Crackdown on migrants forces NHS doctors to "act as border guards"

A medical charity has launched a campaign against government guidance which “makes border guards of doctors” by allowing the Home Office to access details of undocumented migrants who seek NHS treatment.

Doctors of the World runs clinics for undocumented migrants, victims of trafficking and asylum seekers. It has assisted numerous patients, some pregnant and some with cancer, who are afraid of accessing NHS healthcare due to concerns that a visit to the doctor could lead to deportation.

The organisation has joined forces with the human rights charity Liberty and the National Aids Trust to launch a petition aimed at reversing a data-sharing policy between the NHS and the Home Office implemented this year. They want the government to “stop using NHS patients’ personal information to carry out immigration enforcement”.

Lu Hiam, a GP and Doctors of the World adviser, said: “Confidentiality is the cornerstone of the doctor-patient relationship. Deterring sick people from getting healthcare has serious consequences. Putting this data-sharing agreement in place without consulting doctors is nonsensical, given what a huge impact it has on our professional role.”

The government and NHS Digital, the body that stores patient information, published the agreement in January. The pact makes it clear that NHS Digital is legally required to hand over non-clinical patient details – including addresses and dates of birth – to the Home Office.

Use of NHS data has allowed immigration officials to locate, arrest and deport visa overstayers and undocumented migrants.

Doctors of the World has produced a “safe surgeries” toolkit that outlines practical methods doctors can use to keep patients’ addresses off NHS records, helping them circumvent the Home Office memorandum of understanding on data sharing.

The kit suggests ways to register patients using the address of the local GP practice and informs medical staff that they do not need to ask for a passport or proof of identity when registering patients. The pack also includes posters telling patients that they are not legally required to provide such information.

Martha Spurrier, the director of Liberty, says: ‘Fostering fear of the doctor in this way is a whole new dangerous and irresponsible low. Photograph: David Levene for the Guardian

Prompted by similar unease, the National Union of Teachers this week passed a motion condemning the Department for Education’s requirement, introduced last September, that parents must supply details of pupils’ nationality and country of birth to schools. The DfE may subsequently pass on this information to the Home Office. The request also forms part of a drive by Theresa May to create a “hostile environment” for illegal immigrants.

Miriam Beeks, a GP at Lower Clapton Group Practice in east London, has put up posters telling patients they can register as “no fixed abode”.

“Doctors, in general, hate the idea that they are being used as immigration officers. Doctors should feel confident about standing against this. We are backed up by both NHS and GMC confidentiality rules – our interactions with our patients are confidential,” she said.

Figures released this year show the number of Home Office requests to NHS Digital has tripled since 2014. Department of Health data reveals the Home Office made 8,127 requests for patient details in the first 11 months of 2016, which led to 5,854 people being traced by immigration enforcement.

Martha Spurrier, director of Liberty, said: “This government has made border guards of teachers, landlords, bank clerks and now even doctors – all as part of a misguided and counterproductive obsession with creating a ‘hostile environment’ for undocumented migrants.

“Fostering fear of the doctor in this way is a whole new dangerous and irresponsible low. It will put the health of the most vulnerable in society at risk, including children and victims of trafficking and torture.”
Deborah Gold, chief executive, of the National Aids Trust, said the decision must be reversed. “Without any consultation, NHS Digital have agreed to share important personal information with the Home Office. They have betrayed their responsibility to safeguard the confidentiality of NHS patients. They have also harmed public health as people are deterred from healthcare,” she said.

A government spokesperson said no clinical information would be shared. “We share non-clinical information between health agencies and the Home Office to locate individuals suspected of committing immigration offences. Access to this information is strictly controlled, with strong legal safeguards.

“Immigration officials only contact the NHS when other reasonable attempts to locate people have been unsuccessful. Anyone in genuine need can always receive treatment from the NHS – urgent or necessary care is never withheld.”

In its clinics providing basic healthcare to undocumented migrants, Doctors of the World has encountered numerous patients who have avoided seeking medical help because of their irregular immigration status.

The charity said it recently helped a woman who visited their east London clinic in labour. She had avoided seeking antenatal care because she feared being reported to the Home Office and was concerned about the cost of treatment.

Doctors of the World also highlighted the case of a young Ugandan woman who was almost six months pregnant and had not sought antenatal care because she was too scared to visit the doctor. She has lived in the UK for five years, her partner is a UK citizen and they are in full-time work, but she does not have a visa.

“I feel trapped. I’m in a situation where I need to go to the hospital but I can’t, because I feel my information might not be confidential,” the woman said. “I can’t imagine being separated from my partner. Maybe they would make me go back without my baby too. I would be separated from one or even both of them.”

Doctors of the World has also been contacted by a woman from the Philippines who has lived here for several years without a visa. She found a lump on her breast last September and was concerned because of a family history of breast cancer.

The woman, who worked as a cleaner, received an appointment for a biopsy but did not attend amid concerns that the hospital would share her details with the Home Office.

She said: “I felt like I was carrying the weight of the whole world. I was worried that if I went to the hospital and the immigration authorities know about it they might get me and deport me. But if I didn’t go to hospital, then what about the lump?”

She said she forced herself to go to a second appointment and the lump was eventually removed. She said: “In the end, I thought I must go. The lump was getting bigger, it was over 4cm by then. I was so scared at the hospital – my pulse was going so fast!”

The woman remains concerned about the risks of seeking medical help. “For years I had just tried to protect myself from getting sick – like by always wearing warm clothes – because I thought it wasn’t safe to go to the doctor,” she said.

Crackdown on migrants forces NHS doctors to "act as border guards"

Teething problems: why dental records are a poor way of checking age for migrants

The media furore over dental checks to establish the ages of child migrants arriving from Calais has raised the question of how we define – and prove – adulthood. Dentists have said the checks would likely be inaccurate, not to mention unethical. Brain imaging wouldn’t be much use either, as recent research has shown the brain continues developing right up until the mid-20s and beyond.

Growth of grey matter is very rapid from around the age of 12, but peaks a few years later. What follows in later adolescence is a pruning and sculpting of the many connections that have sprouted during puberty. It could be argued that experiences in this period are as important as earlier ones, and in some ways more significant, as they affect the brain’s frontal lobe which deals with the development of character and morality.

Insurance companies seem to have realised this, as car insurance premiums change depending on your age right into your 20s. And since 2013, child psychologists have worked with under 25s, not just under 18s. It’s just a shame that this is not currently reflected by our asylum policy.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Teething problems: why dental records are a poor way of checking age for migrants

Migrants face "living hell" in Greek detention

The Greek coastguard rescued a boatload of far more than 300 migrants in the sea near Crete on Monday 31 March 2014. But many detained migrants face hellish circumstances in Greece. Photograph: ZUMA/REX

Migrants and asylum-seekers detained in Greece are currently being forced to endure deplorable situations, typically with devastating results on their overall health, in accordance to a report from help agency Médecins Sans Frontières (MSF).

Physicians who have attended internment camps, police stations and coastguard services all around the nation described “a residing hell” for 1000′s of immigrants denied fresh air, all-natural light and fundamental sanitation.

In one detention camp in Komotini, not far from the Turkish border, medics noticed human excrement seeping via cracked pipes between the building’s floors.

“I did not think that such situations have been attainable on European soil,” said Marietta Provopoulou, who invested more than a decade functioning in Africa prior to returning to Athens to head MSF in Greece. “The major complaint of migrants is that they are not being taken care of like human beings, that they are being subjected to a living hell,” she told the Guardian. “And they are appropriate.”

MSF explained the practice of rounding up migrants on a huge scale had designed a breeding ground for condition in detention centres nationwide.

Outbreaks of scabies in overcrowded camps had been commonplace. So, as well, were respiratory infections, gastrointestinal ailments, musculoskeletal issues, dental troubles and tuberculosis. Unaccompanied minors – largely from Afghanistan – wrongly registered as adults were also currently being detained.

“The conditions are surprising,” explained Panagiotis Tziavas, a MSF medical professional.

“Not only are men and women crammed in a very little region. An additional key problem are the sanitary circumstances … most of the latrines are in a disgusting state.”

Greece is a key transit level for immigrants desperate to get to Europe from Asia, Africa and the Middle East. Beneath strain from the EU to stem the influx, Greece’s conservative-dominated coalition began a “clean-up” operation in the summer of 2012, systematically detaining migrants and asylum-seekers, frequently indiscriminately.

MSF teams with accessibility to detention facilities more than the past 6 many years said they had witnessed a surge in the numbers topic to prolonged detention, with most incarcerated for the greatest restrict of 18 months. In an atmosphere of far-right anti-immigrant sentiment, there was also the chance of repeated detentions. Even asylum-seekers fleeing war-torn countries this kind of as Syria were getting incarcerated for up to 15 months.

“Usually migrants are detained for up to 18 months in the holding cells of police stations that were only meant to maintain folks for a handful of days,” said Ioanna Kotsioni, head of migration policy at MSF Greece.

Several former army camps and military academies had been hastily transformed into detention centres overnight. Amenities have been cramped and humid with soggy mattresses triggering developing numbers to suffer from musculoskeletal problems, the group stated.

“About 6,000 migrants and asylum seekers are currently getting detained and the illnesses we are seeing are linked, with no doubt, to the squalid living conditions,” she extra. “In police stations, exactly where bed bugs are frequent, detainees rarely have access to fresh air, organic light or workout places – in violation of European law. In some detention camps they have limited or no access to showers or toilets. And in Komotini, we noticed human waste seeping through broken pipes from 1 floor of the developing to the next. The indifference on the part of authorities was extraordinary.”

A number of migrants have reportedly experimented with to consider their very own lives. A single 16-yr-outdated Afghan boy, who had manufactured the perilous journey from his house nation to Greece, but was detained in Komotini, recently jumped from the roof of the building in protest more than the living problems, in accordance to MSF.

“We are detained for 18 months. Why? I have come for peace, I am not a criminal,” the boy, who broke the two his legs, was quoted as telling the relief organisation. “The water of the showers is always cold and the toilets in no way work. The food is negative, it is not healthier foods. Numerous instances I have asked to be launched since I am a small but they have usually refused … given that they didn’t want to release me I imagined it was greater for me to jump off the roof than to remain right here.”

Migrants face "living hell" in Greek detention

Tourists and migrants to be charged to use NHS emergency services

A Division of Health report estimated up to £500m a year could be recovered through much better charging for use of the NHS. Photograph: Christopher Thomond for the Guardian

Overseas guests and migrants are to be charged for making use of NHS accident and emergency providers in England underneath measures announced by the government to deter so-called health tourism.

No 1 will be turned away from an A&ampE department in an emergency, but there will be a bill to pay out afterwards for individuals from overseas. Other alterations include extending charging for prescriptions to men and women from overseas, and requiring them to pay larger charges for providers that are subsidised for individuals entitled to NHS care, such as optical and dental companies.

GP and nurse consultations will continue to be totally free, which the government believes will minimize hazards to public well being such as HIV, TB and sexually transmitted infections.

Details of the scheme, which has been drawn up following a government consultation, are still getting worked out. Ministers have said they will publish a total implementation strategy in March.

Additional alterations could contain overseas visitors currently being charged for small surgical treatment that is carried out by a GP and physiotherapy that has come by means of a GP referral.

Wellness minister Lord Howe said: “Having a universal wellness service free at the level of use rightly tends to make us the envy of the globe, but we must make certain the program is honest to the hardworking British taxpayers who fund it.

“We know that we need to have to make adjustments across the NHS to much better determine and charge guests and migrants. Introducing charging at principal care is the 1st step to attaining this. We are already looking at taking action, and subsequent year we will set out our thorough strategies to clamp down on the abuse of our NHS.”

A Department of Well being report this year estimated that up to £500m a yr could be recovered by means of greater charging for use of the NHS by site visitors. However, it explained estimates had been based mostly on “incomplete information, sometimes of various high quality, and a huge number of assumptions”.

There is currently concern amongst a lot of Tory MPs that the ending of restrictions on migrants from Bulgaria and Romania on 1 January will see an influx of migrants, putting further strain on the NHS and other public providers.

The shadow overall health minister Lord Hunt stated: “But again, ministers are placing spin just before substance – their personal report undermines the attempts to grab much more headlines with this re-announcement.

“Labour is in favour of enhancing the recovery of charges from individuals with no entitlement to NHS remedy. Rather than a lot more grandstanding, the government demands to provide sensible, considered-by means of alterations to make that occur. Alternatively this out-of-touch government is left asking medical doctors and nurses to act as surrogate immigration officials.”

At current treatment in hospital A&ampE departments is cost-free, but any subsequent remedy as a consequence of admission is chargeable. The changes are aimed at tightening and standardising what is and is not chargeable for main healthcare.

The principles presently state that even though maternity or antenatal providers need to not be withheld, overseas guests should be charged. Asked for the duration of the consultation whether or not maternity care ought to be exempt, the mind-boggling response from NHS frontline personnel was that it ought to not be free for everyone, the Division of Overall health stated.

Doctors’ leaders explained the proposed modifications could price a lot more to administer than they would raise for the NHS and could deter men and women in want of remedy from in search of care.

Dr Mark Porter, chair of the British Health care Association (BMA) council, said: “This could suggest the technique of administering the new charging system will finish up really costing more to run than it collects in income. There stays a genuine threat that some migrants and short-term site visitors who desperately need care could be discouraged from approaching the NHS if they can’t pay out the proposed fees.

“There is certain confusion above entry entitlements to emergency care services, given that the proposals introduce charging for A&ampE visits, yet say that no patient will be turned away if they require care.”

Dr Chaand Nagpaul, chair of the BMA’s GP committee said: “It is encouraging that the government has listened to the public health issues expressed by the BMA about the affect of charging migrants and brief-term guests for GP appointments. We can’t have a predicament the place any patient with a severe well being require is deterred from going to a GP, particularly if their condition raises a prospective public wellness risk.”

He added the proposals could introduce “one more layer of time-consuming bureaucracy to general practice at a time when GPs and their workers are struggling to cope with rising workload and patient demand”.

Dr Helen Stokes-Lampard, a Birmingham GP and spokesperson for the Royal School of General Practitioners, stated: “We are grateful that the government seems to have made some concessions to its authentic proposals and we are pleased that accessibility to a GP will remain free at the level of require.

“Even so, we nevertheless require reassurances that GPs are not going to be pressed into acting as an arm of the Border Agency and we continue to be unconvinced that the proposals will perform across the NHS.”

Tourists and migrants to be charged to use NHS emergency services