NHS is failing refused asylum seekers

Written by Musmirah_Shahzada on Monday, November 13, 2006 12:16

Refugee Council says at Safe from Harm conference

Written by Claire Frauenfelder in BMJ 2006;333:988 (11 November)

NHS hospitals are failing to provide adequate maternity care for refused asylum seekers who are pregnant, the UK Refugee Council claimed at a conference last week in London.

Speakers from the council also said that hospitals were denying treatment to refused asylum seekers who are dying of cancer or who have AIDS, when such treatment was available to others in the same situation in other European countries.

The council told its "Safe from Harm" conference how changes made in 2004 to NHS policy to charge refused asylum seekers as overseas visitors (BMJ 2004;328:1217) is having an inhumane and devastating effect and that the policy was created without any evidence base.

Parveen Kumar, president of the BMA, said, "This is a group of people with no one and nowhere to turn to. While they are here they are ours to look after."

Several speakers at the conference discussed how this is not the first time the Department of Health has been called on to justify its agenda of eradicating "health tourism." A 2005 report on HIV and AIDS policy by the parliamentary select committee on health questioned the policy's validity, stating that "no evidence exists to objectively quantify the scale" of health tourism (BMJ 2005;330:688). The report said, "By the department's own admission, these changes have been introduced without a cost-benefit analysis, and without having even a rough idea of the numbers of individuals likely to be affected."

Maternity care is one area hit hard by this change. Although such care is always deemed "immediately necessary," and patients are not meant to be charged for it because of the possible risk to mother and child, "in practice, rules are being applied very differently," said Karen McColl of the charity Médecins du Monde UK.

She described how terrified women are being threatened by "overseas visitors managers," brought in by trusts because clinical staff refused to turn patients away, and that "some women are completely deterred from going for any further care at all."

Nancy Kelley, the Refugee Council's head of international and UK policy, said, "This represents a massive change in deciding who has access to health care. Previously all allocation of care was based on clinical need. This introduces a new way of thinking about who receives care."

She described how the rules were introduced in response to what was perceived as health tourism. In reality, however, many refugees and asylum seekers are often "under-users of healthcare systems," who wait months after arriving in the United Kingdom until their situation is desperate before seeking help.

"Ultimately this policy is difficult to justify, because it is incredibly inhumane," she said, "The action needed is a health select committee inquiry to look at the effects this change is having."

Under the new rules, refused asylum seekers are allowed to attend emergency departments for treatment that is "immediately necessary" without being charged, but any other secondary care is chargeable.

The Refugee Council and Oxfam published a report in June, First Do No Harm, which explained how the new rules work. It states that trusts have to take deposits from patients before providing any "urgent" care, defined as when a doctor decides that "treatment is not immediately necessary but cannot wait until the patient returns home."

First Do No Harm: Denying Healthcare to People whose Asylum Claims have Failed is at www.refugeecouncil.org.uk.

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