used to access
services such as benefits, housing and health care, asylum seekers
without one may find it even harder to get services they are
entitled to.”

Sophie Corlett, director of policy at Mind, has similar concerns
for people with mental health problems, who may be unable to cope
with bureaucracy and keeping their possessions in order. They could
become further disadvantaged by a system that is not designed to
meet their needs.

“If ID cards were to be compulsory for individuals wishing to use
NHS treatment or social services, we would be very concerned,” she
says. “It is possible that people with certain kinds of mental
health problem would mislay or lose cards and would be excluded
from, or face delays in, receiving vital services or treatments as
a result.”

People without a card, or with one carrying outdated or inaccurate
information, would be liable to a fine. For anyone who is homeless
or vulnerably housed, this becomes an extra cost and worry.

Sue Regan, housing charity Shelter’s director of policy, says:
“With record numbers of homeless people and families shunted from
one form of temporary accommodation to another, linking ID cards to
a person’s address risks creating a barrier to vital services. This
is particularly crucial for homeless people and families, including
over 100,000 children, who frequently have poorer health and are
more dependent on benefits.”

All these concerns about the IDcard scheme will be considered by
the government, says a Home Office spokesperson. “This is in its
early stages and there is still no commitment to legislation. We
will look at all these issues and make sure no one is excluded. The
important point is that ID cards are key to the country’s future:
the way in which the world responds to security is ID and we need
to make sure the UK is at the forefront. We would look at what
needs to be done to ensure no one is precluded by their mental
health, general state of mind or any other reason of
vulnerability.”

Even the critics admit there could be benefits to the scheme, if it
incorporated safeguards and the facility to adapt the system to
meet the needs of users of public services. “The BMA is not opposed
to an ID card system,” says Nathanson. “Indeed, such a scheme might
be useful in providing an unbureaucratic method for GPs to assess
eligibility to health care.”

Regan agrees that an adapted system could work. “We would like to
see a flexible system, which recognises particular circumstances
and problems faced by homeless people – making it easier, not more
difficult, to gain services and support.”

Scepticism has been expressed about whether the ID card will prove
effective even in addressing the risk of terrorism. But it also
remains to be seen how many people will find themselves in
difficulty because they cannot prove their eligibility for a health
or social service. The Home Office is adamant the scheme will
benefit society and that there will be plans in place to help
people obtain and maintain their cards. However, people working in
the fields of mental or physical health, homelessness and with
asylum seekers know the reality is not always as straightforward as
the politicians like to portray.