Patient rights must be protected as UK policies and government rhetoric indicate a shift from a hostile environment to an abusive one, say a group of experts and campaigners involved in refugee and migrant health.
In a new commentary, published by the Journal of the Royal Society of Medicine, the group describes a decade of destitution and ill-health caused by the hostile environment, which was introduced in 2012 through a set of policies embedding immigration control within a range of public and private services.
Lead author Dr Ryan Essex, a research fellow with the University of Greenwich, said: “While the hostile environment has had sweeping force, its impact on health and the provision of healthcare has been particularly concerning as it undermines the founding principles of the NHS.”
In their commentary, the authors highlight how the NHS employs teams responsible for upfront charging which in practice targets refused asylum seekers, undocumented migrants and others caught up by the dysfunctional immigration system, selling their data to bailiffs who go on to harass them.
As a result, urgent and immediately necessary care is often wrongly delayed and withheld from vulnerable patients. People are deterred from seeking treatment, with many fearful of potentially being detained and deported. Thousands more have been wrongly turned away from services.
A number of services exist to fill gaps created by the hostile environment, with countless frontline migrant support organisations working to navigate extremely complex charging regulations and supporting people to access healthcare. These include grassroots, migrant and health worker-led networks.
Dr Essex said: “For healthcare professionals, these policies raise a range of clinical and ethical issues. At the heart of these is the risk of being co-opted to act with policies that clearly undermine health and wellbeing, as a de-facto boarder guard.”
“Given the current course of the UK government, including the Nationality and Borders Bill currently being debated, it seems that only through collective action will patient rights be protected and the hostile environment resisted. One can hope that after another decade, we are not having this conversation and that these policies are scrapped and replaced by ones that move the NHS toward the truly universal ideals upon which it was founded.”
A decade of the hostile environment and its impact on health (DOI: 10.1177/01410768221078327) by Ryan Essex , Ayesha Riaz, Seb Casalotti, Kitty Worthing, Rita Issa, James Skinner and Aliya Yule, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 9 February 2022.
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