Asylum seekers and the NHS: are hostile policies damaging services?

Luna Williams, IAS, writes about the hardships faced by those attempting to claim asylum in the UK.


In 1948, the NHS was founded as an ethical body; a public health service which doesn’t discriminate and offers support for any person no matter what their wealth, class or background. Unfortunately, over the last decade, a combination of budget cuts and hostile immigration policies have caused the NHS to compromise these ethics and forced it into a position in which it must discriminate in order to stay afloat.


According to a report which was released by the Observer earlier this year, at least three-quarters of NHS trusts hired private debt collector firms over the past three years to deal with the debts of destitute asylum-seekers. 8,468 patient debts were referred, according to the report, between the years of 2016 and 2018. Members of the firms were found to use tactics such as intimidating phone calls, doorstep visits and, in some cases, property possession. Despite this, only 7% of the unpaid debts were recovered, making these tactics not only unethical, but also unnecessary. This behaviour was despite guidelines issued by the Department of Health and Social Care, stating that NHS trusts are allowed to write off unpaid patient debts if it is “clear that a person is destitute or genuinely without funds”.


This is yet another sign of a UK service-provider being confused by hostile policies. A report by the Joint Committee for Welfare for Immigrants (JCWI) found that after the introduction of the Right to Rent Scheme – which encouraged landlords to discriminate against those who might be ‘illegal’ immigrants – caused a huge spike in discriminatory decision-making. According to the report, 43% of landlords said they would be less likely to rent to a tenant who didn’t have British citizenship, while a shocking 27% said they would be less willing to negotiate with anyone who had a “foreign-sounding” name or accent.


The Right to Rent Scheme was introduced alongside many other Government procedures which encouraged service-providers to act as border control officers, as part of the larger “hostile environment policy”. This policy was introduced initially to make the UK as unwelcoming as possible for ‘illegal’ immigrants, in the hope that they may “voluntarily leave”. As is seen in the case of the Right to Rent Scheme, many elements of the policy ultimately resulted in mass-discrimination, which affected the lives of genuine asylum-seekers, refugees and settled migrants across the UK. The policy was ultimately ended after the Windrush scandal – which saw hundreds of settled Windrush citizens and their families harassed and deported after their paperwork had been lost by the Home Office – but still seems to be continuing to impact and confuse the decisions made by various service-providers, employers and individuals in the UK today.


As in the case of many landlords, the blame cannot be placed on the NHS itself for such issues. The NHS has received various budget cuts over the last decade and is struggling to stay afloat: according to the Institute For Fiscal Studies (IFS), the public health sector’s budget has been cut by 40% over the last eight years. As a result of these cuts, NHS trusts are evidently having to compromise their ethics in order to make ends meet.


Nonetheless, doctors have come forward to argue that discriminative procedures aimed at asylum-seekers and vulnerable migrants go against their professional and personal ethics. In one particular case, which took place in January, an Eritrean asylum-seeker was refused urgent cancer treatment by an NHS trust because he was unable to produce the correct paperwork. Doctors claim that circumstances like this force them to compromise their Hippocratic Oath: “to treat the ill to the best of your ability”.


Equally, paediatricians have voiced their feelings on policies which mean they must refuse care to individuals who are unable to produce documents to show they are eligible or pay upfront. With at least 120,000 undocumented migrant children in the UK (many of whom are victims of human trafficking), the refusal of health services causes major barriers in allowing them to reach the correct authorities and ultimately be healthy and safe.


It should not be up to the NHS to make decisions on the welfare and safety of asylum-seekers. Instead, the Government needs to clarify its stance on immigration policies and schemes in order to ensure that the NHS can retain its fundamental ethics of universality.


This article has been written by Luna Williams, political correspondent at the Immigration Advice Service; an organisation of immigration lawyers who give free legal advice and support to asylum seekers.