What comes to mind when you think of the UK? Perhaps cricket, rain, a sense of history, culture, somewhere with sturdy, progressive values. It’s not a place where heavily pregnant women who desperately need healthcare can’t get it. It’s not somewhere where some of the most vulnerable suffer illness in silence until they die.
Except that it is.
As an international humanitarian health charity, we face the extraordinary scenario of deploying mobile clinics to Britain's streets to plug gaps in healthcare services – resources that arguably would be better spent in places such as Syria or Gaza right now.
91 per cent of the patients we see at Doctors of the World’s clinic in London live below the poverty line. 90 per cent are not registered with a GP. 75 percent of the pregnant women who come through our doors have not had appropriate antenatal care. We see women due to give birth who’ve not even had an ultrasound.
Many, despite being fully entitled to primary care, have been denied access to a doctor or are afraid they will be arrested if they try because of their immigration status.
This can lead to tragic consequences. We recently became aware of the case of a woman who had cancer but had been too frightened to see a doctor and was told by friends not to risk it. She'd been in the UK for 10 years but did not have legal status. The last few months of her life were spent in extreme pain. She died alone in her room.
There are estimated to be more than half a million irregular migrants in the UK, and many are extremely vulnerable. The right to health is part of the UN’s Universal Declaration of Human Rights, and regardless of your views on immigration – which is very much a separate issue – once people are in a country there is a duty to ensure they get the healthcare they need.
So why is this not happening?
Even though everyone living in the UK has the right to see a doctor, frontline healthcare workers – such as GP surgery receptionists – are often unsure about entitlement rules and are incorrectly turning people away. Once someone has been refused they are less likely to try again even though their health may have deteriorated. Others are afraid that seeing a doctor could lead to a visit from immigration officials – a fear perhaps not unfounded considering recent revelations that the Home Office regularly accesses NHS data. Others are scared of being presented with a huge bill they cannot pay.
We advocate on behalf of our patients to ensure they get the mainstream healthcare they are entitled to. But for every person that comes to us there are thousands more we don’t see, and so we’re calling for administrative staff across the country to be better informed about entitlements. No healthcare system should ever discriminate against someone because of their immigration status.
Yet things are likely to get worse.
As part of the UK Government’s attempt to engender a “hostile environment” for irregular migrants, there are plans to create extra charges for both Accident and Emergency (A&E) and some primary care services. This will require a new registration system throughout the NHS, including GP surgeries, to see whether a patient should be charged.
These changes will also apply to children which could lead to parents being too afraid to take their child to A&E. Just how this fits with the UK’s obligations under the UN Convention on the Rights of the Child is unclear.
Creating these extra barriers could be damaging in many ways, not just to the health of excluded people and their children but to the UK itself. Economically, the cost of implementing new procedures and regulations is likely to outstrip any savings – not least because fears about so-called ‘health tourism’ have been shown to be widely exaggerated (our patients have, on average, been in the UK for over four years before accessing our service).
And, more crucially, with an increasing amount of people with communicable diseases not being treated, it will also have a knock-on effect to the health of the general public.
Leigh Daynes is Executive Director of the health charity Doctors of the World UK, part of the international Médecins du Monde network