Health care

United Kingdom

Country Report: Health care Last updated: 30/11/20

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In England, there is free hospital treatment to asylum seekers with a current claim, those refused asylum seekers who are receiving Section 95 or Section 4 support and unaccompanied children in the care of the local authority.[1] Current asylum seekers are entitled to register with a general doctor although in practice many face barriers in registering. In 2016, for example, Doctors of the World assisted 1,906 people, including asylum seekers, to access the National Health Service (NHS).[2] More recent figures are not available.

 

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.[3]

 

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. General doctors have the same discretion to register refused and unsupported asylum seekers that they have for any person living in their area.[4]

 

In Scotland all asylum seekers are entitled to full free health care, 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.[5]

 

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 while they remain in Northern Ireland.[6]

 

Access to mental health services is not guaranteed, and is often lacking.[7]

 

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. Language and cultural barriers also hinder appropriate referrals from workers with initial contact, and impede asylum seekers' own awareness of what is available. Smaller NGOs also specialise in counselling for refugees.[8]

 

In practice, inadequate levels of support, destitution and the charging regime impede and discourage access to healthcare. 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.[9] 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.[10] 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 she has been previously living.

 

Charges for those with no leave to remain in the UK were introduced in April 2015.[11] Respondents to a government consultation which preceded these charges voiced concerns that to introduce charges for migrants which are not fully understood would result in more loss of care for very vulnerable asylum seekers and refused asylum seekers.[12] Guidance was issued by the Government (Department of Health) in April 2016.[13] A report from the National Audit office in 2016 reported that the policy has unintended consequences and that some people are wrongly charged.[14] Similar findings were revealed in a report and review of evidence published by the Equality and Human Rights Commission in 2018.[15]

 

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.[16] During a parliamentary debate the government agreed to review the impact of the regulations. There has been a lot of lobbying on the issue.[17] 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.[18] A scoping study of the impact on maternity services conducted in 2017 showed similar findings. [19]



[1]Part 4 HM Government National Health Service (Charges to Overseas Visitors) Regulations 2015 No. 238.

[2]Doctors of the World, Our UK clinics, available at: http://bit.ly/2lL5nWf.

[3] Department for Health, Guidance on implementing the Hospital Charging Regulations 2015, para 7.51.

[4] British Medical Association, Access to health care for asylum seekers and refused asylum seekers – guidance for doctors, April 2012, available at: http://bit.ly/1CqjDlN.

[5]Scottish Government Healthcare Policy & Strategy Directorate, April 2010, CEL 9 (2010) Overseas Visitors’ Liability to Pay Charges for NHS Care and Other Services.

[6] Provision of Health Services to Persons Not Ordinarily Resident Regulations (Northern Ireland) 2015 SI No. 27 reg. 9, available at: http://bit.ly/1PcmHMJ.

[7]Yohannes Fassil and Angela Burnett, Commissioning mental health services for vulnerable adult migrants August, 2014, available at: http://bit.ly/2jHiNle.

[8]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.

[9]Refugee Council and Maternity Action, When Maternity Doesn’t Matter, 2013. 

[10]Ibid.

[11]Section 38 Immigration Act 2014 and National Health Service (Charges to Overseas Visitors) Regulations 2015 No. 238.

[12]Department of Health: Migrant Access to the NHS: Consultation, July 2013, available at: http://bit.ly/1JdI3Xw.

[13] Department of Health, Guidance on overseas visitors hospital charging regulations, 6 April 2016, available at: http://bit.ly/1mU47FG.

[14]National Audit Office, Recovering the cost of NHS treatment for overseas visitors, October 2016, available at: http://bit.ly/2e4ri6z.

[15]Equality and Human Rights Commission, ‘Asylum seekers in Britain unable to access healthcare’, 29 November 2018, available at: https://bit.ly/2QW9WJe.

[16]The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017, available at: http://bit.ly/2tFXxxz

[17]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.  

[18] Doctors of the World, Deterrence, delay and distress, 2017, available at: http://bit.ly/2n5nANs; Maternity Action et al, The impact on health inequalities of charging migrant women for maternity care,  2017, available at: https://bit.ly/2GuxCSi.

 

Table of contents

  • Statistics
  • Overview of the legal framework
  • Overview of the main changes since the previous report update
  • Asylum Procedure
  • Reception Conditions
  • Detention of Asylum Seekers
  • Content of International Protection