Author
In England, there is free hospital treatment to asylum seekers with a current claim on Section 95 or Section 4 support, those refused asylum seekers who are receiving Section 95 or Section 4 support and unaccompanied children in the care of the local authority.[1] Free hospital treatment is not generally available to asylum seekers who are not on Section 95 or Section 4 support. Hospital doctors should not refuse treatment that is urgently needed for refused asylum seekers who are not receiving Section 95 or Section 4 support, but the hospital is required to charge for it. The hospital also has discretion to write off the charges. Any course of treatment should be continued if it is under way at the time when asylum is refused, and thus when Section 95 support stops for single people.[2] Accident and emergency services (but not follow-up in-patient care) and treatment for listed diseases are free to all including refused asylum seekers who are not on asylum support.
Moreover, current asylum seekers, regardless of the support they receive, are entitled to register with a general doctor although in practice many face barriers in registering. General doctors (GPs) have the same discretion to register refused and unsupported asylum seekers that they have for any person living in their area.[3] Resources to assist people to register with a GP remain an important practical and advocacy tool as, for example, GPs will often ask for ID documents that asylum seekers will not have, even though this is not a legal requirement. Doctors of the World have produced a card that can be used to successfully challenge those requests.[4] .
In Scotland all asylum seekers are entitled to full free health care (including GP practices, mental health treatment, hospitals, emergency services, eye examinations, dental examinations[5]), including those refused asylum seekers not on Section 4 support and including the spouse/civil partner and any dependent children of any of these people.[6]
In Northern Ireland, exemptions for refugees and asylum seekers are similar to those in England except that refused asylum seekers are able to obtain free health care (including GP practices, mental health treatment, hospitals, emergency services, eye examinations, some dental services[7]) while they remain in Northern Ireland.[8]
Access to mental health services is not guaranteed anywhere is the UK, and is often lacking.[9]
Specialised treatment for victims of torture and traumatised asylum seekers is available, but is in short supply. It is provided by a number of independent charities, the largest being Freedom from Torture, the Helen Bamber Foundation, and the Refugee Therapy Centre. Specialist trauma practitioners, including psychiatrists, psychologists and trauma counsellors and therapists, also work in health authorities and trusts around the country, but they are few and access is extremely limited.[10] Language and cultural barriers also hinder appropriate referrals from workers with initial contact and impede asylum seekers’ own awareness of what is available.[11] Smaller NGOs also specialise in counselling for refugees.[12]
In practice, inadequate levels of financial asylum support, destitution and the charging regime impede and discourage access to healthcare.[13]
Mothers on asylum support who are required to move during pregnancy usually lose continuity of ante-natal care. Moves during pregnancy may take place including at very late stages of pregnancy, even when doctors and midwives advise against a move, and are thought to contribute to the far higher infant and mother mortality rate which there is among asylum seekers.[14] Moves sometimes entail a break of several weeks in antenatal care including monitoring and treatment of conditions such as diabetes or hepatitis, which need to be sustained during pregnancy.[15] Moves are not frequent once accommodation is allocated, but can happen for instance when an asylum seeker is allocated Section 95 or Section 4 housing away from the area where they had been previously living.
Charges for those with no leave to remain in the UK and who are not entitled to healthcare as described above were introduced in April 2015.[16] Guidance was issued by the Government (Department of Health) in April 2016.[17] A report from the National Audit office in 2016 reported that the policy has unintended consequences and that some people are wrongly charged.[18] Similar findings were revealed in a report and review of evidence published by the Equality and Human Rights Commission in 2018.[19]
In 2017 the government announced its intention to extend charging for many more frontline services (except GPs) and to introduce a duty for health services in England to check a person’s immigration status before treating. To enable this to happen regulations were introduced to Parliament; some changes were made in August 2017 and others in October 2017.[20] During a parliamentary debate the government agreed to review the impact of the regulations. There has been a lot of lobbying on the issue.[21] A report by Doctors of the World in 2017 concluded that people were being deterred from seeking medical care as a result of the charges.[22] A scoping study of the impact on maternity services conducted in 2017 showed similar findings.[23] A 2023 paper also suggested that fears of charging can deter people from accessing healthcare, although it noted that the quality of the evidence was ‘poor’.[24]
The Refugee Council developed a range of health-related guides for refugees, asylum seekers and health practitioners including guides to maternity rights and therapeutic services.[25]
Notably the government made those arriving on the new Ukraine visa schemes exempt from NHS charges as soon as March 2022[26] (see Ukraine Visa Support).
[1] Part 4 HM Government National Health Service (Charges to Overseas Visitors) Regulations 2015 No. 238.
[2] Department for Health, Guidance on implementing the Hospital Charging Regulations 2015, para 7.51.
[3] British Medical Association, Refugees and asylum seekers’ entitlement to NHS care, 4 September 2023, available at: https://bit.ly/49oXKtI.
[4] Doctors of the World GP access cards available at: https://bit.ly/3H1AnrK ; Refugee Council guides to therapeutic services and maternity care, see: https://bit.ly/3fIuSCj.
[5] NHS inform, ‘Accessing and using the NHS in Scotland’, accessed 24 March 2024, available at: https://bit.ly/3UKr2hX.
[6] NHS inform, ‘Healthcare for refugees and asylum’, accessed 24 March 2024, available at: https://bit.ly/3wu8sk3.
[7] NI Direct, ‘Help with health costs’, accessed 24 March 2024, available at: https://tinyurl.com/588x2v4f.
[8] Provision of Health Services to Persons Not Ordinarily Resident Regulations (Northern Ireland) 2015 SI No. 27 reg. 9, available at: https://bit.ly/49oWarO.
[9] Yohannes Fassil and Angela Burnett, Commissioning mental health services for vulnerable adult migrants August, 2014, available at: https://bit.ly/3TaOl3n.
[10] Practice based observation by the expert, January 2024.
[11] Practice based observation by the expert, January 2024.
[12] Some, such as Nasfiyat intercultural Therapy centre, are long established https://www.nafsiyat.org.uk/ and some specialise in particular groups e.g. Vietnamese Mental Health Service vmhs.org.uk.
[13] Practice based observation by the expert, January 2024.
[14] Refugee Council and Maternity Action, When Maternity Doesn’t Matter, 2013 available at: https://bit.ly/3SHoXAw, and https://bit.ly/42ObN9E.
[15] Ibid.
[16] Section 38 Immigration Act 2014 and National Health Service (Charges to Overseas Visitors) Regulations 2015 No. 238.
[17] Department of Health, Guidance on overseas visitors hospital charging regulations, 6 April 2016, available at: http://bit.ly/1mU47FG.
[18] National Audit Office, Recovering the cost of NHS treatment for overseas visitors, October 2016, available at: http://bit.ly/2e4ri6z.
[19] Equality and Human Rights Commission, ‘Asylum seekers in Britain unable to access healthcare’, 29 November 2018, available at: https://bit.ly/3OVWXs6.
[20] The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017, available at: http://bit.ly/2tFXxxz.
[21] See e.g. Health Stream of Sanctuary, ‘Changes to Accessing Healthcare – Impact on Refugees & Asylum-Seekers – Take Action Now!’, 31 August 2017, available at: http://bit.ly/2wrObsh.
[22] Doctors of the World, Deterrence, delay and distress, 2017, available at: https://bit.ly/42SmYhO.
[23] Maternity Action et al, The impact on health inequalities of charging migrant women for maternity care, 2017, available at: https://bit.ly/2GuxCSi.
[24] BMC Public Health, ‘The impact of NHS charging regulations on healthcare access and utilisation among migrants in England: a systematic review’, 28 February 2023, available at: https://bit.ly/42OH8sM.
[25] Refugee Council, ‘Guides for refugees and practitioners’, accessed 24 March 2023, available at: https://bit.ly/3Mnn5ZK.
[26] Response to a parliamentary question, ‘Outcome of the review of the NHS Charging Regulations exemption for Ukrainians’, 24 October 2022, available at: https://bit.ly/3AOwd5J.