Parinaz is a journalist from Iran who came to the UK seeking asylum over eight years ago. Despite the services of a caring solicitor, her claim has been refused many times. To add to her despair, she discovered a breast lump earlier this year. Imagine the additional worry you would have receiving an NHS invoice for several thousand pounds just as you find out that you have breast cancer.
This is a common problem for many of the refused asylum seekers living in England [NB there are currently no healthcare charges for refused asylum seekers in Wales, Scotland, and Northern Ireland]. NHS England classes them as ‘migrant tourists’, not ‘ordinarily resident’ and the only free treatment is in primary care and immediately necessary and acute care. Any NHS data gathered about you before 2018 could be shared with the Home Office. So, it becomes clear why many of these people are too afraid to seek help. This fear may lead to late diagnosis, poor maternity outcomes and no provision for mental health care, apart from an acute in-patient stay in crisis. There are no economic benefits to health charging – health tourism takes up only 0.3 per cent of the NHS budget.
This is not the first time CMF has raised these issues. In 2004, when the government first mooted the idea of excluding refused asylum seekers from free access to primary care, we produced a detailed submission challenging the issue on justice and public health grounds. In 2017, GP Dr Becky McFarlane (who has worked with asylum seekers for many years) challenged us about our Christian duty to welcome and care for the stranger. In 2018, transcultural consultant psychiatrist Bert Nanninga wrote compellingly in Triple Helix about his experiences working with refugee communities in the Netherlands. Becky wrote a detailed paper on the issue of charging for healthcare in spring 2021 and recorded a podcast on refuges healthcare last summer. CMF also produced a resource to help members write to MPs on the issue last year.
Two events now further challenge us to show justice and compassion as a nation to those coming to us for healthcare while fleeing war or persecution. The Nationality and Borders Bill is currently passing through both Houses of Parliament. It is promoted as a means of stopping small boats from crossing the channel and of breaking up the gangs of people smugglers (although in practice, the bill contains nothing to target the smugglers but criminalises those who try to come here for protection). We are also led to believe that the country is being overrun with economic migrants with bogus claims. However, a glance at the statistics negates this view. We need to understand that people only leave their country, communities and families under extreme persecution or war, looking for safety and freedom.
The bill also contains clauses to create prison-like conditions for asylum seekers and hold them away from welcoming communities and poor healthcare access. There will also be cuts to Legal Aid, making it difficult to present an accurate case. The opportunity for family reunions will also be reduced, leaving some partners and children unable to join them.
It’s good to see Christian organisations (in particular the Evangelical Alliance) calling the Government to account for this. It’s also good to see many organisations and charities working together to stand against the bill.
The second event is the global pandemic that has affected everyone. It has been, perhaps, the greatest challenge to the NHS since its inception in 1948. Asylum seekers are housed in some of the poorest and most crowded accommodation, and it’s a credit to public health teams to have reached so many people of different languages and cultural backgrounds with the vaccination programme. However, reaching out for their other many healthcare needs may seem impossible. It is a challenge to make primary care accessible to all and to begin to address the need for mental health support. Isolating and criminalising people who are already traumatised and suffering from PTSD cannot be the approach of Jesus.
Two resources stand out to me that can help us in address these needs in primary care:
- The City of Sanctuary Mental Health Resource Pack, and
- The Safe Surgeries Toolkit project, which trains miracle-working reception staff to provide a welcoming environment for everyone in their community and equitable service for all their patients.
I began with Parinaz’s story. A caring solicitor and a GP prepared to go the second mile took issue with the Home Office for her. Within the month, her visa had arrived. She was also told to ignore the NHS invoice. How would others fare who did not have this support?
Good news only comes as we care for the one in front of us. Jesus said, ‘Then the King will say to those on his right, “Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry, and you gave me something to eat, I was thirsty, and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.”’ (Matthew 25:34-37)
How can we take action in these times?
- How can my church be more welcoming? Even this week, I overheard, ‘I wanted to try my local church, one I could walk to, but nobody spoke to me…’ we may not know what to say but simply encouraging our congregations to smile and offer a welcome to all visitors makes a huge difference.
- How can my surgery know who can register and what ID is needed? Using the surgery toolkit can help. Standing up for the healthcare needs of asylum seekers can encourage the practice team. This replicable joint services model from Camden published in the BMJ last month is helpful in most settings.
- How can I encourage my hospital team to show inclusion and welcome to staff who are new to the UK and our healthcare system? The Patients, Not Passports toolkit has some helpful ideas.
- Please email your MP! They are the ones who can vote for change – and they represent your views!
Dr Margaret Hooper is retired a GP in the West Midlands
NB CMF will be running a Refugee & Asylum Seeker Health Course on February 12 2022 in Birmingham.