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.

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