Last week, the Guardian reported on the case of Albert Thompson, a man who came to London 44 years ago from Jamaica, at a time when many people from Commonwealth countries were migrating to the UK. This includes, of course, the thousands of nurses from Jamaica recruited in response to the NHS staffing crisis of the 1950s and 60s. Thompson’s mother was in fact one of these nurses.
In November 2017, Thompson, suffering from prostate cancer, was told he could not continue to receive treatment unless he paid a staggering £54,000 upfront. Unable to pay, he was denied further care. This comes within the first month of the introduction of upfront payments, one facet of the government’s policy of charging for NHS services provided to people who aren’t “ordinarily resident” – in practice, charges for immigrants. The charging policy was first introduced under Gordon Brown in 2009, and extended in 2014 as part of a series of Conservative-led hostile environment measures. This is why Docs Not Cops – the campaign group I am part of – was set up: to campaign for free healthcare for everyone, whatever their immigration status.
Government guidance makes it a statutory duty for the NHS to charge patients not deemed to be “ordinarily resident” in the UK. This means that patients with precarious immigration status are left with bills of thousands of pounds. Since October last year they can be denied care if they are unable to pay upfront, as Thompson was. If patients are unable to pay, the Department of Health effectively punishes them by handing their personal information to the Home Office, where their inability to pay for healthcare may mean their immigration applications are refused.
While this case is particularly shocking given the length of time Thompson has lived in the country, it is sadly not uncommon.
Commonwealth citizens who came to the UK decades ago, but whose right to remain does not show in Home Office records, are now being excluded from work, housing and welfare benefits, as well as healthcare, and even held in immigration prisons, as the government’s “hostile environment” for migrants deepens border control across all areas of life.
As a doctor, I know that a decision to refuse care on the basis of a patient’s inability to pay is incredibly dangerous. If a patient’s cancer treatment is denied or delayed because it is not considered to be “urgent”, their condition risks rapidly deteriorating. This is the difference between cancer that can be cured, and cancer that will kill.
Health is not a black-and-white issue – it is often not possible to make a clearcut distinction between “immediately necessary” and “non-urgent” care. These crucial decisions are being made in response to ill-thought out, politically motivated policy that has nothing to do with clinical judgment. The government’s brutal charging regime risks the lives of hundreds if not thousands of patients.
And it isn’t just the charging regime that is putting lives at risk. The Home Office can now access confidential patient medical records via NHS Digital to obtain up-to-date addresses for people it wants to subject to immigration enforcement. In January, a health select committee inquiry into the data-sharing policy was shocked to hear that one domestic worker with precarious immigration status had died after she was too frightened to seek treatment for pneumonia.
Data sharing and charging have a cumulative effect: they deter patients from seeking and receiving potentially life-saving treatment, and ultimately, people die. I know of patients who have had to crowdfund thousands of pounds for necessary and unavoidable care, something that is more common in countries like the United States. The government knows that if a patient isn’t able to raise those funds and is denied care, they will not receive any care at all.
And for what justification? The charging system is framed as part of efforts to reduce NHS overspending. However, so-called “deliberate health tourism” accounts for only 0.3% of the NHS annual budget, compared to the massive debt of over £200bn to private finance initiatives for contracts such as those in the NHS. It is clear that these callous policies are ideologically motivated, and that healthcare is being used to extend the hostile environment and to scapegoat migrants for the underfunding and privatisation of our NHS.
As an NHS doctor, I believe denying anyone access to healthcare on the basis of their ability to pay is fundamentally inhumane. Healthcare workers have a primary duty of care to our patients, which we cannot fulfil if we are policing the UK’s borders too. Access to healthcare is a human right, and no one should be denied or fear seeking treatment on the basis of financial ability and immigration status. But this isn’t just about immigration. Universality and privacy are the founding principles of our NHS. To lose them would be a high price to pay for the government’s obsession with immigration control.